Treatment of hypertension in Bahrain

OBJECTIVE: To evaluate the adequacy of blood pressure (BP) control and therapeutic appropriateness of anti hypertensive drug(s) prescribed, taking into consideration laboratory parameters and the presence of comorbidities, in hypertensive patients. METHODS: Therapeutic audit of medical records of hypertensive patients from 9 primary care health centers in Bahrain using World Health Organization/International Society of Hypertension guidelines criteria. RESULTS: The recommended target BP <140/<90 mm Hg was achieved in 37 (16.5%) patients with a mean BP of 126 +/- 6 / 80 +/- 5 mm Hg. Groups with inadequate BP control were 15 (6.7%) with normal systolic BP (SBP) and high diastolic BP (DBP), 59 (26.3%) with high SBP and normal DBP, and 113 (50.4%) with high SBP and high DBP. Pulse pressure of the controlled group was 46.3 +/- 5.9, whereas pulse pressures of the inadequately controlled groups with BP cutoffs <140/greater than or equal to90, greater than or equal to140/<90, and greater than or equal to140/greater than or equal to90 mm Hg were 37.4 +/- 6.1, 72.7 +/- 13.5, and 59.7 +/- 13.6 mm Hg, respectively. Of the 281 treated hypertensive patients, 56.6% were on monotherapy; BP of patients on combination therapy versus monotherapy did not differ. The choice of antihypertensives in relation to comorbidities and laboratory findings revealed that many hypertensive patients with dyslipidemia were on beta-blockers and diuretics, 39.3% of patients with ischemic heart disease were on beta-blockers, approximately 20% of patients with hyperuricemia were on diuretics, and 27.6% and 10.4% of patients with isolated systolic hypertension were on diuretics and calcium-channel blockers, respectively. CONCLUSIONS: BP control was achieved in 1 of 6 treated patients. In several instances, metabolic abnormalities and comorbidities were apparently not considered while prescribing antihypertensives. A rational drug therapy approach is needed in treating hypertension to achieve better control rates.