Characteristics and control of severe hypertension in a specialist, private practice in Jamaica

OBJECTIVE: To determine the characteristics of patients with severe uncontrolled hypertension, in a Jamaican specialist practice; the level of blood pressure control achieved in routine clinical practice, and the number/type of antihypertensive medications required for blood pressure control. DESIGN: This was a retrospective analysis of the medical records of 500 consecutive patients presenting to a consultant physician private group-practice between January and December 2000. Data were extracted from the records of the 48 patients with severe (Grade III) hypertension (WHO/ISH). RESULTS: Fifty per cent (252) werefound to be hypertensive, 19% (48) had Grade III hypertension. The patients with severe uncontrolled hypertension were of mixed ethnicity, predominantly African. Most were less than 65 years old, never smoked cigarettes and were overweight/obese. Nearly one-half had LDL cholesterol >3.4 mg/dL. Diabetes (31%) and congestive heart failure (21%) were the most common comorbid conditions. Fifteen per cent had no illnesses other than severe hypertension. Cardiovascular symptoms were predominant, followed by dizziness. Only 19% of patients were asymptomatic. More than half of the patients achieved blood pressure > 140/90 mm Hg during the study period. Most patients received four drugs and the number of drugs prescribed increased with duration of follow-up. The antihypertensive medications most prescribed at one year were--angiotensin converting enzyme inhibitors (87%), diuretics (78%), calcium channel blockers (63%) and beta-blockers (69%). CONCLUSION: Severe hypertension was a common problem in the specialist private practice in Jamaica. Most patients had cardiovascular symptoms, were dyslipidaemic and required four or more antihypertensive drugs for adequate long-term control.