Barriers to management of cardiovascular risk in a low-resource setting using hypertension as an entry point

J Hypertens. 2004 Jan;22(1):59-64. doi: 10.1097/00004872-200401000-00013.


Objective: Assess capacity of health-care facilities in a low-resource setting to implement the absolute risk approach for assessment of cardiovascular risk in hypertensive patients and effective management of hypertension.

Design and setting: A descriptive cross-sectional study in Egbeda and Oluyole local government areas of Oyo State in Nigeria in 56 randomly selected primary- (n = 42) and secondary-level (n = 2) health-care and private health-care (n = 12) facilities.

Participants: One thousand consecutive, known hypertensives attending the selected facilities for follow-up, and health-care providers working in the above randomly selected facilities, were interviewed.

Results: About two-thirds of hypertensives utilized primary-care centers both for diagnosis and for follow-up. Laboratory and other investigations to exclude secondary hypertension or to assess target organ damage were not available in the majority of facilities, particularly in primary care. A considerable knowledge and awareness gap related to hypertension and its complications was found, both among patients and health-care providers. Blood pressure control rates were poor (28% with systolic blood pressure (SBP) < 140 mmHg and diastolic blood pressure (DBP) < 90 mmHg] and drug prescription patterns were not evidence based and cost effective. The majority of patients (73%) in this low socio-economic group (mean monthly income 73 US dollars) had to pay fully, out of their own pocket, for consultations and medications.

Conclusions: If the absolute risk approach for assessment of risk and effective management of hypertension is to be implemented in low-resource settings, appropriate policy measures need to be taken to improve the competency of health-care providers, to provide basic laboratory facilities and to develop affordable financing mechanisms.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antihypertensive Agents / economics
  • Antihypertensive Agents / therapeutic use
  • Blood Pressure / drug effects
  • Cardiovascular Diseases / economics
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / therapy*
  • Costs and Cost Analysis / economics
  • Cross-Sectional Studies
  • Diastole / drug effects
  • Disease Management
  • Female
  • Follow-Up Studies
  • Health Facilities / economics
  • Health Facilities / statistics & numerical data
  • Health Personnel / economics
  • Health Personnel / statistics & numerical data
  • Health Resources* / economics
  • Health Resources* / statistics & numerical data
  • Health Services Accessibility / economics
  • Humans
  • Hypertension / drug therapy
  • Hypertension / economics
  • Hypertension / epidemiology
  • Male
  • Middle Aged
  • Nigeria / epidemiology
  • Primary Health Care / economics
  • Risk Factors
  • Sex Factors
  • Systole / drug effects


  • Antihypertensive Agents