Barriers to up-titrated antihypertensive strategies in 12 sub-Saharan African countries: the Multination Evaluation of hypertension in Sub-Saharan Africa Study.

Autor:	Cavagna P; Department of Pharmacy, PITIE-SALPETRIERE Hospital, AP-HP Sorbonne université, 47-83 Boulevard de l'Hôpital.; Université Paris Cité, Inserm, PARCC, F-75015 Paris, France., Kramoh KE; Institute of Cardiology of Abidjan (Côte d'Ivoire), BPV 206, Abidjan, Côte d'Ivoire., Diop IB; Cardiology Department, University Hospital of Fann, Dakar, Senegal., Kouam Kouam C; Internal Medicine Department, Regional Hospital, Bafoussam, Cameroon., Ikama MS; Cardiology Department, National University Hospital of Brazzaville, Marien NGOUABI University, Brazzaville., Takombe JL; Department of Internal Medicine of la Gombe (CMCG), Ngaliema Hospital, Kinshasa, Democratic Republic of the Congo., Damorou JM; Cardiology Department, Central Hospital of Lome, Lome, Togo., Ali Toure I; Internal Medicine and Cardiology Department, University Hospital of Lamorde, Niamey University, Niamey, Niger., Balde DM; Department of Cardiology, University Hospital of Conakry, Guinea., Dzudie A; Cardiac Intensive Care & Cardiac Pacing Unit, Douala General Hospital, Douala, Cameroon., Khoury S; Université Paris Cité, Inserm, PARCC, F-75015 Paris, France., Perier MC; Université Paris Cité, Inserm, PARCC, F-75015 Paris, France., Asselin A; Université Paris Cité, Inserm, PARCC, F-75015 Paris, France., Azizi M; Cardiovascular Epidemiology Department, University of Paris Cité.; Hypertension Unit, European Georges Pompidou Hospital, AP-HP Centre.; INSERM, Centre d'Investigation Clinique 1418, Paris, France., Houenassi MD; National University hospital of Hubert K. MAGA (CNHU-HKM), Cotonou, Benin., Kane A; Cardiology Department, General Hospital of Grand Yoff, Dakar, Senegal., Kimbally-Kaki SG; Cardiology Department, National University Hospital of Brazzaville, Marien NGOUABI University, Brazzaville., Kingue S; University of Yaoundé, Ministry of Public Health, Cameroon., Limbole E; Department of Internal Medicine of la Gombe (CMCG), Ngaliema Hospital, Kinshasa, Democratic Republic of the Congo.; Cardiology Department, University of Medicine of Kinshasa, Democratic Republic of the Congo., Mfeukeu Kuate L; Cardiology Department, Central hospital of Yaoundé, Cameroon., Mipinda JB; Cardiology Department, University Hospital of Libreville, Libreville, Gabon., Ferreira B; Instituto do Coração (ICOR), Maputo, Mozambic., Nhavoto C; Instituto do Coração (ICOR), Maputo, Mozambic., Sidy Ali A; Cardiology clinics, Nouakchott, Mauritania., Empana JP; Université Paris Cité, Inserm, PARCC, F-75015 Paris, France., N'guetta R; Institute of Cardiology of Abidjan (Côte d'Ivoire), BPV 206, Abidjan, Côte d'Ivoire., Jouven X; Université Paris Cité, Inserm, PARCC, F-75015 Paris, France.; Cardiovascular Epidemiology Department, University of Paris Cité.; Cardiology Department, European Georges Pompidou Hospital, AP-HP Centre, Paris, France., Antignac M; Department of Pharmacy, PITIE-SALPETRIERE Hospital, AP-HP Sorbonne université, 47-83 Boulevard de l'Hôpital.; Université Paris Cité, Inserm, PARCC, F-75015 Paris, France.
Jazyk:	angličtina
Zdroj:	Journal of hypertension [J Hypertens] 2022 Jul 01; Vol. 40 (7), pp. 1411-1420.
DOI:	10.1097/HJH.0000000000003169
Abstrakt:	Background: Sub-Saharan Africa (SSA) faces the highest rate of hypertension worldwide. The high burden of elevated blood pressure (BP) in black people has been emphasized. Guidelines recommend two or more antihypertensive medications to achieve a BP control. We aimed to identify factors associated with prescription of up-titrated antihypertensive strategies in Africa. Methods: We conducted a cross-sectional study on outpatient consultations for hypertension across 12 SSA countries. Collected data included socioeconomic status, antihypertensive drugs classes, BP measures, cardiovascular risk factors and complication of hypertension. We used ordinal logistic regression to assess factors associated with prescription of up-titrated strategies. Results: The study involved 2123 treated patients with hypertension. Patients received monotherapy in 36.3 vs. 25.9%, two-drug in 42.2 vs. 45% and three and more drugs strategies in 21.5 vs. 29.1% in low (LIC) and middle (MIC) income countries, respectively. Patients with sedentary lifestyle [OR 1.4 (1.11-1.77)], complication of hypertension [OR 2.4 (1.89-3.03)], former hypertension [OR 3.12 (2.3-4.26)], good adherence [OR 1.98 (1.47-2.66)], from MIC [OR 1.38 (1.10-1.74)] and living in urban areas [OR 1.52 (1.16-1.99)] were more likely to be treated with up-titrated strategies. Stratified analysis shows that in LIC, up-titrated strategies were less frequent in rural than in urban patients (P for trend <0.01) whereas such difference was not observed in MIC. Conclusion: In this African setting, in addition to expected factors, up-titrated drug strategies were associated with country-level income, patient location and finally, the interplay between both in LIC. These results highlight the importance of developing policies that seek to make multiple drug classes accessible particularly in rural and LIC. (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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