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Evaluation and management of patients referred to a tertiary-level hypertension clinic in Cape Town, South Africa

M S Moosa, L S Kuttschreuter, B L Rayner

Abstract


Background. Hypertension remains a global health burden, with a high incidence of long-term morbidity and mortality.

Objective. To evaluate blood pressure (BP) control, factors associated with poor BP control, target organ damage (TOD), white-coat hypertension, treatment-resistant hypertension and secondary hypertension in patients referred to a tertiary-level hypertension clinic.

Method. This was a prospective case-control study of patients referred for specialist hypertension management. Patient parameters recorded included age, gender, body mass index, uric acid, cholesterol, screening BP, follow-up BP, TOD and medications. We also recorded causes of secondary hypertension. Net BP change and the percentage achieving target BP were calculated in all patients followed up.

Results. A total of 175 patients were sampled (72 males and 103 females, mean age 46.5 years). Of the patients 16.6% had a normal screening BP; 62.9% of patients were followed up, and 43.6% of these achieved BP control. After intervention, there was a net drop of 13.2 mmHg (range 7.9 - 18.4) in systolic BP and of 3.8 mmHg (4.4 - 12.0) in diastolic BP. Of all the patients, 12.6% had resistant hypertension, 49.1% had evidence of left ventricular hypertrophy and 18.3% had microalbuminuria; 13.1% of the patients were diagnosed with secondary hypertension.

Conclusion. Specialist intervention was useful in identifying patients with white-coat and secondary hypertension, as well as in improving hypertension control in patients with apparent treatment-resistant hypertension. However, a significant percentage of patients did not reach target BP, and further efforts are required to identify the underlying causes for this.

Authors' affiliations

M S Moosa, Department of Medicine, New Somerset Hospital, Cape Town, South Africa

L S Kuttschreuter, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

B L Rayner, Division of Nephrology and Hypertension, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa

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Keywords

Hypertension; Management; Tertiary level; Resistant hypertension

Cite this article

South African Medical Journal 2016;106(8):797-800. DOI:10.7196/SAMJ.2016.v106i8.9610

Article History

Date submitted: 2015-03-16
Date published: 2016-07-04

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