Guidelines for the Management of Hypertension in Nigeria 2020

Abstract

Background
Hypertension, defined as blood pressure > 140/90
mmHg, has assumed greater public health importance
in Nigeria in the last 2 decades. Many reports put the
adult prevalence rates at 20-40%, with some major
ones specifically reporting 27.8% and 28.9%. Low
detection and reporting rates, inadequate investigation
and treatment rates all combine to increase the burden.
The guidelines provide updated information.
Recommendations
The traditional risk factors, with the addition of high
income and education status, are highlighted.
Recommendations regarding the use of devices and
the setting, including home and ambulatory, in the
measurement of the blood pressure, are updated. The
importance of total cardiovascular risk assessment
and risk stratification, employed in initiating and guiding
therapy, is emphasized.
Lifestyle modifications are prescribed for all;
they are described with estimates of BP responses
and with a greater reference to local conditions.
Attention is drawn to the early use of medicine
therapy in those with high CV risk and multi-medicine
therapy in those with BP > 160/100 mmHg. The use
of single pill combinations, wherever feasible, is
recommended, and the prediction is made of most
patients eventually requiring multi-medicine therapy.

Considerations of cost, availability, tolerance
and patient-specific factors influence the choice of
medicines, and although any of the several medicine
classes could be used for initial therapy, thiazide and
thiazide-like diuretics and calcium channel blockers
are recommended for single or dual-medicine therapy.
Alternatively, any of these and any of angiotensin
converting enzyme inhibitor, angiotensin receptor
blocker, centrally acting agent, beta-blocker or alphablocker
could be used for combination therapy.
Effective and recommended combinations and a list
of the commonly available medicines in Nigeria are
listed. Aspirin for secondary prevention and statin
therapy should be used as required. The goal of
treatment is commonly <140/90 mmHg, but could be
lower in patients with diabetes, chronic kidney
disease. Patient counselling, follow-up and treatment
monitoring are emphasised.
Outlines of treatment in special groups or
situations including diabetes, chronic kidney disease,
haemoglobinopathies, HIV-infection, paediatric
patients, patients with sexual dysfunction, resistant
hypertension, hypertension emergency, community
control and prevention are provided.