📖 ABSTRACT/OVERVIEW
Background: The debate between family medicine-led versus specialist-led chronic disease management hinges on comparative long-term outcome evidence that remains sparse in low-income country contexts. This study compares cardiovascular outcomes of hypertensive patients managed in family medicine versus cardiology clinics in Southwest Nigeria over a ten-year follow-up period. Methodology: A retrospective cohort study linked electronic medical records from University College Hospital Ibadan and two affiliated primary care centres. Propensity score matching controlled for baseline differences across 420 matched pairs followed for ten years. Primary outcomes included incident stroke, myocardial infarction, heart failure, and all-cause mortality. Secondary outcomes included blood pressure control rates and number of hospitalisations. Results: Family medicine patients demonstrated equivalent cardiovascular outcomes to cardiology-managed patients in propensity-score-matched analysis. Blood pressure control rates were non-inferior. All-cause hospitalisation was lower among family medicine patients. Overall costs of care were significantly lower in the family medicine pathway. Conclusion: Family medicine management of hypertension achieves outcomes equivalent to specialty cardiology care in Southwest Nigeria with lower associated costs and hospitalisation rates. These findings provide original empirical support for investment in family medicine-led hypertension management as the cornerstone of Nigeria's cardiovascular disease prevention strategy. Keywords: hypertension, cardiovascular outcomes, family medicine, cardiology, retrospective cohort
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