**1. Introduction**

Hypertension is a global health condition of developed and developing countries including South Africa. South Africa has the highest prevalence of people with hypertension (between 42% and 54%) compared with the eastern (15%) and western (25%) parts of Southern Africa. Sadly, the condition of these patients is still not controlled even while on treatment [1]. A recommendation of this study is that a regionally tailored intervention is implemented to prevent disastrous consequences relating to hypertension mortality and morbidity. While hypertension is a chronic, lifelong condition that needs regular and continued follow-up care, it also requires

skilled health care providers who are supported by the treatment guidelines of the National Department of Health (NDoH), South Africa.

Approximately 17-million patients diagnosed with hypertension, a chronic, non-communicable and preventable disease, visit South PHC clinics for consultation. Hypertensive patients are initially encouraged to follow lifestyle modifications to promote control and management of the disease as part of its non-treatment management. Thereafter, if condition remains uncontrolled, hypertensive patients are informed to use daily treatment for the rest of their lives [2]. The NDoH of South Africa recommends that health professionals who are practicing in PHC clinics provide health education to enhance compliance with the management and control of hypertension [3].

Before 2006 parallel guidelines were developed by the Southern African Hypertension Society and the South African Department of Health, but the 2006 guideline is the combination task of the two bodies [4]. The guideline outlines dissimilar broad steps that health professionals should adhere on to achieve controlled blood pressure effectively, beginning from the patient risk screening/profiling, the measurements and investigations, the classification and complete treatment of hypertensive patients with or without co-morbidities, to their repeat and continuous plan [5]. A research conducted in Pretoria (Tshwane) on adherence to the hypertension guidelines among private practitioners and PHC physicians found that overall adherence to the hypertension practice guidelines used by generalists in private practice was 55%, while among PHC doctors in public-service, it was 56.4% [6].

Although two guidelines, Adult Primary Care (APC)/ Standard Treatment Guidelines (STG) and Essential Medicines List (EML), are available for use in PHC facilities when consulting patients with hypertension, the challenge is whether these guidelines are adhered to or not. To this end, the study sought to assess adherence or non-adherence to these guidelines and to describe the followup care received by patients in the Tshwane district of the Gauteng province, South Africa.

As far as the workshop on Diabetes Mellitus was concerned, the former Deputy Minister of Health in South Africa Dr. Joe Phaahla reported concerns about the quality of records in some clinics during auditing of patients' records. Hypertensive patients' medical history was recorded in two sentences, for example *"For follow up. Medication issued".* The researchers noted this trend with seriousness since students following the R48 are taught comprehensive health assessment, which includes correct history taking and physical examination plus treatment of illnesses. Truly, if health assessment and treatment are done correctly, medical history could not be recorded in two sentences, which proves that if it is not recorded, it was undone. Adherence to the guidelines is stipulated throughout the R48 training programme to prove that there is standardisation regarding how hypertensive patients are treated at PHC level. During clinical practical of students, the researchers also realised that chronic services are regarded as fast track and sometimes, very incompetent nurses are assigned to that because they are considered mainly treatment collection. The South African' health care system is predominantly nurse-based and requires nurses to have the appropriate competence and expertise to manage the country's quadruple burden of diseases, of which hypertension forms a significant part [7]. To achieve this requirement, nursing education and training must produce safe and competent nursing professionals who are capable of making a meaningful contribution [8]. This prompted the researcher's interest in assessing the follow-up care received by the patients with hypertension at PHC facilities in the Tshwane district.

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*Assessment of Follow-Up Care Received by Patients with Hypertension at Primary Health Care…*

Detailed history, physical examination and interpretation of investigations should form an integral part of the routine care of patients with hypertension. Regarding measurements, it is important to ensure that PHC nurses who take blood pressure measurements have adequate initial training and their performance periodically reviewed. Equipment for measuring blood pressure must be correctly checked, serviced and adequately recalibrated according to the companies' instructors' manuals. When checking blood pressure, PHC nurses in the clinics should calm the setting and provide a relaxed, temperate atmosphere, with the patients quiet and seated, and arms outstretched and supported. Use of a correct machine for the patient's arm is important [9]. A community-based study to estimate the prevalence of hypertension and its associated factors in municipalities of Kathmandu, Nepal [10], found that factors associated with hypertension were smoking, Body Mass Index (BMI), alcohol use, poor physical activity and diabetes. The guidelines [9] emphasise the importance of the following lifestyle

*DOI: http://dx.doi.org/10.5772/intechopen.99623*

• Administer continuous lifestyle advice to patients

• Offer guidance and written or audiovisual materials to promote life-

• Encourage patients to keep their dietary sodium intake low

• Discourage excessive consumption of coffee and other caffeine-rich products

• Inform patients about support groups such as local initiatives, health care teams or patient organisations that provide support and promote life-style

In South Africa, the following lifestyle modification is also recommended [11]:

• Educate patients about adequate dietary fibre intake (fruits, vegetables and

The research is quantitative because it sought to measure the phenomenon by attaching numerical values to express quantity [12]. The observation was carried out in the PHC facilities whereby entries of patients' files were evaluated. Perusal of patients' files and documentation using checklist was also done. Furthermore, quantitative research is described as a formal, objective, systematic methodology to describe variables, to test relationships, and to examine cause and effect [13]. However, for this study, only the former is applicable. The patients whose files were

• Promote a healthy diet and regular exercise

• Encourage reduced alcohol consumption

• Offer advice and help smokers to stop smoking

**2. Research design and methods**

**2.1 Patient's history**

modifications:

style changes

change [9].

**2.2 Study design**

unrefined carbohydrate).

*Assessment of Follow-Up Care Received by Patients with Hypertension at Primary Health Care… DOI: http://dx.doi.org/10.5772/intechopen.99623*
