Antihypertensive Medication Prescribing Patterns and Predictors of Uncontrolled Blood Pressure among Patients with Chronic Kidney Disease and Co-morbid Hypertension in a Nigerian Tertiary Hospital

Abstract

It is obvious in the literature that the majority of patients with chronic kidney disease (CKD) are concurrently inflicted with hypertension. Hypertension and CKD are both independent risk factors for cardiovascular disease and significantly contribute to disease progression. The study aimed to evaluate the antihypertensive medication prescribing patterns,and assess blood pressure (BP) control and the potential predictors of uncontrolled BP in the study population.
This one-year retrospective cross-sectional study was conducted in the Nephrology unit of a tertiary teaching hospital in Maiduguri, Nigeria. This study enrolled adult patients with confirmed diagnoses of any CKD stage and co-morbid hypertension, who received care at the facility between August 2022 and July 2023. Relevant data were collected from 16 January to15 February 2024 using a predesigned proforma. Study results were presented using descriptive
statistics, while binary logistic regression analysis was used to explore the predictors of uncontrolled BP at p < 0.05 level of statistical significance. Among 300 patients with CKD and
hypertension, 292 (97.5%) patients were prescribed multiple antihypertensive medications. Of 851 antihypertensive medications prescribed for the study population, diuretics (29.5%) mainly furosemide (23.0%) followed by calcium channel blockers [CCBs] (28.7%) were the most frequently prescribed. Furthermore, 213 (71.0%) patients had uncontrolled BP. Age 45 - 54 years (AOR = 4.01, 95 % CI 1.03 to 15.60, P = 0.045), and use of three antihypertensive
medications (AOR = 7.08, 95% CI 1.33 to 37.55, P = 0.022), and four anti-hypertensive medications (AOR = 15.30, 95% CI 1.57 to 149.24, P = 0.019), respectively were significantly independently associated with uncontrolled BP. The study established that an overwhelming number of patients were prescribed multiple antihypertensive medications with diuretics and CCBs being the most common. Uncontrolled BP was highly prevalent in the study population
and was significantly associated with middle age, and use of more than two antihypertensive medications. Therefore, interventions targeted at these factors are recommended to improve BP control in this high-risk group.