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Ethn_14_113.82_86.tp

INADEQUATE CONTROL OF BLOOD PRESSURE IN NIGERIANS WITH DIABETES
pressure (BP) was reduced to below 140/90mm Hg in Nigerians with diabetes (DM), datawere collected using structured questionnaire,standard sphygmomanometer, and measure-ment of fasting blood glucose (FBG).
INTRODUCTION
males) aged 17–84 years with a mean duration of patient’s attendance at the clinic and of DM of 7.9 years and who regularly attended the clinic for diabetes at least monthly for no rated using patient’s appointment hand- less than 6 months were involved. Eleven per- cent, 13 of the 115 treated hypertensives, had card entries and their medical records.
BP controlled to levels below 140/90 mm Hg.
Nifedipine was the most frequently prescribed strongly suggest.1–5 In Nigeria, practical antihypertensive (44.30%), followed by ␣- difficulties are often associated with an methyldopa (15.7%) and then the angiotensin- individual’s efforts to maintain glucose converting enzyme inhibitors (ACEIs) captopril and lisinopril (11.3%). Thiazides (9.7%) or thi- azide-based fixed combination tablets were prescribed in about 25% of the patients. Eigh- teen percent were on more than one antihy- viduals from the patient’s hospital re- pertensive concurrently and dosages were of- factors related to the provision of health ten at threshold. The majority of the hyperten- thiazide-based medications. In 152 partici- pants, the presence of hypertension did not af- the next clinic visit for identification.
fect glycemic control (␹2ϭ4.41, dfϭ2, Pϭ.1) observed and 60% of the entire populationhad FBG Յ7.9 mmol/L.
these findings and suggests an area for im- provement. Fortunately, the data also show nometer after a 5-minute rest in the sit- that thiazides were associated with better con- Location and Patients
trol of BP at a cost that was affordable without As described elsewhere,8–9 the site for jeopardizing diabetic control. (Ethn Dis. 2004; facility which serves as a tertiary referral Key Words:
center for 6 adjoining states. The facility pital. The federal government provideshealth-care services to the public at a ly for consultation, laboratory tests, pre- of Ն90 mm Hg who were not aware oftheir hypertensive status, were also in- (EOO) and Department of Statistics (BAO), University of Ilorin, Ilorin, Nigeria.
ined using t statistics. The distribution about date of diagnosis of diabetes, uti- Medicine; University of Ilorin; PMB 1515;Ilorin, Nigeria; 031-227153; eookoro@ Ethnicity & Disease, Volume 14, Winter 2004 CONTROL OF BLOOD PRESSURE IN NIGERIANS WITH DIABETES - Okoro and Oyejola
hypertensives (Nϭ115), the mean du- (Nϭ7) prescribed. The 13 hypertensive were similar (Pϭ.69), equating to 8.7 ing chi-square analysis. Differences were considered significant when PϽ.05, ex- effect (␹2ϭ4.4, dfϭ2, Pϭ.1) on the de- (extract of Nuclea lati folia tree) (1).
teen of the 115 treated hypertensives (ie, for the variation in the sample size rep- resented as indicated in the Results sec- that the unit cost of purchase was lowest (Pϭ.3) from a mean of 8.3 years for the body mass index (BMI) of 25.6 kg/m2.
of all prescriptions. Ten percent of treat- latter category, 23 had mild elevation of Lente. Subjects receiving Lente were sig- BP, 9 fell into the category of moderate, Table 1. Distribution of selected variables by blood pressure classification
95% Confidence
Interval for
Variables
Normotensives
Hypertensives
t value
P value
Difference
Number in parentheses indicates sample size.
DOMϭdifference of means; SEDϭstandard error of difference of means.
* Statistical significance at P value of means.
Ethnicity & Disease, Volume 14, Winter 2004 CONTROL OF BLOOD PRESSURE IN NIGERIANS WITH DIABETES - Okoro and Oyejola
Table 2. Frequency of individual antihypertensive medications prescribed as at the time of evaluation
Recommended
Most Frequent
Maximum Daily
Dose Prescribed
*Unit Price of Purchase
(50 mg chlorthalidone ϩ 0.25 mg reserpine) (5 mg clopamide ϩ 0.1 mg reserpine ϩ0.5 mg dihydroergo cristine) (0.5 mg prazosin HCL ϩ 0.25 mg polythiazide) (5 mg amiloride HCL ϩ 50 mghydrochlorothiazide) (extract of Nuclea lati folia tree) * Quoted prices as at April 4, 2000 at the Teaching Hospital Pharmacy.
† Upper limit of dose in hypertension.
NϭNaira (unit of Nigerian currency). Exchange rate US $1 approximately N110. Approved (May 1, 2000) National Minimum wage for public servants. FederalϭN7,500 Average family sizeϭ6.
Cost of taxi rideϭN10–N20 per drop.
sive (Table 2). This prescription pattern used higher cut-off points or did not de- DISCUSSION
thiazides could adversely affect diabetic dividuals with diabetes also had elevated BP. These findings are similar to a recent finding is reassuring and reinforces data and elsewhere4,5,18 which are affirmative from 2 earlier studies,6,7 which reported about the efficacy and safety of low-dose diabetes. Since thiazides are the least ex- are relatively resistant to the antihyper- Ethnicity & Disease, Volume 14, Winter 2004 CONTROL OF BLOOD PRESSURE IN NIGERIANS WITH DIABETES - Okoro and Oyejola
tensive effects of ACEIs, ␣-blockers and rin, for helping in the collation of results and 14. Ducorps M, et al. Prevalence of hypertension ␤-blockers,19–23 it follows that thiazides data entry. The secretarial assistance of Mrs in a Black African diabetic population. Arch Funke Adeyemi is gratefully acknowledged.
Mal Coeur Vaiss. 1996;89(8):1069–1073.
15. Opadijo OG, Omotosho ABO. Blood sugar profile in mild to moderate systemic hyper- EFERENCES
1. UK Prospective Diabetes Study Group. Tight tensives on thiazide diuretics whose blood blood pressure control and risk of macrovas- pressure are well controlled. Niger Q J Med.
1995;5(2):48–50.
Nigeria.7,8,24–25 Unfortunately, the pre- cular and microvascular complications in type 16. Opadijo OG. Biochemical and metabolic ef- 2 diabetes: UKPDS 38. BMJ. 1998;17:703–712.
fects of short-term thiazide diuretics in mild 2. UK Prospective Diabetes Study Group. Effi- to moderate hypertension. Nig Med Pract. cacy of atenolol and captopril in reducing the risk of macrovascular and microvascular com- 17. Ajayi AA, Babalola RO. Enalapril and hydro- chlorothiazide in hypertensive Africans with plications in type 2 diabetes: UKPDS 39.
BMJ. 1998;317:713–719.
proteinuria. Practical Diabetes Digest. 1991;5: 3. UK Prospective Diabetes Study Group. Cost effectiveness analysis of improved blood pres- 18. The Hypertension Detection and Follow-up sure control in hypertensive patients with Program Cooperative Research Group. Mor-tality findings for stepped-care and referred- type 2 diabetes: UKPDS 39. BMJ. 1998;317: care participants in the Hypertension Detec- 4. Hansson L, Zanchetti A, Garruthers SG, et tion and Follow-up Program, stratified by rectly borne by patients in out-of-pocket al, for the HOT study group. Effects of in- other risk factors. Prev Med. 1985;14:312– tensive blood-pressure lowering and low-dose ability to afford prescribed drugs is the aspirin in patients with hypertension: princi- 19. Ajayi AA, Oyewo EA, Ladipo GOA, Akinsola A. Enalapril and hydrochlorothiazide in hy- pal results of the Hypertension OptimalTreatment (HOT) randomized trial. Lancet. pertensive Africans. Eur J Clin Pharmacol. 5. Curb JD, Pressel SL, Cutler JA, et al. Effect 20. Salako BL, Kadiri S, Walker O, Fehintola FA.
of diuretic-based antihypertensive treatment Evaluation of lacidipine (a calcium blocker) on cardiovascular disease risk in older diabetic in the treatment of hypertension in Black Af-rican people: a double blind comparison with patients with isolated systolic hypertension.
Systolic Hypertension in the Elderly Program hydrochlorothiazide. Afr J Med Med Sci. Cooperative Group. JAMA. 1996;276:1886– 21. Matterson BJ, Reda DJ, William MS, et al.
Single drug therapy for hypertension in men:a comparison of six antihypertensive agents Ogunrinola EO. Hypertension in diabetic pa-tients. Int Diabetes Digest. 1997;7(2):39–45.
with placebo. N Engl J Med. 1993;328(13): 7. Bojuwoye BJ. Clinical pattern, management, and problems of diabetes mellitus in Ilorin, 22. Falase AO, Salako LA, Aminu JM. Lack of Nigeria. Trop J Health Sci. 1995;2(1):1–5.
effect of low dose prazosin in hypertensive abetes occurred even less frequently. The 8. Okoro EO, Jolayemi ET, Oyejola BA. Ob- Nigerians. Curr Ther Res. 1976;19(6):603– servations on the low dose hydrochlorothia- zide in the treatment of hypertension in dia- 23. Prince MJ, Stuart Ca, Padia M, et al. Meta- betic Nigerians. Heart Drug. 2001;1(2):83– bolic effects of hydrochlorothiazide and enal- april during treatment of hypertensive dia- prescription and misplaced emphasis.
9. Okoro EO, Adejumo AO, Oyejola BA. Dia- betic patient: enalapril for hypertensive dia- Fortunately, the data also show that thi- betic care in Nigeria. Report of a self audit. J betics. Arch Intern Med. 1988;148:263–268.
Diabetes Complications. In press.
24. Onwuchekwa AC. Problems of hypertensive 10. Kumwanda J, Harries AD, Nyirenda C, Wir- care in Nigeria. Nig Med Pract. 1996;31(516): ima C, Wirima JJ. Diabetes mellitus and hy- without jeopardizing diabetic control.
pertension in Malawian adults. Malawi Med 25. Okoro EO, Adewara AA, Davies AE. Quality of diabetic care in Nigeria: a patient satisfac- 11. Okoro EO, Adeyemi IM. Physical stature of tion survey. Diabetes Int. In press.
three groups of adolescent children in Ilorin 26. Olayemi SO, Mabadeje AFB. Cost evaluation ACKNOWLEDGMENT
metropolis: a comparative study. Nig Med This work is dedicated to Drs. Hisham Na- drugs and the pattern of prescription among 12. Cobey JC, Cunnighan N. An evaluation of a local calendar used in determining ages of Hospital. Nig J Health Biomed Sci. 2002;1(2): this study for their cooperation and the doc- children in a Nigerian village. J Trop Pediatr. tors. Particularly, the authors wish to thank 27. Kadiri S, Walker O, Salako BL, Akinkugbe 13. Okoro EO, Uroghide JE, Jolayemi ET. Salt O. Blood pressure, hypertension, and corre- taste sensitivity and blood pressure in a group lates in urbanized workers in Ibadan, Nigeria: collection. We also thank Mr. A.A. Adewara, of adolescent school children in southern Ni- a revise. J Hum Hypertens. 1999;13:23–37.
Department of Statistics, University of Ilo- geria. East Afr Med J. 1998;75(4):196–200.
28. Hypertension management in Nigeria. Inte- Ethnicity & Disease, Volume 14, Winter 2004 CONTROL OF BLOOD PRESSURE IN NIGERIANS WITH DIABETES - Okoro and Oyejola
grated management of cardiovascular risk.
AUTHOR CONTRIBUTIONS
Design and concept of study: Okoro, Oyejola 29. Udoh FV, Lot TY. The cardiovascular effects Data analysis and interpretation: Okoro, Administrative, technical, or material assis- of extract of Nuclea lati folia. West Afr J Pharm Drug Res. 1991;9/10:127–128.
Ethnicity & Disease, Volume 14, Winter 2004

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