Assessment of Increased Use of Methyldopa for the management of Hypertension and Hypertension-related Conditions in Ho Teaching Hospital, Ho

Introduction: Hypertension is the number one risk factor for cardiovascular disease in Africans, with risk doubling with every 20/10 mmHg increase in blood pressure. Cardiovascular diseases remain one of the top non-communicable diseases associated with high mortality in Ghana. Hypertensive patients have been shown to be highly sensitive to catecholamines. Methyldopa after crossing the blood-brain barrier inhibits the decarboxylation of dihydroxyphenylalanine, a precursor of catecholamines. Methyldopa is reserved for the management of hypertension in pregnancy and hypertension that is unresponsive to maximal doses of other anti-hypertensives. 

Objective: The study was to assess the rise in the prescription of methyldopa for the management of hypertension and hypertension-related conditions.

Methodology: A cross-section of patients who received methyldopa for the management of hypertension in the past 6 months; from July to December 2018 were assessed. Information was obtained from the Hospitals Administration Management System (HAMS) and descriptive analysis performed using SPSS Tool 18.

Results: A total of 28,505 tablets of Methyldopa were dispensed over the period of 6 months to 153 patients. September recorded the highest number of prescriptions with 9,849 tablets representing 34.55% dispensed. Out of the 153 patients, 80.39% are females and 19.61% are males. One hundred and twenty-two patients were found to be methyldopa naive, out of which 81.15% are females and 18.85% males. Sixty women were on methyldopa for the management of hypertension-related disorders in pregnancy. Ten per cent discontinued therapy post-partum, whiles 63.33% continued therapy after birth whiles 26.67% were lost to follow up. Ninety-three patients made up the non-pregnant population out of which 67.74% were females and 32.26% males. Thirty-four patients had renal impairment with an almost even gender distribution; 47.06% females and 52.94% males. Fifty-nine out of the 93 patients had long-standing uncontrolled hypertension, with 79.66% females and 20.34% males. 

Conclusion: The accentuation of the prescription of methyldopa can be attributed to uncontrolled hypertension and the escalating numbers of hypertensive-related diseases in pregnancy.