Guidelines for the Management of Hypertension in Nigeria 2020

BackgroundHypertension, defined as blood pressure > 140/90mmHg, has assumed greater public health importancein Nigeria in the last 2 decades. Many reports put theadult prevalence rates at 20-40%, with some majorones specifically reporting 27.8% and 28.9%. Lowdetection and reporting rates, inadequate investigationand treatment rates all combine to increase the burden.The guidelines provide updated information.RecommendationsThe traditional risk factors, with the addition of highincome and education status, are highlighted.Recommendations regarding the use of devices andthe setting, including home and ambulatory, in themeasurement of the blood pressure, are updated. Theimportance of total cardiovascular risk assessmentand risk stratification, employed in initiating and guidingtherapy, is emphasized.Lifestyle modifications are prescribed for all;they are described with estimates of BP responsesand with a greater reference to local conditions.Attention is drawn to the early use of medicinetherapy in those with high CV risk and multi-medicinetherapy in those with BP > 160/100 mmHg. The useof single pill combinations, wherever feasible, isrecommended, and the prediction is made of mostpatients eventually requiring multi-medicine therapy. Considerations of cost, availability, toleranceand patient-specific factors influence the choice ofmedicines, and although any of the several medicineclasses could be used for initial therapy, thiazide andthiazide-like diuretics and calcium channel blockersare recommended for single or dual-medicine therapy.Alternatively, any of these and any of angiotensinconverting enzyme inhibitor, angiotensin receptorblocker, centrally acting agent, beta-blocker or alphablockercould be used for combination therapy.Effective and recommended combinations and a listof the commonly available medicines in Nigeria arelisted. Aspirin for secondary prevention and statintherapy should be used as required. The goal oftreatment is commonly <140/90 mmHg, but could belower in patients with diabetes, chronic kidneydisease. Patient counselling, follow-up and treatmentmonitoring are emphasised.Outlines of treatment in special groups orsituations including diabetes, chronic kidney disease,haemoglobinopathies, HIV-infection, paediatricpatients, patients with sexual dysfunction, resistanthypertension, hypertension emergency, communitycontrol and prevention are provided.