Experts in public health have demonstrated that pharmacy-based treatment of hypertension is possible. The Centre for Epidemiology and Health Development (CEHD), Lagos in collaboration with the Amsterdam Institute for Global Health and Development and Omron Healthcare (OMC) have proved this.
It was at a day conference in Lagos, where findings from a study on the feasibility of pharmacy-based treatment of hypertension, carried out in urban Lagos, were presented. The research became necessary because of the need to find ways of improving access to diagnosis and treatment of hypertension.
According to the conference convener, Prof Akin Osibogun of CEHD, who is also a consultant epidemiologist at the Lagos University Teaching Hospital (LUTH), hypertension, is prevalent among Nigerians from 18 years and above. “Unfortunately, several studies from Nigeria have also documented a high percentage of people with elevated blood pressure not being aware of their status. Furthermore, a large percentage of those who are aware of their hypertensive status are not following a consistent treatment plan due to challenges in access to treatment,” he explained.
Prof Osibogun said: “Elevated and uncontrolled blood pressure is a leading risk factor for cardiovascular disease, heart attack and stroke in Nigeria. It is often referred to as the silent killer because many of its victims might not have had their blood pressure checked or known their status. Hopefully, a community based strategy that facilitates access to diagnosis and regular monitoring in collaboration with cardiologists for possible referral, will contribute to the control of this looming epidemic.”
Prof Osibogun gave the details: “The prevalence of raised blood pressure is highest in Africa where, in 2008 it was 46 per cent, and lowest in the Americas at 35 per cent for both sexes. In Nigeria, a survey on non-communicable diseases (NCDs) in 1992 reported a prevalence of about 10 percent for elevated blood pressure among Nigerians aged between 18 and 65 years.
In 2003, a survey carried out under the auspices of the World Health Organisation (WHO) and the Nigerian Heart Foundation reported a prevalence of 28 per cent. The currently reported prevalence of Hypertension in Nigeria in various studies is approximately 30 to 35 per cent. Hypertension is, therefore, a looming epidemic in Nigeria. Age, gender, family history, and ethnicity are non-modifiable risk factors, while modifiable risk factors for hypertension are alcohol use, cigarette smoking, diabetes mellitus, elevated serum lipids, excessive dietary sodium, obesity, sedentary lifestyle, socio-economic status and stress.”
He said the study being reported has been an effort at searching for a way to improve access to diagnosis and treatment.
A cardiologist, Dr. Olusegun A. Joseph, described hypertension as elevated blood pressure. “It is one of the leading causes of cardiovascular disease and the leading cause of mortality globally. It could be caused by saturated fat, which causes oxidative stress and could come with non serious symptoms like headache, feeling unwell, insomnia (inability to sleep). People who are not careful might just be treating typhoid and malaria, without knowing it is something more dangerous,” said Dr Joseph.
On how one should check his blood pressure, Dr Joseph, who works at the Lagos University Teaching Hospital (LUTH), said: “When anyone gets into a health facility, he/she should do himself/herself a favour of checking his/her blood pressure. All Nigerians from ages 18 to 20 should check their blood pressure often, especially if there is a family history. When one’s BP is above 140/90, he should worry. If it becomes frequent like 140/90, 140/80, 150/80, it is hypertension.”
Dr. Anja van’t Hoog of the Amsterdam Institute for Global Health and Development (AIGHD) gave an overview of the Omron Medical Connect (OMC) Pilot Project and the Evaluation Study. According to her, patients were recruited through community screening at the five participating pharmacies and through LUTH.
Dr van’t Hoog said patients were assessed by a medical doctor, who prescribed or adjusted anti-hypertensive medication if needed. Thereafter, patients continued their care at the five participating pharmacies. The pharmacists uploaded information in the OMC application (in a tablet device). A cardiologist reviewed the patient information from a distance, added his medical advice, and prescribed medications. Patients were informed to come to the pharmacy again to pick their prescribed medications, and for continuous monitoring of blood pressure and life style advice.
Dr. Van’t Hoog also introduced the Evaluation Study, which was conducted by an independent team of researchers from AIGHD and CEHD. “The aim of the study was to evaluate the feasibility of providing hypertension care through community-based pharmacies, including e-monitoring of patients, in an urban setting in Nigeria. The study followed patients in the pilot programme for six months, and employed both quantitative and qualitative research methods. The enrolled patients age, sex and hypertension treatment status at enrollment are available,” she added.
Ms. Heleen Nelissen of AIGHD said with results mostly obtained by quantitative analyses of the study data, indeed, adherence to prescriptions can alter hypertension.
“The feasibility of OMRON Medical connect pharmacy-based hypertension care in terms of screening and recruitment, and the number needed to screen to get one patient in the OMRON Medical Connect programme.
“Pharmacy visits and retention in-care as recorded in the OMC app and as reported by patients during the end line interviews; patterns in medication prescription, drug pick-ups, and medication adherence as reported by patients themselves, and how this changed during the programme for patients, who were already on anti-hypertensive medications, are all documented with positive results that pharmacy-based treatment of hypertension is possible. Impressive changes in blood pressure between baseline and end line and quality of care parameters are all captured.”
Dr. Okwor Tochi of CHED said that despite many challenges, the programme had helped patients in reducing blood pressure. She explained how various challenges with recruitment, use of the OMC App, retention in care, medication adherence, and financial challenges could be overcome for future directions for the program based on the results of the pilot and evaluation study.
CEHD member of staff and research fellow, Dr. Abiola Alege, said pharmacy has a huge role to play in the success story of any Pharmacy-Based treatment of hypertension. “According to some patients, pharmacists are more accessible and there is an already existing relationship with them. They save a lot of time for patients and serve as an alternative hospital. Also, people should use pharmacies more often because it could be a way of managing financial constraint,”he said.
However, she had explained that some people do not adhere to hypertension treatment because they believed they were feeling healthy. “Some were tired of drugs, others had side effects of taking drugs and for some, because of their financial status, they couldn’t sustain their purchase. Some pharmacists have also complained that after giving some of their patients what is described as ‘drug holidays’, there are those who declined to turn up for their drugs, believing that they are cured.”
Prof Jane Ajuluchukwu, who chaired the conference said people are not aware of how fast hypertension kills and this is a big problem. “Globally, hypertension kills nine million people, a statistic less than the mortality rate of malaria. It is advised that the average Nigerian check his blood pressure often for early detection sake,” she added.
