Making a heartfelt difference in patients with high blood pressure

Dr Trenton Oliver has very personal reasons for going into medicine and research. When he was only a year old, he lost his policeman father in an on-duty car crash. Then just four years ago, his grandmother, who he lived with during his high-school years in Durban, was diagnosed with metastatic breast cancer.

"I grew up in Queensburgh in Durban and attended Pinetown Boys High. I lived with my gran for my high school years. We grew very close," he says.

He wants to be a specialist physician within three years and then super-specialise in medical oncology. "If I can better care for cancer patients and maybe prolong life that would be great. I don't expect to find the cure for cancer, but I've developed a huge love for research that can improve people's quality of life."

Discovery Foundation Award honours life-saving research

Dr Oliver's love for research began simmering strongly after he received a Discovery Foundation Award in 2019 to conduct a retrospective study of 170 stable hypertensive patients at the Prince Mshiyeni Memorial Hospital hypertension clinic in Umlazi.

He aimed to uncover why patients take their blood pressure medicine incorrectly or stop taking it. His life-saving research has the potential to introduce widespread, targeted preventive interventions that could save many lives.

Why is his research important? Dr Oliver says that hypertension, if left untreated, can cause strokes, vascular disease, and gangrene of the feet and hands. This could lead to potential amputation and permanent disability, and irreversible renal failure requiring ongoing dialysis or a kidney transplant.

"High blood pressure affects even your basic senses, your ability to walk or even see. And that's just the morbidity," he adds.

So, why do patients struggle to take their medicine?

Dr Oliver says that first, people need to understand the difference between compliance and adherence to medicine.

Compliance involves the timing, dosage and frequency of taking prescribed medicines, while adherence is the act of refilling a prescription on time.

"If you really want to address compliance, you have to do a qualitative study. Take a smaller group of a dozen or so chronic hypertensive patients and interview them, do home visits and do recorded interviews," he adds passionately.

He says factors affecting medicine adherence and compliance include patients' age, with the elderly and the very young being most vulnerable, co-morbidities, and even simple things like the doctor-patient relationship and poor counselling.

"Language is a huge daily barrier that too many healthcare providers face," he says, explaining that 99% of his patients in Umlazi speak isiZulu.

Raising awareness on SA's high hypertension rate

Data shows that South Africa has the highest reported rate of hypertension among the 50-plus age group globally.

"We need better counselling and communication to improve adherence, more social workers and more translators," he says. "Just the record taking itself is fraught and involves taking a travel history, for example for malaria testing, and what immunisations or vaccines or any other prophylaxis they have had. Many of our patients would rather see a traditional healer before taking prophylactics for travel."

He says that for children and the elderly, support services are crucial, especially for people with diabetes. "The simplest thing like having a social or healthcare worker explain the importance of their daily insulin shots can save a life," he adds.

"Purely as a doctor, how can I make a difference seeing 500 patients a week? I mean, if we just had a better transportation system, you'd see an immediate drop in mortality and morbidity," he says.

His awareness campaign to alert patients of the dangers of uncontrolled chronic hypertension included catchy illustrated pamphlets, tailored to specific local findings, and a multi-media messaging system, reminding patients of appointments and carrying preventive behaviour messaging.

2021 and Dr Oliver is going strong

This year, Dr Oliver is specialising in clinical oncology focusing on radiation therapy. "I have a further desire to research deeper into the cancer care treatment of patients," he says.

When his mind is not on his patients, Dr Oliver is a surfer who enjoys cooking, high-detail sketching (his art teacher was bitterly disappointed he did not study art) and spending time with his wife, who is also a medical doctor.

"My wife has a great interest to specialise in internal medicine too and to do medical oncology," he says, "and we have just had our first beautiful baby boy."