Hypertension treatment by primary care physicians in Lagos

Background: Globally, hypertension (HTN) control is poor. We studied the contribution of primary care physicians to this. Methods: Lagos-based primary care physicians were studied using anonymous self-administered questionnaire on HTN treatment goals and drug therapy. Results: Data from 403 respondents with a mean age and experience of 40 ± 11.34 years and 14.3 ± 11.1 years, respectively, were analyzed. Two hundred and twenty-eight physicians (61.1%) practiced in primary health-care facilities, while 125 (33.5%) and 20 (5.4%) practiced in facilities affiliated to the secondary and tertiary health-care centers, respectively. One hundred and twenty-three (35.7%) of the respondents correctly indicated the treatment blood pressure goal for uncomplicated HTN. Eighty (26.1%), 37 (12.2%), and 54 (18.5%) of respondents correctly indicated the treatment goals in hypertensive patients with diabetes mellitus (DM), old stroke, and coronary artery disease (CAD), respectively. The correct choice(s) of antihypertensive drugs vis-a-vis compelling/possible indications were made by 259 (76%) for uncomplicated HTN, 194 (63.4%) for hypertensives with chronic kidney disease, 128 (44.3%) for hypertensives with previous stroke, 250 (76.7%) for pregnant hypertensives, 166 (57%) for hypertensives with CAD, and 165 (61.6%) for hypertensives with DM. Choice(s) of antihypertensive medications were determined by the patient's age 302 (79.4%), gender 233 (58.4%), race 234 (59.8%), associated clinical condition 365 (90.6%), duration of action of antihypertensive drugs 340 (85.5%), and the cost of antihypertensive medications: 334 (85%). Conclusions: The physicians' knowledge of HTN management is suboptimal. This may be contributory to the poor HTN control in Nigeria. These deficiencies may be addressed through continuing medical education together with popularizing and simplifying of the guidelines.