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Masterclass: Hypertension in the Counties

Posted BY Dr. Emma Karari
21/08/2020
Posted in: Hypertension
79 Comments

Kindly share the biggest challenge that you experience in managing hypertension at your center,
be it related to diagnosis, treatment, prevention or policy.

Michael Milimu

My Biggest challenge comes when (though a few cases) you get a hypertensive urgency with hyperglycemia in a patient. The balancing between fluids for hyperglycemia and lowering the bps.

Wyclif Odira Odhiambo

Policy and guidelines on hypertension are not standardized, all clinicians giving prescription based on what their teachers preference and available medications for prescription. Also late presentation of patients, when already they have complications making treatment even more complex.

Dr. Aarif Varvani

At my center, there are numerous challenges as regards Hypertension. 1) When it comes to diagnosis, the unavailability of gadgets like 24 hour ambulatory Blood Pressure machines makes it difficult to diagnose especially masked Hypertension. 2) Treatment: the lack of appropriate fixed drug combinations of antihypertensive agents makes it necessary to prescribe single drug pills leading to high pill burden and thus non-compliance. 3) Prevention: poor lifestyle of most high risk patients e.g. Obesity, sedentary lifestyle, excessive intake of alcohol, cigarette smoking etc. 4) Policy: with the advent of numerous fixed drug combination of antihypertensives, and with Universal Health Care and Health being part of the Big Four Presidential Agenda, it is surprising not to find most of the fixed drug combinations under the essential medical drugs list. Also, it is surprising why only a small percentage of the National Yearly Budget is set aside for Health Care whereas more could be invested into preventive health strategies including but not limited to creating public awareness.

Robert Ngasa

Lack of adequate BP monitors Lack of antihypertensive drugs Followup of patients on care made worse due to financial difficulties

Dr. Fadhil Hussein

Financial constraints of most patients, inexistence of appropriate medication(s) including combinations, herbal preference to treatment options, patient denial of hypertension diagnosis.

Mbarak Mbarak

Challenge in Treatment: due to lack of variety in antihypertensive drugs. For eg the only CCB available is Nifedipine, the only Beta blocker available is Carvedilol. In patients experiencing side effects or contraindications to these options, they have to buy from private chemists raising questions of affordability. Challenge in Compliance amongst patients: patients have beliefs that no medication should be taken for life , and that actually medication taken for long is harmful to the body. Patients would only take antihypertensives when symptomatic

Benard Owino

1-Lack of awareness on guidelines/ protocols for diagnosis and treatment among many health workers. 2-Difficulty in following guidelines on treatment when recommended drugs are not available. 3-Poor compliance on medication among patients especially when they have to buy meds.

Charles Ndirangu

Non compliance, irregular and inconsistent clinic follow up, lack of an aggressive screening program, clients have to buy some medications from chemists die unavailability in the public hospital,some live far from the hospital and cannot afford the scheduled MOPC visit.

Khuweillah Rudainy

Hypertension is a chronic disease affecting many organ systems. Left untreated, it can lead to detrimental events in someone's life namely End Stage Renal Disease and Stroke. Most patients fail to understand this concept as compliance is poor when it comes to blood pressure control. Once blood pressure is stabilized, it is assumed that they are healed. This increases the admission rates at the accident and emergency department for an avoidable phenomenon. Patients need to understand the mechanisms of actions of different drug groups so that the pill burden is not a problem. This will improve compliance and avoid under or over treating the disease. Herbal medicine should be taken as adjuvant and not a substitute to conventional anti-hypertensives as no statistically proven benefit has been arrived at. Owing to insufficient knowledge on the mechanisms of action and the exact dose to be taken, some of these herbs can do more harm than good specifically leading to acute renal injury during their excretory phase. Lifestyle modification plays a role in bringing the blood pressure down and prevent cardiovascular accidents hence it should be emphasized in every visit. Hypertension being one the leading non-communicable disease, hospitals should be stocked with the necessary drugs needed at all times in order to improve compliance. Knowledge about the disease is not frequently shared on media and social media as is HIV, COVID-19 and other communicable diseases. Health workers should be trained more often at a subsidized rate or sponsored to do so in order to improve the management in preventing and treating the disease.

Shadrack Musyoki

Non compliance especially among the elderly with poor social support back at home.

mutwiri rarama

When i see this question I always wonder where to start, I work in Kanyakine Subcounty Hospital in Meru and these are our challenges. Diagnosis: 1. Health seeking behaviour is poor and therefore the opportunity to take BPs is missed many times. Then there is poor knowledge by the primary healthcare workers on the current normal BP ranges and how to refer the patients appropriately for further management. 2. In terms of treament, our ability to assess target organ damage is usually low because of lack of lab services and cardiac evaluation, as well as opthalmology servies are only available in Level 5 facilities thus inaccessible to most patients. The basic anti HTN drugs are available in most facilities however trained and skilled personnel who are supposed manage the high risk patients are not available in level 4 facilities. 3. In terms of prevention policy we have a program by the National Gvt and Kenya Red Cross which has equipped and trained CHVs to go to the villages and triage as many people as they can so as to diagnose hypertension before they suffer complications and as well educate them on the various ways to prevent HTN. The challenge here comes in after patients are identified but fail to present to the respective facilities once they are referred, this can be either due to financial constraints or other patient related factors.

Dr. Mohamed Naji

Hypertension is one of the major risk factor in cardiovascular morbidity and mortality. Globally about 900 million people are diagnosed to have hypertension. Practitioners are faced with many challenges in managing hypertension. I would like to stipulate my challenges in two major factors. 1. Patient's factors Many hypertensive clients are elderly who may have not gone through formal education and getting these patients to actually understand their condition proves to be a hurdle most of the time. Hypertension mainly is asymptomatic thus many patients tend to remain uncompliant and not follow the practitioners advice since they feel not sick. Most of our patients are in active and prefer a sedentary lifestyle proving difficult in terms of prevention and treatment as it requires both drugs and lifestyle modification to control hypertension. 2.Physician factors. We lack institutionalized guidelines that makes our management of patients not uniform. Lack of funds to support research in our set up to try and find what drugs works best to our patients thus ending up depending on the western world for the choice of medication.

Saddam Hassan

Diagnosis-no major challenges. Mostly on patients part Treatment - there's a strong belief That a hypertensive patient cannot be hydrated at all. For example a htn patient whose having a hyperglycemia episode too frequently and is compliant on medication? How best to advice patients on prevention when all the food is culturally a risk factor.

Geoffrey Sangany

Getting the appropriate "1st line" pharmacotherapy while handling emergencies is proving difficult.

Dr. Cedric Tumbo

1- late diagnosis- patients tend to consider other ways(traditional beliefs and especially for the educated who ”google treat”)of managing their symptoms ,especially the generalized ones, before coming to seek healthcare. 2-poor resource setup, lack the basic tests, funds to carry out the tests that could help in managing hypertension. 3- lack of proper follow up for patients.

Florence Karanja

Losing patients on follow up and non-compliance to medication, the patients then end up coming back with complications such as stroke, heart failure, CKD. Unawareness of the patients to continue with their medication, whereby once they feel they are well the get off their medication. Lack of standardized guidelines on the appropriate anti-hypertensive medications.

Florence Karanja

Losing patients on follow up and non-compliance to medication, the patients then end up coming back with complications such as stroke, heart failure, CKD. Unawareness of the patients to continue with their medication, whereby once they feel they are well the get off their medication. Lack of standardized guidelines on the appropriate anti-hypertensive medications.

Dr. Magdalene Randa

Lack of Knowledge among patience they don’t know about the disease, importance of taking the medication consistently and complications of non compliance. Patients also have challenges in getting medication when they are out of stock they can’t afford to buy it and wait for the next batch

Dr. Kenty Isabella

My biggest challenge would be patients reluctance to go through with appropriate referrals especially for those with possible complications of the disease and as the healthcare worker you end up still handling the same patients months later.Also the lack of constant supply of antihypertensives and patients are sometimes expected to purchase these drugs poses a challenge.Both challenges are brought about by our patients population social economic challenges.Finally being in a rural set up accessing consultants/our senior collegues to review some of these patients is a huge challenge and more often than not patients dont get access to any specialists throughout their care/hypertensive journey.

Priscilla Mbigo

Challenges i encounter in management of hypertension are patient and healthcare worker factored. 1. Patient factor includes lack of awareness concerning hypertension and its complications, being a 'silent' killer disease most patients don't take into account the importance of early diagnosis, compliance to medications and follow up. Once Bps stabilize or symptoms wear off, patient no longer follow up with outpatient clinics and only come back when complications have set in. Another limiting factor on the patient is the socio- economic status in terms of follow up on investigations and getting medication fit for the condition. 2. Doctor related factors in terms of managing patients in a resource limited set up also poses a challenge. Guidelines are not followed mainly by virtue on operating with what's available and what the patient can afford.

Dr. QHALIB ALI ABDI

The biggest challenge in our hospital is lack of anti-hypertensives, sometimes we tend to require the relatives to buy the medications for the hospitalized patients but most of the times they are neglected in the hospital due to financial constraint.

Dr. Maureen Maleche

The major challenge faced is compliance to anti-hypertensive medications especially due to bill burden & side effects especially headaches, fatigue with calcium channel blockers. most of my patients are from low socio-economic status, hence unable to buy anti-hypertensive drugs. Covid-19 pandemic has also impacted negatively on the management of patients with hypertension because most of my patients have missed coming for follow up appointments due to fear of contracting coronavirus from health workers. also re-assignment of most healthcare workers to COVID-19 response teams leads to shortage of staff specifically managing other conditions like hypertension, rescheduling & long appointments in order to reduce work load and to mitigate for CIVID-19.

Zainab Bagha

Patients not taking preventive measures. Only coming when symptoms get very bad. No follow up on medication mainly due to financial constraints but also because of lack of proper information that these drugs are lifetime drugs. Also lack of follow up in terms of tests like renal functions.

Dr. Haji Musuko

My biggest challenge is lack of basic antihypertensive medications in the rural primary care facilities. Patients managed in such facilities do not go to the next level facilities for basic investigations due to cost implications. In my view policy issues such as having dispensaries and health centres managed by nurses and clinical officers need to be revisited to accomodate medical officers do outreach clinics to improve on patients care.

Abdikadir A. Adow

Hypertension is the most common chronic disease that followed up at MOPC clinics in my facility. Surprisingly it is affecting younger patients nowadays. Though we have seen improvements on BP control and regular visits,there are still challenges. Lack of proper medications at public facilities and clients unable to afford them from private clinics. In hypertensive emergencies, lack of standard drugs and also inadequate updates and training for clinical staff on current management of HTN crises.

Dr. Faith Vuku

Biggest challenge is poor patients’ compliance to medication coupled with ignorance.

Dr. Rajab Idris

Non compliance to medication mostly due to lack of funds to purchase the meds plus inability to perform/do necessary investigations on follow up or when a complication arises

Amal Almas

My biggest challenge in managing hypertensive patients is compliance. Mostly due to pill burden, lack of proper information by the patient regarding the disease and medications and financial constraints. Unfortunately majority are brought to the emergency dept with end organ damage.

Mr. Abdulrazak Ali

My biggest challenge is patient believes...that when you take antihypertensive drugs you will never get better so they herbal (traditional) concoctions.the other is that patients only takes drugs when symptoms sets in eg headache. Another is question of affordability when the right combinations prescribed is not in the public facility.

Dr. Tendwa Ongas

The biggest challenge involves financial constraints. Most of the patients cannot consistently afford the drugs prescribed and end up splitting doses. This is Especially once Symptoms resolve and hence they see no dire need to Continue with the medication as regularly. This also highlights the issue of lack of information concerning the disease as well as the long term implications of not taking medication (especially in the asymptomatic patients) There is also the issue of poor follow up. Both on the physician's end as well as the patient's. On our end it involves lack of consistency with regards to the healthcare provider who is caring for the patient. With every follow up the patient meets a new doctor who may not be fully aware of the ongoing management and why certain decisions were made. this leads to a change in the plan with every other follow up, hence demotivating the patient. On the patient's end, they fail to show up for appointments (I repeat, more so if asymptomatic), and this prevents any complications of the disease or adverse effects of the medication from being addressed early.

Dennis Nanyingi

The challenges experienced at our facility in regard to management of hypertension is financial issues. Occasionally, some patients take longer days to come back to the clinic due to finances, for those not on insurance charter, thus lacking drugs and worsening their conditions. In addition, some emergency antihypertensive drugs such as i.v labetalol and i.v hydrazaline are most of the time not in the hospital, and if the patients purchases from private chemists, they are usually overcharged. Another problem that we face in our center is patient adherence to treatment plan. Some patients usually stop using their medication after sometime when they feel better and get stable bps, once adviced by home (quack) doctors. Furthermore, inadaquate staff at the clinic sometimes poses a challenge especially when we have a high influx of booked patients at the clinic, taking time to advice some patients might be difficult in such scenarios, hence decreasing patient adherence.

Dennis Nanyingi

The biggest challenge faced in our facility is lack of drugs meant for hypertensive patients in some seasons. This forces some of the patients to dig deeper in their pockets.

Jane Kenani

Having a patient with hyperglycemia, hypertensive urgency and fluid overload.. It's been always my greatest challenge with lack of proper medication for the hypertensive urgency, always stuck on what to start with in management n how to do it.

Caroline Bichii

The two biggest challenges are late presentation to hospital and non compliance to medication for those already diagnosed. In the past 4 months we have seen many patient's present with various end organ damage manifestations. This could probably be due to inadequate patient education and support. The COVID 19 pandemic has also contributed to decreased clinic visits and follow up. Another challenge is lack of standardized institutional guidelines on treatment of hypertension.

William Derrick Olando

Escalating medical therapy in low resource settings especially in late presentations of hypertensives with comorbidities

Brenda Juma

Compliance to medications and lack of proper education to patient regarding there condition

Brenda Juma

Compliance to medications and lack of proper education to patient regarding there condition

James Mugo

In our centre, the challenges include non-compliance of patients on their antihypertensives, failure of healthworkers to educate patient's on the importance of compliance, and lack of a standard hospital protocol for managing hypertensive emergencies.

Ms. BEATRICE MOTURI

My biggest challenge has been lack of appropriate equipment to test for hypertensive and diabetic related complications before it's too late.....incase I get a patient in the MOPC who needs an ECG,Echo,or UECS,I have to refer them to the nearest town for them to have those investigations done ...due to that,most patients end up not doing the tests because of distance and because of the cost too since they are expensive too

Muthoni Maina-Luzing'a

Diagnosis: poor health seeking behavior and inconsistent lab reagents to pick out the sequelae, improvement or deterioration. Treatment: inconsistent supply of meds. Prevention: inadequate and inappropriate knowledge of hypertension (amongst other NCDs) in the community, high illiteracy levels, cultural beliefs. Policy: poor prioritization of and in the facility, unwillingness to have hypertension (amongst other conditions and diseases) managed in a multi-sectoral approach, poorly stipulated up and down referral structures and inadequate update and training of staff.

Dr. Ivy Barasa

The greatest challenge in managing hypertension at my centre is in patients' adherence to the drugs. Most of the patients seen at the MOPC get lost to follow up and later come in either hypertensive urgency or hypertensive emergency only for a practitioner to note that they stopped taking a drug out of whatever regimen they were on or stopped taking the drugs all together. This results into the management of complications and at times death from intracerebral bleeds mostly. Drug adherence, patient education and follow up is being championed but as of now, it still exists as the main challenge.

Uzma Bagha

Noncompliance to medication as well as loss to follow up. Mostly because of lack of education.

Ruth Komu

The main challenge at my station as regards management of hypertension is non compliance to treatment for whatever reason. You find that patients are put on a regimen in MOPC but when the drugsrun out, they don’t come for a refill or go to a peripheral facility and have their regimen changed. The change is at times because they lost the prescription or forgot their usual medication or the clinician preference. Sometimes it is due to side effects. Sometimes they can’t afford to refill the prescription in between clinics. Therefore, you end up having to start all over at every visit. On top of that, because of the numbers, the bookings are months apart. Therefore, by the time a client comes to clinic, they have taken different regimens for several months sometimes with detrimental effects from poor control.

Ruth Komu

My biggest challenge in management of hypertension is non-compliance to medication. This is mostly due to financial issues.

Ruth Komu

Non-compliance to medication is my biggest challenge in management of hypertension. This is mostly due to financial constraints coupled with low education levels.

Bella Juma

One BP machine in the whole hospital which sometimes is functional sometimes not,irregular supply of antihtnsives, patients noncompliance

Abdijabar Adan

The challenges I have faced are related to both NCD program design and clinical practice.In terms of clinical practice,uncontrolled hypertension in CKD and ESRD patients is a dilemma I often encounter with patients already on 3 Anti-HTNs regimens at full doses,adherence to medications or prescribed regimens remains a challenge with the main reason being of lack of finances by the elderly and the fact that they feel OK most of the time and will only buy the medications when they have a headache. On the program design,first there is no program at all,we still call them MoPC,DoPC,there is still the centralized management of HTN patients in one Centre which compromises the quality of the work and the outcomes of your work.Decentralizion of NCD to level 2 or 3,will improve compliance,follow up and prioritization of patients at Level 4 and 5 hospital

Dr. Pateti Kelvin

I work in Samburu County Referral Hospital, where majority of our clients are illiterate, low social economic status(poor) and strongly believe in traditional / cultural practices/treatment as a result of this early detection of Hypertension is a big challenge, and for the few we detect are not compliant to medication and follow up and hence the high incidences of complications such as Stroke/Heart failure/Renal failure are depicted in our admissions. Again the few who are compliant to medication and follow up we are faced with yet another big challenge in lack of proper and routine investigations to detect early signs of complications this includes the UECS, Echo, ECG... Majority of our clients have to get this services as far as Nakuru and Nairobi and it only proves to be expensive to our clients. We are however privileged to have a Physician /Nephrologist to follow up the cases and offer timely management to patients who can afford the investigations, medications and routine follow up.

Dr. Erick Leparmorijo

1. Late detection because most patient don't do regular BP check up due to inadequate knowledge on hypertension, illiteracy, low socioeconomic status, cultural beliefs. 2. Non compliance to both medications and clinics 3. Late detection of complications due lack of equipments 4. Lack of variety of antihypertensives in the facility, the only available is nifedipine.. if the rest are prescribed not all can afford in nearby private facilities 5. Poor referral systems from dispensary to health center to county hospital to regional hospital incase of complications

Gamar Bajaber

My biggest challenge is compliance,and associated it mainly with limited finances from the patients,which also limits screening patients for target organ damage.Loss of some patients to follow up is another challenge,they then present later with stroke .

Peter Boro

I would say the biggest challenge in managing Hypertension is lack of adherence to national guidelines on the part of the clinicians while managing the disease and also poor adherence by patients to their medications. Late diagnosis of the disease with missed opportunities in terms of screening for those attending the hospital for other conditions is an issue.

Habiba Hassan

Non compliance to medication and delayed health seeking behaviour which leads to patients being brought to hospitals in Hypertensive emergencies.

Dr. Flora Kithikii

Step up management especially in patients with cormobidities.

Abdulaziz Abeid

I face several challenges at my workplace: 1. Prevention and policy challenges: there has been lack of motivation to educate patients on cardiovascular preventive health. Through the years, we have seen efforts put in tackling HIV and cancer screening awareness with little to no work in hypertension. 2. Diagnosis: the diagnosis of hypertension requires the use of calibrated machines which will give accurate readings. Most of the BP machines do no get calibrated and in most places we use machines meant for home use. For those patients who require home blood pressure monitoring for diagnosis of white coat or masked hypertension, subsidized BP machines are lacking. This also applies for those who need ambulatory BP monitoring. 3. Treatment: Most patients require combination treatment which is best given as dual or triple fixed dose combination pills for better compliance. Most of the time, we don't have access to these drugs and end up giving patients multiple tablets which is often felt like burden with many patients defaulting on treatment. 4. Follow-up: Being a referral facility, we tend to have many patients from other county facilities for no reason. If we could train more doctors to treat hypertension in the peripheries so that referral hospitals can deal with those patients with resistant hypertension.

Dr. Michelle Wangui Getao

- Lack of access to simple tests like ECG, serum creatinine, electrolytes, urinalysis, lipid profile and capillary blood glucose to screen for complications, screen for other cardiovascular risk factors and monitor therapy. -Low literacy among patients makes informed decision making and compliance to treatment difficult. - Lack of knowledge about hypertension diagnosis, treatment and cardiovascular risk reduction among health care professionals results in patients getting conflicting/inconsistent management advice. - Adverse patient lifestyle issues - sedentary, smoking, unhealthy lifestyle, stress etc. - Lack of access to drugs for patients who cannot afford to buy antihypertensive medication at market rates. - Lack of true government commitment to fight NCDs beyond committees and guideline formulation.

Paul Wangwe

most patient are unable to afford necessary tests required for follow up of a hypertensive patient. This is worsened by the fact that most of them present with end organ damages due to years of non compliance.

Alfred Bikeri Manduku

1 Non compliance to hypertension medication / non adherence to follow up clinic. 2 Financial constraints, some medication are expensive most of the clients can"t afford. 3 Denial - difficulties in clients accepting that they are hypertensive

Effat Abdulwahab

This is a good opportunity to get some issues dealt with hopefully. Working in government facilities is challenging esp with hypertension and diabetes. We are limited to prescribe what is available to the patient which may not be helpful in controlling blood pressure. Financial constraints are major challenges in prescribing good medications. We also are limited in equipment. We don't have 24 hours bp monitors...to diagnose n monitor blood pressure. We rely mostly on the available resources for diagnostic n treatment. Commonly seen also in elderly yet some even don't understand their medications... Need to interact with care givers..to ensure good drug compliance. Furthermore.... complications of hypertension...a huge challenge even getting an ECG n ECHO done in our hospital. We hv to refer to KNH with a booking.....it's heart breaking to deal with delays in diagnosis.

Tommy Temesi

One among major challenges is constant stock out of antihypertensives which means that patients do not get enough drugs to last them between clinic visits. This requires that they buy drugs over the counter, something which is more often than not precluded by the financial strain of most of my patients. Related to financial constraint is the inability of patients to access investigations to check for end organ damage e.g UEC, Fundoscopy, Urine microalbumin, echo, ecg. One other challenge: lack of home Bp machines for continued monitoring of blood pressure

Effat Abdulwahab

Diagnosis challenges.... equipment n tests especially with government facilities. Things such as ECG n ECHO not available when urgently needed for such hypertensive cases Treatment being limited to what is available. Guidelines n policy not appropriately put in place considering other comorbidities such as diabetes in these patients as well

Dr. Kevin Odhiambo

Poor compliance, Lack of Follow-up and Late referral which can be attributed to either financial constraints or lack of awareness /education on the significance of good pressure control to avoid the long-term complications.

Zipporah Wachira

Main challenge I face is inaccurate information that one hypertension is social stressor related and that a normal bp reading equates to cessation of treatment. This therefore lead to poor compliance and refusal to seek healthcare services. Also noted is the lack of understanding on what clinic check ups are meant for. Most people use them to refill prescription and fail to understand what else they are there for and so do alot of otc treatment. nutrition and lifestyle advice is known by many but most people tend to ignore the above and a lifestyle disease is diagnosed. On policy making, I feel more education and the catastrophic effects of lack of treatment and regular bp checks, would improve the manner in which we approach hypertension.

Dr. Ngugi Wamuyu

At my center the main challenges include 1. Inadequate screening capacity and poor diagnosis of hypertension due to lack of effective BP monitoring tools 2. Lack of standardized treatment protocols for patients which leads to patients' poor compliance due to high pill burden, unexplained drug side effects. 3. Lack of effective health education to patients on needed lifestyle adjustments, expected drug side effects, need for compliance and adherence, and regular monitoring via MOPC attendance. 4. Lack of needed testing equipment especially Thyroid function tests, testing for phaeochromocytoma, testing for renal artery stenosis for patients with secondary hypertension. The ECG machine keeps failing thus denying hypertensive patients the benefit of regular ECGs when needed. 5. Financial constraints thus patients are not able to attend MOPC, do investigations, or purchase medications not available in the hospital which leads to poor compliance and eventual complications. 6. Political meddling on the drugs one can prescribe since one is limited to what is available in the pharmacy. 7. Staffing shortages thus BP readings are taken by casuals instead of nurses, there aren't enough doctors and physicians to attend frequent MOPC clinics.

Sheila Kirongothi

1. Inadequate screening for hypertension 2. Failure of patients to adhere to clinic visits 3. Poor adherence to regimen prescribed. This can be explained by the cost implication of drugs prescribed, and the pill burden of some regimens.

Dr. Hassanfahad Adan

1. Poor compliance to medications leading to complications such as stroke.. 2. Inavailability of some of the antihypertensives.

Evans Wanyama

Financial constrains which limit patients access to antihypertensives, poor patient compliance and a good number of patients sometimes are lost to follow up.

Winfred Nyanya

my challenge as an HIV clinician is managing clients who have comorbidity e.g diabetes and hypertension. The HIV is well managed and most are virally suppressed however their other comorbidities are sometimes not taken care of well due to lack of integration of services and the fact that they have to pay for other meds other than ARVs. capacity gaps in clinicians in the HIV care clinic and lack of effective treatment for hypertension affect clinical outcomes in clients.

Faith Mbuvi

1.Hypertensive patients being in denial since they are not having any symptoms . 2.financial constraints on medication, regular lab checks, ecg 3.non compliance to medication

Zeytun Somo

Major challenge is lack of patient education , most patients are not educated on the illness, lifestyle modifications required and the complications thus a big number presents with complications 2. Most healthcare workers i have encountered in the medical wards especially government hospitals take hypertension casually and thus Bp monitoring not done as required 3.How to give fluids to a patient with hypertensive emergency and hyperglycemia 4. Inadequate screening

Dr. Robbinson Nduati

1. Stock out of essential hypertension drugs making compliance difficult as the majority of the clients are elderly and very poor thus can't afford to buy medicines in the private facilities 2. Compliance in patients with underlying psychiatric diseases who have poor insight into their conditions.

Naomi Munywoki

Lack of funds, Specialists, drugs and labs.

June Chebichii

Patient based: 1. Poor compliance of antiHTNs 2. Some may comply with their meds but fail to keep appointments, refill their antiHTNs OTC and come months later with poor control 3. Refusal/ difficulty in modifying lifestyle i.e lack of exercise, diet change or continues to smoke. No effort in trying to loose weight Hospital Based 1. Lack of regular supply of antiHTNs. Sometimes we write prescriptions for patients to buy outside but the dont because its more costly outside. 2. Lack of screening tools for target organ injury e.g ECG, Fundoscopy, UECs, head CT scans if CVA is suspected 3. Staff not well trained in Mx of HTNsive urgencies and emergencies in OPD. 4. Managing HTN with other comorbidities eg CKD, DM,

Crispus Adalla

The biggest challenge in my setting is the economic stability of the clients on Hypertension treatment, rendering adherence to clinic visits and medication a challenge. Thoughts go towards UHC and other means of ensuring sustainability for the common Kenya e.g through strengthening NHIF.

Francis Soita

Challenges 1 Unavailability of drugs 2. Patients loss to follow up 3.Lack of necessary lab tests to aid management of patient condition 4.Lack of adequate imaging like Echo, CT scan

Sidney Sawe

Drugs are not available, unavailable lab chemistries, no imaging and loss of patients to follow up.

David Okeyo

Challenges at our facility 1. Availability of drugs 2. insufficient laboratory work ups 3. No imaging e.g CT scan, MRI 4. Capacity building like training in ACLS, ATLS, CMOC

Dr. Ombati Mokua

the biggest challenge at our facility is lack of essential drugs , breakdown of the laboratory machines hence the tests aint available and lack of some essential tests. there is lack of capacity building on healthcare workers.

Peter Olyam

supply of essential antihypertensives not consistent. lack of essential labotratory tests due to lack of reagents.

Dr. SILUS OMUTSANI

The greatest challenge is having patients accept the diagnosis of hypertension which is a key component when it comes to compliance to treatment . This a challenge both in the rural area and Nairobi
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