Blood pressure-lowering medicines implemented in 12 African countries: the cross-sectional multination EIGHT study
Objective In Africa, the number of patients with hypertension is expected to reach 216.8 million by 2030. Large-scale data on antihypertensive medications used in Sub-Saharan Africa (SSA) are scarce.Here, we describe antihypertensive drug strategies and identify treatment factors associated with blo...
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BMJ Publishing Group
2021-12-01
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| author | Xavier Jouven Bamba Gaye Marie Antignac Ibrahima Bara Diop Marie Cécile Perier Jean Laurent Takombe Dadhi Balde Roland N'Guetta Anastase Dzudie Liliane Mfeukeu Kuate Charles Kouam Kouam Samuel Kingue Adama Kane Pauline Cavagna Jean Marie Damorou Stephane Méo Ikama Kouadio Euloge Kramoh Ibrahim Ali Toure Beatriz Ferreira Martin Houenassi Suzy Gisele Kimbally-kaki Emmanuel Limbole Jean Bruno Mipinda Carol Nhavoto Abdallahi Sidy Ali Gabriel S Tajeu Diane Macquart De Terline Michel Azizi |
| author_facet | Xavier Jouven Bamba Gaye Marie Antignac Ibrahima Bara Diop Marie Cécile Perier Jean Laurent Takombe Dadhi Balde Roland N'Guetta Anastase Dzudie Liliane Mfeukeu Kuate Charles Kouam Kouam Samuel Kingue Adama Kane Pauline Cavagna Jean Marie Damorou Stephane Méo Ikama Kouadio Euloge Kramoh Ibrahim Ali Toure Beatriz Ferreira Martin Houenassi Suzy Gisele Kimbally-kaki Emmanuel Limbole Jean Bruno Mipinda Carol Nhavoto Abdallahi Sidy Ali Gabriel S Tajeu Diane Macquart De Terline Michel Azizi |
| author_sort | Xavier Jouven |
| collection | DOAJ |
| description | Objective In Africa, the number of patients with hypertension is expected to reach 216.8 million by 2030. Large-scale data on antihypertensive medications used in Sub-Saharan Africa (SSA) are scarce.Here, we describe antihypertensive drug strategies and identify treatment factors associated with blood pressure (BP) control in 12 Sub-Saharan countries.Setting Outpatient consultations for hypertension in urban tertiary cardiology centres of 29 hospitals from 17 cities across 12 SSA countries between January 2014 and November 2015.Participants Patients ≥18 years of age with hypertension were enrolled at any visit during outpatient consultations in the cardiology departmentsMain outcome measure We collected BP levels, demographic characteristics and antihypertensive treatment use (including traditional medicine) of patients with hypertension attending outpatient visits. BP control was defined as seated office BP <140/90 mm Hg. We used logistic regression with a random effect on countries to assess factors of BP control.Results Overall, 2198 hypertensive patients were included and a total of 96.6% (n=2123) were on antihypertensive medications. Among treated patients, 653 (30.8%) patients received a monotherapy by calcium channel blocker (n=324, 49.6%), renin–angiotensin system blocker (RAS) (n=126, 19.3%) or diuretic (n=122, 18.7%). Two-drug strategies were prescribed in 927 (43.6%) patients including mainly diuretics and RAS (n=327, 42% of two-drug strategies). Prescriptions of three-drugs or more were used in 543 (25.6%) patients. Overall, among treated patients, 1630 (76.7%) had uncontrolled BP, of whom 462 (28.3%) had BP levels ≥180/110 mm Hg, mainly in those on monotherapy. After adjustment for sociodemographic factors, the use of traditional medicine was the only factor significantly associated with uncontrolled BP (OR 1.72 (1.19 to 2.49) p<0.01).Conclusion Our study provided large-scale data on antihypertensive prescriptions in the African continent. Among patients declared adherent to drugs, poor BP control was significantly associated with the use of traditional medicine. |
| format | Article |
| id | doaj-art-fdcefe53a2744ffcb321cedf1feb6b10 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-12-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-fdcefe53a2744ffcb321cedf1feb6b102025-08-20T02:38:54ZengBMJ Publishing GroupBMJ Open2044-60552021-12-01111210.1136/bmjopen-2021-049632Blood pressure-lowering medicines implemented in 12 African countries: the cross-sectional multination EIGHT studyXavier Jouven0Bamba Gaye1Marie Antignac2Ibrahima Bara Diop3Marie Cécile Perier4Jean Laurent Takombe5Dadhi Balde6Roland N'Guetta7Anastase Dzudie8Liliane Mfeukeu Kuate9Charles Kouam Kouam10Samuel Kingue11Adama Kane12Pauline Cavagna13Jean Marie Damorou14Stephane Méo Ikama15Kouadio Euloge Kramoh16Ibrahim Ali Toure17Beatriz Ferreira18Martin Houenassi19Suzy Gisele Kimbally-kaki20Emmanuel Limbole21Jean Bruno Mipinda22Carol Nhavoto23Abdallahi Sidy Ali24Gabriel S Tajeu25Diane Macquart De Terline26Michel Azizi27professor of cardiology and epidemiology3 UFR des Technologies et des Métiers, Université Cheikh Ahmadoul Khadim (UCAK) de Touba, Diourbel, SenegalPharmacy department APHP Saint-Antoine Hospital, PARIS, FranceCardiology, University Hospital of Fann, Dakar, SenegalUniversité de Paris, PARCC, INSERM, F-75015 Paris, France, Paris, FranceDepartment of Internal Medicine, General Hospital of Kinshasa, Kinshasa, Democratic Republic of the CongoCardiology, University Hospital of Conakry, Conakry, GuineaCardiology, Institute of Cardiology of Abidjan (Côte d`Ivoire), BPV 206, abidjan, Côte d`IvoireCardiology and Cardiac Pacing Unit, Department of Medicine, Douala General Hospital, Douala, CameroonCardiology, Central hospital of Yaoundé, Yaoundé, CameroonInternal Medicine, Regional Hospital, Bafoussam, CameroonUniversity of Yaoundé, Ministry of Public Health, Yaoundé, CameroonCardiology, St Louis Hospital, Dakar, SenegalDepartment of Pharmacy, St Antoine Hospital, AP-HP Sorbonne Université, Paris, FranceCardiology, Central Hospital of Lome, Lome, TogoCardiology, National University Hospital of Brazzaville, Marien NGOUABI University, Brazzaville, CongoCardiology, Institute of Cardiology of Abidjan (Côte d`Ivoire), BPV 206, abidjan, Côte d`IvoireInternal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niamey, NigerInstituto do Coração, Maputo, MozambiqueNational University Hospital of Hubert K. MAGA (CNHU-HKM), Cotonou, BeninCardiology, National University Hospital of Brazzaville, Marien NGOUABI University, Brazzaville, CongoCardiology, University of Medicine of Kinshasa, Kinshasa, Democratic Republic of the CongoCardiology, University Hospital of Libreville, Libreville, GabonInstituto do Coração, Maputo, MozambiqueCardiology clinics, Nouakchott, MauritaniaDepartment of Health Services Administration Cardiology Clinics and Policy, Temple University, Philadelphia, Pennsylvania, USADepartment of Pharmacy, St Antoine Hospital, AP-HP Sorbonne Université, Paris, FranceDepartment of Hypertension, Hopital Europeen Georges Pompidou, Paris, FranceObjective In Africa, the number of patients with hypertension is expected to reach 216.8 million by 2030. Large-scale data on antihypertensive medications used in Sub-Saharan Africa (SSA) are scarce.Here, we describe antihypertensive drug strategies and identify treatment factors associated with blood pressure (BP) control in 12 Sub-Saharan countries.Setting Outpatient consultations for hypertension in urban tertiary cardiology centres of 29 hospitals from 17 cities across 12 SSA countries between January 2014 and November 2015.Participants Patients ≥18 years of age with hypertension were enrolled at any visit during outpatient consultations in the cardiology departmentsMain outcome measure We collected BP levels, demographic characteristics and antihypertensive treatment use (including traditional medicine) of patients with hypertension attending outpatient visits. BP control was defined as seated office BP <140/90 mm Hg. We used logistic regression with a random effect on countries to assess factors of BP control.Results Overall, 2198 hypertensive patients were included and a total of 96.6% (n=2123) were on antihypertensive medications. Among treated patients, 653 (30.8%) patients received a monotherapy by calcium channel blocker (n=324, 49.6%), renin–angiotensin system blocker (RAS) (n=126, 19.3%) or diuretic (n=122, 18.7%). Two-drug strategies were prescribed in 927 (43.6%) patients including mainly diuretics and RAS (n=327, 42% of two-drug strategies). Prescriptions of three-drugs or more were used in 543 (25.6%) patients. Overall, among treated patients, 1630 (76.7%) had uncontrolled BP, of whom 462 (28.3%) had BP levels ≥180/110 mm Hg, mainly in those on monotherapy. After adjustment for sociodemographic factors, the use of traditional medicine was the only factor significantly associated with uncontrolled BP (OR 1.72 (1.19 to 2.49) p<0.01).Conclusion Our study provided large-scale data on antihypertensive prescriptions in the African continent. Among patients declared adherent to drugs, poor BP control was significantly associated with the use of traditional medicine.https://bmjopen.bmj.com/content/11/12/e049632.full |
| spellingShingle | Xavier Jouven Bamba Gaye Marie Antignac Ibrahima Bara Diop Marie Cécile Perier Jean Laurent Takombe Dadhi Balde Roland N'Guetta Anastase Dzudie Liliane Mfeukeu Kuate Charles Kouam Kouam Samuel Kingue Adama Kane Pauline Cavagna Jean Marie Damorou Stephane Méo Ikama Kouadio Euloge Kramoh Ibrahim Ali Toure Beatriz Ferreira Martin Houenassi Suzy Gisele Kimbally-kaki Emmanuel Limbole Jean Bruno Mipinda Carol Nhavoto Abdallahi Sidy Ali Gabriel S Tajeu Diane Macquart De Terline Michel Azizi Blood pressure-lowering medicines implemented in 12 African countries: the cross-sectional multination EIGHT study BMJ Open |
| title | Blood pressure-lowering medicines implemented in 12 African countries: the cross-sectional multination EIGHT study |
| title_full | Blood pressure-lowering medicines implemented in 12 African countries: the cross-sectional multination EIGHT study |
| title_fullStr | Blood pressure-lowering medicines implemented in 12 African countries: the cross-sectional multination EIGHT study |
| title_full_unstemmed | Blood pressure-lowering medicines implemented in 12 African countries: the cross-sectional multination EIGHT study |
| title_short | Blood pressure-lowering medicines implemented in 12 African countries: the cross-sectional multination EIGHT study |
| title_sort | blood pressure lowering medicines implemented in 12 african countries the cross sectional multination eight study |
| url | https://bmjopen.bmj.com/content/11/12/e049632.full |
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