1. A. Olowofela and A. O. Isah Clinical Pharmacology and Therapeutics Unit, Department of Medicine University of Benin Teaching Hospital. Benin-City. Nigeria.

2. Introduction The Nigerian Hypertension Society guidelines (2005) was based on that of 1999 ISH/WHO and the 2003 sub-Saharan Africa hypertension guidelines. It was introduced with the intention of promoting proper management of hypertension by physicians. Of interest is the lack of characterization of the prescribing pattern of physicians following the introduction of these guidelines in Southern Nigeria. ICIUM 2011 Antalya Turkey

3. Objectives To assess changes in prescribing of antihypertensives prior to and after the 2005 guidelines. To further assess physicians’ awareness of the guidelines. ICIUM 2011 Antalya Turkey

4. Methodology Design: A policy evaluation and descriptive study and a cross-sectional study of the physicians’ awareness of the guidelines Location: Medical Outpatient Clinic and Department of Internal Medicine, University of Benin Teaching Hospital, (UBTH) Benin-City, Nigeria. A 620-bedded tertiary hospital. Study Population: The study evaluated the case records of 3,379 hypertensive patients who had attended the medical outpatient clinic(1999– 2008) and 48 post registration doctors working in the department of Medicine, UBTH.

5. Methodology All cases were selected using a convenience sampling method. A self-administered semi- structured questionnaire was administered to the doctors to assess awareness. Policies: The Nigerian hypertension guidelines (2005) recommended the use of diuretics as first-choice antihypertensives in uncomplicated hypertension. Outcome Measures: The study’s primary outcome was to determine if diuretics were the most prescribed group of antihypertensives since the release of the guideline; also to determine if diuretics would be the most preferred antihypertensives by doctors ICIUM 2011 Antalya Turkey

6. Results Annual prescriptions of diuretics increased steadily from 38% in 1999 to a peak of 58% in 2005. The values were sustained in 2006 (57%), 2007 (55%), and 2008 (55%). (Figure 1). A total of 37/48 doctors returned the filled questionnaire (response rate 77.1%). A high proportion (32/37; 86.5%) of the doctors were aware of the national guidelines but only 13/37 (35.1%) were satisfied with the recommendations. (Table 1). Diuretics were stated as the most preferred class of antihypertensive medicines by 26/37 (70.3%) of respondents.(Table 2). ICIUM 2011 Antalya Turkey

7. Figure 1: Trends of classes of antihypertensives prescribed during the period 1999-2008. AMD: METHYDOPA, DIUR-DIURETICS, ALPHB- ALPHABLOCKERS, BB-BETA BLOCKERS, OTHERS- RESERPINE, BASED PREPARATIONS.

8. CharacteristicsFrequency of all doctors RegistrarsSenior registrars ConsultantsChi square p value Age (years) Mean(SD)37.60±9.132.10±4.134.8±3.048.8±10.2 Gender (M/F)23/146/712/35/4 Duration of clinical practice (years) 12.0±8.56.8±2.49.6±3.024.5±9.1 Reported awareness of provisions in any HTN guidelines (%) 33(91.9)10(30.3)15(45.5)8(24.2)3.8480.15 Reported awareness of provisions in 1999 WHO/ISH guidelines (%) 11(29.7)3(27.3)5(45.4)3(27.3)0.4250.81 Reported awareness of provisions in JNC VII 2003 (%) 15(40.5)4(26.7)7(46.7)4(26.7)0.8050.67 Reported awareness of provisions in national guidelines (%) 32(86.5)9(28.1)15(46.9)8(25.0)5.700.06 Demographics of participating doctors ICIUM 2011 Antalya Turkey

9. Table 2:Distribution among the cadres of doctors in their choice of first preference antihypertensive medicine Medicine class First preference antihypertensive medicine n(%) Registrars n(%) Senior registrars n(%) Consultants n(%) ACEI2(5.4)01(50.0) ARB0000 BB0000 CCB9(24.3) 2(22.2)3(33.3)4(44.4) Diuretic26(70.3)11(42.3) 4(15.4) Centrally Acting 0000 No response0000

10. Conclusion The findings suggest a less than optimal compliance with the guidelines with growing preference for newer medicines. There was a disconnect in the prescribers’ knowledge of recommendations in the guidelines, their stated preferences for medicines, and the observed findings in the case records. This may be due in part, to the observed dissatisfaction of doctors with the guidelines. ICIUM 2011 Antalya Turkey