Health practitioners' state of knowledge and challenges to effective management of hypertension at primary level

Abstract

Background: Patient- and physician-related factors impact on the management and control of hypertension.

Objectives: To systematically examine: (1) South African primary care doctors' state of knowledge on the management of hypertension; (2) primary health practitioners' knowledge on the South African hypertension guidelines; (3) current approaches to management of hypertensive patients; and (4) challenges to effective management of hypertension at primary level.

Methods: A cross-sectional, observational study using a semi-structured questionnaire was carried out in two large community health centres (CHCs) in the Cape Town metropole. All 16 doctors employed at both CHCs were voluntarily enrolled, seven (43.7%) of whom were female, with 14 (87.5%) younger than 40 years of age. The majority (81.2%) of the doctors surveyed had been practicing for less than 10 years.

Results: Ten (62.5%) of the doctors surveyed aimed to treat hypertension to target, and recommendations on lifestyle modifications were reportedly poorly done. While 11 (68.8%) of the doctors were aware of the South African hypertension guidelines, were (81.8%) of them were not conversant with the contents thereof. Doctors estimated that only 35% of their patients are treated to target. Poor patient adherence to prescribed treatment, language difficulty, heavy patient load, medical staff shortages, and patient loss to follow up were identified by the doctors as significant impediments to the effective management of hypertension at the primary level of care.

Conclusion: Primary healthcare practitioners' knowledge regarding hypertension and the South African hypertension guidelines is poor. Management of hypertension by these doctors is sub-optimal. There are significant challenges to effective management of hypertension at this level of care.

Fig. 1.

Compelling indications for the treatment of hypertension as given by the doctors surveyed. DM = diabetes mellitus, IHD = ischaemic heart disease; PVD = peripheral vascular disease, HC = hypercholesterolaemia, HF = heart failure, PMI = previous myocardial infarction, RD = renal disease, HIV = human immunodeficiency virus infection, CVA = cerebrovascular accident.

Fig. 2.

Choice of preferred antihypertensive agent, when these compelling indications are present. Angina = ischaemic heart disease or angina pectoris, PMI = previous myocardial infarct, HF = heart failure, DM = diabetes mellitus, CVA = prior cerebrovascular accident, PVD = peripheral vascular disease, Alb = albuminuria, CKD = chronic kidney disease, LVH = left ventricular hypertrophy, and JISH = just isolated systolic hypertension.