title: A survey of hypertensive practices at two community health centres in Cape Town.
abstract: BACKGROUND
  Control of hypertension remains an elusive goal, but doctors' non-compliance with guidelines, patient attitudes and adherence to treatment, and poor delivery of care at clinics are important contributing factors.
  
  
  OBJECTIVE
  To determine the overall quality of hypertensive care, and compliance with current hypertension guidelines at community health centres (CHCs) in the Western Cape.
  
  
  METHODS
  Consecutive patients attending hypertension clinics at two CHCs were selected to participate. A questionnaire was designed to determine patient demographics, doctors' compliance with hypertension guidelines, factors leading to treatment non-adherence, and delivery of care. Accuracy of blood pressure (BP) recording was evaluated by comparing the clinic BP with that measured using an approved manometer.
  
  
  RESULTS
  One hundred and sixty-one patients were evaluated, 100 from CHC 1 and 61 from CHC 2. There was no difference in both control systolic and diastolic BP measured by the hypertension nurse (147.9 v. 144.8 mmHg, p = 0.45, and 89.3 v. 85.6 mmHg, p = 0.14) respectively. All clinic BP readings were recorded to the nearest 10 mmHg mercury. The difference in both systolic and diastolic BP > 10 mmHg between the clinic and control BP was significantly greater at CHC 2 than CHC 1 (28% v. 56%, p = 0.005, and 43% v. 64%, p = 0.007) respectively. Overall, 39.8% of patients had a systolic and diastolic BP < 140 and < 90 mmHg. The mean number of antihypertensive drugs was 2.4 per patient. The use of non-steroidal anti-inflammatory drugs (NSAIDs) and tricyclic antidepressants was high at both centres, and few patients underwent basic investigations, lifestyle interventions, risk stratification or global cardiovascular risk reduction.
  
  
  CONCLUSIONS
  39.8% of patients achieved a BP < 140/90 mmHg. There is significant scope for improvement in prescription of medication, application of uniform lifestyle changes, and avoidance of NSAIDs and tricyclic antidepressants. Major deficiencies were identified in BP measurement, assessment of target organ damage, risk stratification and the reduction of overall cardiovascular risk.
authors: Division of Hypertension, Department of Medicine, University of Cape Town, South Africa. brian.rayner@uct.ac.za
authors: Brian
authors: B
authors: Rayner
authors: Marc
authors: M
authors: Blockman
authors: Donette
authors: D
authors: Baines
authors: Yvonne
authors: Y
authors: Trinder
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D003151:Community Health Centers; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy*; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D013019:South Africa
chemical_list: D000959:Antihypertensive Agents