Dami Aladesanmi is a current PGY-3 in Internal Medicine at UNC. He earned a BA in History and Science (with a focus on Medicine and Society) from Harvard College, an MD at Duke School of Medicine, and an MPH in Health Care and Prevention at the UNC Gillings School of Global Public Health. He is interested in cardiovascular health and disease prevention among the sub-Saharan African diaspora, where the rates of cardiovascular disease are rising. His primary mentor is Raquel Reyes, MD, MPA, associate professor of hospital medicine at UNC who helped establish the BHIP. Although he will always cherish his time at UNC, he is excited to start cardiology fellowship at Beth Israel Deaconess Medical Center (BIDMC) in Boston this summer.
Hypertension (HTN) is the leading cause of preventable deaths worldwide with increasing prevalence in low- and middle-income countries (LMICs). We previously established a differentiated HTN clinic at a level III health facility in rural western Uganda: the Bugoye Hypertension Improvement Project (B-HIP). Many patients remain undertreated due to medication unavailability. Regular laboratory monitoring with medication titration is also not standard of care in these resource-poor contexts. We present treatment and novel lab monitoring of a subset of patients with uncontrolled HTN on maximum amlodipine therapy, hypothesizing addition of thiazide diuretics better manages this cohort at low cost and with minimal adverse effects.
We present a group of patients with uncontrolled hypertension with overall improvement in blood pressure with minimal adverse effects at low cost in this level III health center. Such clinical models for HTN treatment may be increasingly useful given increased prevalence and could be extended to other chronic non-communicable diseases (NCDs) in LMICs, especially within sub-Saharan Africa (SSA). In resource-limited contexts, the utility of laboratory monitoring for patients on anti-hypertensive therapy may be debated. Medication procurement and clinical availability remain significant limiting factors in HTN treatment in this context.