A 4-year evaluation of blood pressure management in Trinidad and Tobago

This paper reports a 4-year evaluation of government primary care services in Trinidad and Tobago. The sample included 16 primary care health centres in Trinidad and Tobago with cross-sectional surveys of adult attenders in 1 994 and 1998. Data were obtained from clinic records including details of p rocesses of care, drug utilisation and blood pressure (BP) control. Interve ntion following the initial survey was by means of reports to the Ministry of Health and annual training workshops for medical officers. Data were ana lysed for 1759 adult attenders at study clinics (981 in 1994 and 778 in 199 8). Most attenders had blood pressure recorded (96% in 1994 and 98% in 1998 ). Among 1176 subjects with hypertension (BP greater than or equal to 160/9 5 mm Hg or treated with drugs) the proportion with dietary advice ever reco rded increased from 139/662 (21%) in 1994 to 185/514 (36%) in 1998, and rec ording of exercise advice increased from 36 (5%) in 1994 to 99 (19%) in 199 8. Among subjects treated with drugs, use of Brinerdin decreased from 191/6 25 (31%) in 1994 to 29/486 (6%) in 1998, while use of diuretics, beta-block ers, calcium antagonists and ACE inhibitors increased. The proportion of pa tients with blood pressure adequately controlled (<160/95 mm Hg) was 338 (5 1%) in 1994 and 297 (58%) in 1998 (odds ratio 1.39, 95% confidence interval 0.96 to 2.00). An audit study used to inform health care policy, staff tra ining and clinical practice may contribute to improving processes of hypert ension management in a middle-income country like Trinidad and Tobago.