Managing hypertension in nurse-led primary care clinics in rural Ethiopia

Background: Providing health care for patients with hypertension has been difficult in rural areas of sub-Saharan Africa because of lack of medical staff and facilities. The use of non-physician healthcare workers offers a possible solution, but little is known about the feasibility and clinical response to treatment. Methods: We carried out a descriptive, retrospective review of the records of a sequential sample of 249 hypertensive patients aged 52.3 (SD 12.7) years from eight health centres in a rural area of southern Ethiopia where nurses and health officers had been previously trained to diagnose, treat and manage non-communicable diseases including hypertension. The study evaluated the changes in systolic and diastolic blood pressures following treatment over a 30 month period. Results: The mean systolic blood pressure on admission was 156.1(SD 21.1) mm Hg and the mean diastolic pressure 95.7(SD 12.7) mm Hg. Of the 249 subjects, 105(42.1%) defaulted from clinic follow-up during the period of the study. More than half (53.8%) were controlled on monotherapy with a thiazide diuretic, the remainder required combination therapy. Significant declines in systolic and diastolic blood pressure were achieved in each blood pressure group with the exception of the lowest pressure groups. Conclusion: Our study demonstrates that nurses and heath officers working in remote rural health centres can obtain worthwhile reductions in blood pressure in patients with hypertension. Moreover, this could often be achieved with a single, inexpensive diuretic, hydrochlorthiazide, although combination therapy was sometimes required.