title: Evaluation and management of patients referred to a tertiary-level hypertension clinic in Cape Town, South Africa.
abstract: BACKGROUND
  Hypertension remains a global health burden, with a high incidence of long-term morbidity and mortality.
  
  
  OBJECTIVE
  To evaluate blood pressure (BP) control, factors associated with poor BP control, target organ damage (TOD), white-coat hypertension, treatment-resistant hypertension and secondary hypertension in patients referred to a tertiary-level hypertension clinic.
  
  
  METHODS
  This was a prospective case-control study of patients referred for specialist hypertension management. Patient parameters recorded included age, gender, body mass index, uric acid, cholesterol, screening BP, follow-up BP, TOD and medications. We also recorded causes of secondary hypertension. Net BP change and the percentage achieving target BP were calculated in all patients followed up.
  
  
  RESULTS
  A total of 175 patients were sampled (72 males and 103 females, mean age 46.5 years). Of the patients 16.6% had a normal screening BP; 62.9% of patients were followed up, and 43.6% of these achieved BP control. After intervention, there was a net drop of 13.2 mmHg (range 7.9 - 18.4) in systolic BP and of 3.8 mmHg (4.4 - 12.0) in diastolic BP. Of all the patients, 12.6% had resistant hypertension, 49.1% had evidence of left ventricular hypertrophy and 18.3% had microalbuminuria; 13.1% of the patients were diagnosed with secondary hypertension.
  
  
  CONCLUSIONS
  Specialist intervention was useful in identifying patients with white-coat and secondary hypertension, as well as in improving hypertension control in patients with apparent treatment-resistant hypertension. However, a significant percentage of patients did not reach target BP, and further efforts are required to identify the underlying causes for this.
authors: Department of Medicine, New Somerset Hospital, Cape Town, South Africa. shiraz.moosa@gmail.com.
authors: M S
authors: MS
authors: Moosa
authors: L S
authors: LS
authors: Kuttschreuter
authors: B L
authors: BL
authors: Rayner