Managing Hypertension In Heart Failure Patients In A Teaching Hospital In Ghana

The study was carried to establish hypertension as the major cause of heart failure in patients seen at the medicine directorate of a teaching hospital in Kumasi. The study also determined the efficiency of the pharmacotherapeutical management of hypertension in these patients. It was retrospective covering a 3-year period i.e. 2004 to 2006. It involved 307 heart failure patients consisting of 54.7% males and 45.3 females aged between 13 to 100 years with the age range of 53-60 years forming the majority. The median age of the patients was 54.6 years with a standard deviation of 18.12. The study was non-randomized and hence all heart failure patients who fell within these periods were used. Hypertension was found to be main cause of heart failure affecting 61.7% (n=189) out of the 307 patients who were admitted for heart failure. The patients had a mean systolic blood pressure of 148.2mmHg (SD.38.49) with the majority (28.7%) having systolic blood pressure in the range of 140-165mmHg. Their mean diastolic blood pressure was 92.60mmHg (SD. 22.32) with the majority (52.4%) having diastolic blood pressure in the range of 90-110mmHg. For asymptomatic heart failure patients with hypertension a thiazide diuretic was found be effective especially for elderly patients over 65 years. 23.8% of the patients in this study received the calcium-channel blocker, nifedipine to treat hypertension in heart failure, however, the newer calcium antagonists, felodipine and amlodipine were more effective in treating arterial hypertension in heart failure. 13.3% of the patients in this study received the β-blocker, carvedilol. Maximizing the dose of β-blockers and ACE-inhibitors, which extend survival in heart failure, was found be more effective than adding calcium-channel blockers to control hypertension. 41.7% of the patients in the study received low dose of the ACE-inhibitor, lisinopril (2.5mg-5mg) to treat symptomatic heart failure due to systolic left ventricular dysfunction, however, maximizing the dosage to 10mg-20mg was found to achieve a decrease in blood pressure as well as improved survival of the patients. The centrally acting drug, methyldopa was administered to 18% of the patients. A dosage of 250-1000 twice daily was found to effectively control their blood pressure. Although most of the patients were discharged with a decreased blood pressure levels the recommended target blood pressure levels of <140/90 or 130/80mmHg could not be achieved. This was due to the fact that most of the patients became asymptomatic and therefore were discharged to be reviewed at the cardiac clinic.