Guidelines Adherence and Hypertension Control in an Outpatient Cardiology Clinic in Malaysia

Purpose: To evaluate doctors' adherence to Malaysian Clinical Practice Guideline (CPG) 2008 in established hypertensive patients with cardiovascular diseases and factors associated with guideline adherence and hypertension control in Pulau Pinang Hospital, Malaysia.
Methods: Prescriptions written by 13 doctors for 320 established hypertensive patients with cardiovascular diseases (25 patients per doctor) were noted on first visit. Two hundred and sixty (81%) of the enrolled 320 patients (20 patients per doctor) were followed up until the second visit. Blood pressure (BP) noted on the second visit was related to the prescription written on the first visit.
Results: One hundred and ninety one (73.5%) patients received guidelines-compliant pharmacotherapy. CPG adherence had statistically significant association with left ventricular hypertrophy (LVH) (Φ =-0.241, p < 0.01) and diabetes (Φ =-0.228, p < 0.01). One hundred and fifty four (59.2 %) patients were on goal BP. Hypertension control had statistically significant association with guidelines compliance (Φ = 0.175, p < 0.01), angiotensin converting enzyme (ACE) inhibitors (Φ = 0.195, p < 0.01), diabetes (Φ = -0.148, p = 0.017), LVH (Φ = -0.153, p = 0.017) and monotherapy (Φ = - 0.168, p < 0.01).
Conclusion: Prescribing practices were fairly compliant with guidelines. Doctors poorly adhered to guidelines in hypertensive patients with diabetes and LVH. Significantly better hypertension control was seen in patients who were on ACE inhibitors and guidelines-adherent therapy.