Effect of Antihypertensive Drug Therapy on the Blood Pressure Control among Hypertensive Patients Attending Campus’ Teaching Hospital of Lome, Togo, West Africa


High blood pressure (HBP) is a health problem world—wide. In Togo, that affection constitutes a more and more pre-occupying cause of morbidity and mortality. This study is a prospective one which intended to identify the antihypertensive regimens prescribed and evaluate their effect on patients’ blood pressure (BP) control. Out of the 204 patients enrolled (mean: 55.01 ± 12.55 years; sex ratio: 1.3), 112/176 placed on antihypertensive therapy have controlled their BP (38.39% outpatients vs 61.61% inpatients). Related to the sex factor, we didn’t observe any significant difference in the BP control. Whereas, the mean median value of BP reduction of outpatients (30.00/15.00 mmHg) (p = 0.001) was half lower than that of inpatients (60.00/30.00 mmHg (p = 0.004)). Thirty five outpatients (81.40%) vs 64 inpatients (92.75%) were placed on combination therapy. The bitherapy was prescribed to 23 outpatients (53.49%) against 27 inpatients (39.13%) while the quadritherapy and more than 4 drugs combination were prescribed exclusively to inpatients (20.29%, n = 14). That quadritherapy induced a significant mean reduction of inpatients’ SBP compared to monotherapy (p = 0.043) and to bitherapy (p = 0.004). The favorite combinations were D + CCA, D + ACEI, D + CCA + ACEI and D + CCA + ACEI + CAAD of which the quadruple therapy showed a significant inpatients’ DBP control (p = 0.015) compared to D + CCA combination. The combinations including at least one diuretic induced a significant difference between outpatients (median value: 30.000/10.000 mmHg) (p < 0.001) and inpatients (median value: 60.000 mmHg/30 mmHg) (p < 0.001). The first-line molecules and fixe combinations prescribed in decreasing frequency were among others: hydrochlorothiazide + captopril, nicardipine, α methyldopa for outpatients; furosemide, nicardipine, captopril, α methyldopa, hydrochlorothiazide + captopril for inpatients. Diuretics, CCAs and ACEIs were the 3 favorite pharmacological groups for essential hypertension management in our African resource limited context. Combined to CAAD, they represented the best quadruple combination among inpatients having showed a significant difference in DBP control compared to D + CCA combination.

Share and Cite:

Y. Potchoo, E. Goe-Akue, F. Damorou, B. Massoka, D. Redah and I. P. Guissou, "Effect of Antihypertensive Drug Therapy on the Blood Pressure Control among Hypertensive Patients Attending Campus’ Teaching Hospital of Lome, Togo, West Africa," Pharmacology & Pharmacy, Vol. 3 No. 2, 2012, pp. 214-223. doi: 10.4236/pp.2012.32029.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] A. A. Lopes, “Hypertension in Black People: Pathophysiology and Therapeutic Aspects. Journal of Human Hypertension, Vol. 16, No. 1, 2002, pp. 11-12. doi:10.1038/sj.jhh.1001333
[2] J. G. Douglas and L. Agodoa, “ACE Inhibition Is Effective and Renoprotective in Hypertensive Nephrosclerosis: The African American Study of Kidney Disease and Hypertension (AASK) Trial,” Kidney International Supplements, Vol. 63, Suppl. 83, 2003, pp. 74-76.
[3] B. L. Salako, F. A. Ajose and E. Lawani, “Blood Pressure Control in a Population Where Antihypertensives Are Given Free,” East African Medical Journal, Vol. 80, No. 10, 2003, pp. 529-531.
[4] S. A. Isezuo and C. H. Njoku, “Blood Pressure Control among Antihypertensives Managed in a Specialized Health Care Sitting in Nigeria,” African Journal of Medicine & Medical Sciences, Vol. 32, 2003, pp. 65-70.
[5] S. A. Isezuo and T. C. Opera, “Hypertension Awareness among Nigerian Hypertensives in a Nigerian Tertiary Health Institution,” Sahel Medical Journal, Vol. 3, No. 2, 2000, pp. 93-97.
[6] D. J. Hyman and V. N. Pavlik, “Characteristics of Patients with Uncontrolled Hypertension in the United States,” The New England Journal of Medicine, Vol. 345, No. 7, 2001, pp. 479-486. doi:10.1056/NEJMoa010273
[7] X. S. Ren, L. E. Kazis, A. Lee, H. Zhang and D. R. Miller, “Identifying Patient and Physician Characteristics That Effect Compliance with Antihypertensive Medications,” Journal of Clinical Pharmacy and Therapeutics, Vol. 27, No. 1, 2002, pp. 47-56. doi:10.1046/j.1365-2710.2002.00387.x
[8] R. Düsing, “Optimizing Blood Pressure Control through the Use of Fixed Combinations,” Vascular Health and Risk Management, Vol. 6, 2010, pp. 321-325.
[9] F. Damorou, E. Togbossi, F. Pessinaba and B. Soussou, Epidemiology and Diagnostic Circumstances of Arterial Hypertension in the Hospital Environment in Kpalime (Second Largest City in Togo),” Mali Medical, Vol. 23, No. 4, 2008, pp. 17-20.
[10] F. Damorou, F. Pessinaba, T. Tcherou, K. Yayehd, S. M. Ndassa and B. Soussou, “Arterial Hypertension in Black Subjects over 50 Years of Age in Lomé: Epidemiological Aspects and Evaluation of Cardiovascular Risk (Prospective and Longitudinal Study of 1485 Patients),” Annales de Cardiologie et d’Angéiologie (Paris), Vol. 60, No. 2, 2011, pp. 61-66.
[11] C. P. Page, M. J. Curtis, M. J. Walker, M. C. Sutter and B. B. Hoffman, “Integrated Pharmacology,” 1st Edition, DeBoeck Université, Paris, 1999.
[12] E. Poluzzi, P. Strahinja, A. Vargiu, G. Chiabrando, M. C. Silvani, D. Motola, G. S. Cellini, A. Vaccheri, F. de Ponti and N. Montanaro, “Initial Treatment of Hypertension and Adherence to Therapy in General Practice in Italy,” European Journal of Clinical Pharmacology, Vol. 61, No. 8, 2005, pp. 603-609. doi:10.1007/s00228-005-0957-y
[13] B. A. Staffileno, “Treating Hypertension with Cardioprotective Therapies, the Role of ACE Inhibitors, ARBs, and Beta-Blockers,” Journal of Cardiovascular Nursing, Vol. 20, No. 5, 2005, pp. 354-364.
[14] K. H. Rahn, “Recent Intervention Studies with Antihypertensive Drugs and Their Influence on Guidelines,” Medizinische Klinik (Munich), Vol. 98, No. 12, 2003, pp. 771-775. doi:10.1007/s00063-003-1323-4
[15] A. H. Gradman, J. N. Basile, B. L. Carter and G. L. Bakris, “Combination Therapy in Hypertension,” The Journal of Clinical Hypertension, Vol. 13, No. 3, 2011, pp. 146-154. doi:10.1111/j.1751-7176.2010.00397.x
[16] E. Etuk, S. A. Isezuo, A. Chika, J. Akuche and M. Ali, “Prescription Pattern of Anti-Hypertensive Drugs in a Tertiary Health Institution in Nigeria,” Annals of African Medicine, Vol. 7, No. 3, 2008, pp. 128-132. doi:10.4103/1596-3519.55665
[17] A. V. Chobanian, G. L. Bakris, H. R. Black, W. C. Cushman, L. A. Green, J. L. Izzo Jr., D. W. Jones, B. J. Materson, S. Oparil, J. T. Wright Jr., E. J. Roccella and The National High Blood Pressure Education Program Coordinating Committee, “Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure,” Journal of the American Medical Association, Vol. 289, No. 19, 2003, pp. 2560-2572. doi:10.1001/jama.289.19.2560
[18] J. F. Setaro and H. R. Black, “Refractory Hypertension,” New England Journal of Medicine, Vol. 327, No. 8, 1992, pp. 543-547. doi:10.1056/NEJM199208203270808
[19] The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) ESH and ESC and of the European Society of Cardiology. Guidelines for the Management of Arterial Hypertension. Journal of Hypertension, Vol. 25, No. 6, 2007, pp. 1105-1187. doi:10.1097/HJH.0b013e3281fc975a
[20] K. B. Yusuff and O. Balogun, “Physicians Prescribing of Antihypertensive Combinations in Tertiary Care Setting in Southwestern Nigeria,” Journal of Pharmaceutical Sciences, Vol. 8, No. 2, 2005, pp. 235-242.
[21] I. Gavras and T. Tsenthal, “Combination Therapy as First-Line Treatment for Hypertension,” Current Hypertension Reports, Vol. 6, No. 4, 2004, pp. 267-272. doi:10.1007/s11906-004-0020-x
[22] J. M. Neutel, “The Role of Combination Therapy in the Management of Hypertension,” Nephrology Dialysis Transplantation, Vol. 21, No. 6, 2006, pp. 1469-1473. doi:10.1093/ndt/gfk064
[23] A. V. Chobanian, G. L. Bakris, H. R. Black, W. C. Cushman, L. A. Green, J. L. Izzo Jr., D. W. Jones, B. J. Materson, S. Oparil, J. T. Wright Jr. and E. J. Roccella, “Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure,” Hypertension, Vol. 42, No. 6, 2003, pp. 1206-1252. doi:10.1161/01.HYP.0000107251.49515.c2
[24] L. Hanson, A. Zanchetti, S. G. Carruthers, B. Dahl?f, D. Elmfeldt, S. Julius, J. Ménard, K. H. Rahn, H. Wedel and S. Westerling, “Effects of Intensive Blood Pressure Lowering and Low-Dose Aspirin in Patients with Hypertension: Principal Results of the Hypertension Optimal Treatment (HOT) Randomized Trial,” Lancet, Vol. 351, No. 9118, 1998, pp. 1755-1762. doi:10.1016/S0140-6736(98)04311-6
[25] J. Chalmer, “The ABCD of Antihypertensive Therapy?” Journal of Hypertension, Vol. 20, No. 4, 2002, pp. 615- 616. doi:10.1097/00004872-200204000-00016
[26] J. G. Douglas, G. L. Bakris, M. Epstein, K. C. Ferdinand, C. Ferrario, J. M. Flack, K. A. Jamerson, W. E. Jones, J. Haywood, R. Maxey, E. O. Ofili, E. Saunders, E. L. Schiffrin, D. A. Sica, J. R. Sowers and D. G. Vidt, “Management of High Blood Pressure in African Americans: Consensus Statement of the Hypertension in African Americans. Working Group of the International Society on Hypertension on Blacks,” Archives of Internal Medicine, Vol. 163, No. 5, 2003, pp. 525-541. doi:10.1001/archinte.163.5.525
[27] A. Salvetti, A. Magagna, P. Innocenti, F. Ponzanelli, A. Cagianelli, M. Cipriani, E. Gandolfi, C. Del Prato, A. M. Ballestra, P. Saba, F. Giuntoli, G. Panebianco and S. Amigoni, “The Combination of Chlorthalidone with Nife- dipine Does Not Exert an Additive Antihypertensive Effect in Essential Hypertensives: A Crossover Multicenter Study,” Journal of Cardiovascular Pharmacology, Vol. 17, No. 2, 1991, pp. 332-335. doi:10.1097/00005344-199102000-00021
[28] M. R. Weir, M. A. Weber, H. A. Punzi, H. M. Serfer, S. Rosenblatt and W. J. Cady, “A Dose Escalation Trial Comparing the Combination of Diltiazem SR and Hydrochlorothiazide with the Monotherapies in Patients with Essential Hypertension,” Journal of Human Hypertension, Vol. 6, No. 2, 1992, pp. 133-138.
[29] J. M. Achard and A. Fournier, “Facteurs de Résistance au Traitement d’une HTA,” Revue du Praticien, Vol. 14, 1993, pp. 1813-1819.
[30] C. Thuillez, “Inhibiteurs Calciques,” Revue du Praticien, Vol. 9, 1993, pp. 1163-1165.
[31] A. H. Gradman, J. N. Basile, B. L. Carter, G. L. Brakis, B. J. Materson, H. R. Black, J. L. Izzo Jr., S. Oparil and M. A. Weber, “Combination Therapy in Hypertension,” Journal of the American Society of Hypertension, Vol. 4, No. 2, 2010, pp. 90-98. doi:10.1016/j.jash.2010.03.001
[32] W. H. Frishman, C. V. S. Ram, F. G. McMahon, S. G. Chrysant, A. Graff, J. W. Kupiec and H. Hsu, “Comparison of Amlodipine and Benazepril Monotherapy to Amlodipine plus Benazepril in Patients with Systemic Hypertension: A Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Study,” The Journal of Clinical Pharmacology, Vol. 35, No. 11, 1995, pp. 1060-1066.
[33] T. Philipp, T. R. Smith, R. Glazer, M. Wernsing, J. Yen, J. Jin, H. Schneider and R. Pospiech, “Two Multicenter, 8-Week, Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Studies Evaluating the Efficacy and Tolerability of Amlodipine and Valsartan in Combination and as Monotherapy in Adult Patients with Mild to Moderate Essential Hypertension,” Clinical Therapeutics, Vol. 29, No. 4, 2007, pp. 563-580. doi:10.1016/j.clinthera.2007.03.018
[34] S. G. Chrysant, M. Melino, S. Karki, J. Lee and R. Heyrman, “The Combination of Olmesartan Medoxomil and Amlodipine Besylate in Controlling High Blood Pressure: COACH, a Randomized, Double-Blind, Controlled, 8- Week Factorial Efficacy and Safety Study,” Clinical Therapeutics, Vol. 30, No. 4, 2008, pp. 587-604. doi:10.1016/j.clinthera.2008.04.002
[35] S. G. Chrysant, “Antihypertensive Effectiveness of Low-Dose Lisinopril Hydrochlorothiazide Combination,” Archives of Internal Medicine, Vol. 154, No. 7, 1994, pp. 737-743. doi:10.1001/archinte.154.7.737
[36] S. G. Chrysant, T. Fagan, R. Glazer and A. Kriegman, “Effects of Benazepril and Hydrochlorothiazide, Given Alone and in Low- and High-Dose Combinations, on Blood Pressure in Patients with Hypertension,” The Annals of Family Medicine, Vol. 5, No. 1, 1996, pp. 17-24. doi:10.1001/archfami.5.1.17
[37] J. Pool, W. C. Cushman, R. K. Saini, C. E. Nwachuku and J. P. Battikha, “Use of the Factorial Design and Quadratic Response Surface Models to Evaluate the Fosinopril and Hydrochlorothiazide Combination Therapy in Hypertension,” American Journal of Hypertension, Vol. 10, No. 1, 1997, pp. 117-123. doi:10.1016/S0895-7061(96)00323-8
[38] A. H. Gradman and R. Kad, “Renin Inhibition in Hypertension,” Journal of the American College of Cardiology, Vol. 51, No. 5, 2008, pp. 519-528. doi:10.1016/j.jacc.2007.10.027
[39] J. H. Mackay, K. E. Arcuri, A. I. Goldberg, S. M. Sna- pinn and C. S. Sweet, “Losartan and Low-Dose Hydrochlorothiazide in Patients with Essential Hypertension,” Archives of Internal Medicine, Vol. 156, No. 3, 1996, pp. 278-285. doi:10.1001/archinte.1996.00440030072009
[40] G. Mancia, S. Laurent, E. Agabiti-Rosei, E. Ambrosioni, M. Burnier, M. J. Caulfield, R. Cifkova, D. Clément, A. Coca, A. Dominiczak, S. Erdine, R. Fagard, C. Farsang, G. Grassi, H. Haller, A. Heagerty, S. E. Kjeldsen, W. Kiowski, J. M. Mallion, A. Manolis, K. Narkiewicz, P. Nilsson, M. H. Olsen, K. H. Rahn, J. Redon, J. Rodicio, L. Ruilope, R. E. Schmieder, H. A. Struijker-Boudier, P. A. van Zwieten, M. Viigimaa and A. Zanchetti, “Reappraisal of European Guidelines on Hypertension Management: An European So
[41] M. Veronesi, A. F. G. Cicero, M. G. Prandin, A. Dormi, E. Cosentino, E. Strocchi and C. Borghi, “A Prospective Evaluation of Persistence on Antihypertensive Treatment with Different Antihypertensive Drugs in Clinical Practice,” Vascular Health and Risk Management, Vol. 3, No. 6, 2007, pp. 1000-1005.
[42] J. T. Wright Jr., J. K. Dunn, J. A. Cutler, B. R. Davis, W. C. Cushman, C. E. Ford, L. J. Haywood, F. H. Leenen, K. L. Margolis, V. Papademetriou, J. L. Probstfield, P. K. Whelton and G. B. Habib, “Outcomes in Hypertensive Black and Nonblack Patients Treated with Chlorthalidone, Amlodipine, and Lisinopril,” Journal of the American Medical Association, Vol. 293, No. 13, 2005, pp. 1595-1608. doi:10.1001/jama.293.13.1595
[43] D. E. Bild, D. A. Bluemke, G. L. Burke, R. Detrano, A. V. D. Roux, A. R. Folsom, P. Greenland, D. R. Jacob Jr., R. Kronmal, K. Liu, J. C. Nelson, D. O’Leary, M. F. Saad, S. Shea, M. Szklo, R. P. Tracy, “Multi-Ethnic Study of Atherosclerosis, Objective and Design,” American Journal of Epidemiology, Vol. 156, No. 9, 2002, pp. 871-881. doi:10.1093/aje/kwf113
[44] A. Fenves and C. V. Ram, “Are Angiotensins Converting Enzyme Inhibitors and Angiotensin Receptor Blokers Becoming the Treatment of Choice in African-American?” Current Hypertension Reports, Vol. 4, No. 4, 2002, pp. 286-289. doi:10.1007/s11906-996-0006-y
[45] M. Rahman, “Initial Findings of the AASK, African Americans Kidney Benefit from an ACE Inhibitor,” Cleveland Clinic Journal of Medicine, Vol. 70, No. 4, 2003, pp. 304-305. doi:10.3949/ccjm.70.4.304
[46] L. Hanson, L. H. Lindholm, L. Niskanen, J. Lanke, T. Hedner, A. Niklason, K. Luomanm?ki, B. Dahl?f, U. de Faire, C. M?rlin, B. E. Karlberg, P. O. Wester and J. E. Bj?rck, “Effect of Angiotensin Converting Enzyme Inhibition Compared with Conventional Morbidity and Mortality in Hypertension: The Captopril Prevention Project (CAPPP) Randomized Trial,” Lancet, Vol. 353, No. 9153, 1999, pp. 611-616. doi:10.1016/S0140-6736(98)05012-0
[47] J. L. Izzo Jr. and A. S. Zion, “Combined Aliskiren-Amlodipine Treatment for Hypertension in African Americans Clinical Science and Management Issues,” Therapeutic Advances in Cardiovascular Disease, Vol. 5, No. 3, 2011, pp. 169-1725. doi:10.1177/1753944711409615
[48] E. Saunders, “Hypertension in Blacks,” Primary Care, Vol. 18, 1881, pp. 607-622.
[49] L. A. Salako, “Hypertension in Africa and Effectiveness of Its Management with Various Classes of Antihyper- tensive Drugs and in Different Socio-Economic and Cultural Environments,” Clinical and Experimental Hypertension, Vol. 15, No. 6, 1993, pp. 997-1004. doi:10.3109/10641969309037087
[50] L. Welsh and A. Ferro, “Drug Treatment of Essential Hy- pertension: The Case for Initial Combination Therapy,” International Journal of Clinical Practice, Vol. 58, No. 10, 2004, pp. 956-963. doi:10.1111/j.1368-5031.2004.00392.x
[51] S. A. Revaz, A. Morabia, C. Goehring and H. Stalder, “Evaluation of Drug Prescription in the Primary Care Clinic in Geneva in 1997,” Schweiz Med Wochenschr, Vol. 129, No. 49, 1999, pp. 1935-1937.
[52] A. V. Chobanian, “The Hypertension Paradox—More Uncontrolled Disease despite Improved Therapy,” The New England Journal of Medicine, Vol. 361, No. 9, 2009, pp. 878-887. doi:10.1056/NEJMsa0903829

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.