Mijinyawa Muhammad Sani, Yusuf Mohammed Shehu, Mohammed Hamza, Saidu Hadiza, Sulaiman Balarabe Aminu, Uloko Andrew E
Niger J Med. 2016 Jul-Sep;25(3):220-5.
Hypertension, if untreated or uncontrolled, leads to damage of vital organs such as the brain, heart and the kidneys among others. These complications have been shown to be severer in black Africans. Benefit of treatment has been repeatedly demonstrated by many studies. Therefore, many guidelines have been produced by relevant bodies in different countries in order to assist physicians in making the right choices for blood pressure (BP) control. Most of these bodies produce the guidelines based on the peculiarities of hypertension in their respective population. Several reports have shown how different hypertension is, in black Africans, still there is no published unified guideline for its treatment in this population.
This was a survey of known hypertensives who were on follow up visit. Their prescriptions were assessed for drug name, class and number. Their blood pressures at that visit were also recorded. Prevalence of single therapy and combination therapy were determined. Compliance with the AHA recommended 2 – drug combination was determined. The percentage of BP control as well as the prescribed drugs in each group were also obtained.
Those on single agents were 13% out of which 52% were controlled. 87% were on various combination of 2 or more drugs of whom 41.9% of those on 2 drugs and 21.1% of those on more than 2 drugs had controlled BP. BP control in those on 2 drugs was better than in those with > 2 drugs, (p=0.0027). ACEI were the commonest used drug either as single agent (55.9%) or as 2 – drug combination as seen in 54.8% of the subjects on 2 – drug combination. 13 different 2 – drug combinations were identified with the best control in ARB + Diuretic, ACEI + Diuretic and CCB + Diuretic. The least control was observed in the ACEI + CCB group. Compliance with AHA recommendation was good but still 7.7% were under unacceptable group while another 7.7% were unclassified.
ACE-Is are becoming the drugs of choice both as monotherapy and as combination therapy. Despite good compliance to AHA recommendation on drug combination, overall control is still a problem which calls for a revisit of these recommendations in Africans.
高血压若不治疗或控制不佳，会导致脑、心脏和肾脏等重要器官受损。这些并发症在非洲黑人中更为严重。许多研究反复证明了治疗的益处。因此，不同国家的相关机构制定了许多指南，以帮助医生做出正确的血压控制选择。这些机构大多根据各自人群中高血压的特点制定指南。几份报告显示了非洲黑人的高血压情况有多么不同，但针对该人群的高血压治疗仍没有统一的已发表指南。
这是一项对正在接受随访的已知高血压患者的调查。评估他们的处方药物名称、类别和数量。记录他们此次就诊时的血压。确定单一疗法和联合疗法的患病率。确定符合美国心脏协会（AHA）推荐的两药联合治疗的情况。还获取了每组的血压控制百分比以及所开药物。
接受单一药物治疗的患者占13%，其中52%的患者血压得到控制。87%的患者接受两种或更多药物的各种联合治疗，其中接受两种药物治疗的患者中有41.9%血压得到控制，接受两种以上药物治疗的患者中有21.1%血压得到控制。接受两种药物治疗的患者的血压控制情况优于接受两种以上药物治疗的患者（p = 0.0027）。血管紧张素转换酶抑制剂（ACEI）是最常用的药物，无论是作为单一药物（55.9%）还是作为两药联合使用，在接受两药联合治疗的患者中有54.8%使用了该药物。确定了13种不同的两药联合治疗方案，其中血管紧张素受体阻滞剂（ARB）+利尿剂、ACEI+利尿剂和钙通道阻滞剂（CCB）+利尿剂的血压控制效果最佳。ACEI+CCB组的血压控制效果最差。对AHA推荐的依从性良好，但仍有7.7%的患者属于不可接受组，另有7.7%的患者未分类。
ACEI类药物正成为单一疗法和联合疗法的首选药物。尽管对AHA关于药物联合治疗的推荐依从性良好，但总体控制仍然是一个问题，这需要重新审视针对非洲人的这些推荐。
