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Guidelines Adherence and Hypertension Control in an Outpatient Cardiology Clinic in Malaysia
Ahmad, Nafees; Hassan, Yahaya; Tangiisuran, Balamurugan; Meng, Ong Loke; Aziz, Noorizan Abd & Khan, Amer Hayat
Abstract
Purpose: To evaluate doctors' adherence to Malaysian Clinical Practice Guideline (CPG) 2008 in
established hypertensive patients with cardiovascular diseases and factors associated with guideline
adherence and hypertension control in Pulau Pinang Hospital, Malaysia.
Methods: Prescriptions written by 13 doctors for 320 established hypertensive patients with
cardiovascular diseases (25 patients per doctor) were noted on first visit. Two hundred and sixty (81%)
of the enrolled 320 patients (20 patients per doctor) were followed up until the second visit. Blood
pressure (BP) noted on the second visit was related to the prescription written on the first visit.
Results: One hundred and ninety one (73.5%) patients received guidelines-compliant
pharmacotherapy. CPG adherence had statistically significant association with left ventricular
hypertrophy (LVH) (Φ =-0.241, p < 0.01) and diabetes (Φ =-0.228, p < 0.01). One hundred and fifty four
(59.2 %) patients were on goal BP. Hypertension control had statistically significant association with
guidelines compliance (Φ = 0.175, p < 0.01), angiotensin converting enzyme (ACE) inhibitors (Φ =
0.195, p < 0.01), diabetes (Φ = -0.148, p = 0.017), LVH (Φ = -0.153, p = 0.017) and monotherapy (Φ = -
0.168, p < 0.01).
Conclusion: Prescribing practices were fairly compliant with guidelines. Doctors poorly adhered to
guidelines in hypertensive patients with diabetes and LVH. Significantly better hypertension control was
seen in patients who were on ACE inhibitors and guidelines-adherent therapy.
Keywords
Guidelines, Adherence, Hypertension control, Diabetes, Cardiology
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