Hypertensive Urgencies or Emergencies and Co-Morbidities in Bukavu Referral Hospitals: Clinical Profile, Management Regimens, Outcomes and Drug Related Problems

Author(s): Justin Ntokamunda Kadima*, Benjamin Bavhure, Joseph Deo Sepa and Delphin Murhura

Background: Hypertension is known as a silent disease ever complex to manage particularly in poor countries. Pharmacists may contribute to improving efficacy and safety. Objective: The study aimed at monitoring patients hospitalized for hypertensive urgencies or emergencies to evaluate the adequacy of treatment regimens and potential drug related problems. Methods: Retrospective/ prospective chart review of inpatients admitted for hypertensive crisis at two referral hospitals in Bukavu City, DR Congo. Primary outcomes were decrease in blood pressure, resistance to treatment and death. Results: The profile showed the prevalence of inpatients with hypertensive crisis was 9.7% (189/1948); that included 57% men and 43% women aged 23 to 88 years old whose 55% were on alcohol and tobacco. The majority (46%) had severe hypertension (BP>180/110) including 24.4% urgency cases and 76% emergency cases; the end-organ damages consisted of stroke (32%), heart failure (24.6%), chronic kidney disease (19.7%) associated or not with diabetes (39.8%); Co-morbid conditions were respiratory distress, urinary tract infection, sepsis, malaria, gastritis and cancer. Medication regimens included CCBs, ACEIs and ARBs in multidrug combination with diuretics, beta-blockers and a variety of products for co-existing health conditions. The treatment goal BP<140/90 was achieved in 87% while failure and death occurred in 10.6% and 2.4% respectively. Some drug related problems were encountered. Conclusions: The analysis found that the majority of patients are presenting with severe hypertension and in stroke condition showing that many people live with uncontrolled high blood pressure. The management outcome was satisfactory despite some medicines related problems encountered. There is a need to draft best standardized protocols to narrow the quality gap and avoid polypharmacy.

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