Research Article: The burden of hypertension in the emergency department and linkage to care: A prospective cohort study in Tanzania

Date Published: January 25, 2019

Publisher: Public Library of Science

Author(s): Sophie W. Galson, John W. Stanifer, Julian T. Hertz, Gloria Temu, Nathan Thielman, Temitope Gafaar, Catherine A. Staton, Sonak D. Pastakia.


Globally, hypertension affects one billion people and disproportionately burdens low-and middle-income countries. Despite the high disease burden in sub-Saharan Africa, optimal care models for diagnosing and treating hypertension have not been established. Emergency departments (EDs) are frequently the first biomedical healthcare contact for many people in the region. ED encounters may offer a unique opportunity for identifying high risk patients and linking them to care.

Between July 2017 and March 2018, we conducted a prospective cohort study among patients presenting to a tertiary care ED in northern Tanzania. We recruited adult patients with a triage blood pressure ≥ 140/90 mmHg in order to screen for hypertension. We explored knowledge, attitudes and practices for hypertension using a questionnaire, and assessed factors associated with successful follow-up. Hypertension was defined as a single blood pressure measurement ≥ 160/100 mmHg or a three-time average of ≥ 140/90 mmHg. Uncontrolled hypertension was defined as a three-time average measurement of ≥ 160/100 mmHg. Successful follow-up was defined as seeing an outpatient provider within one month of the ED visit.

We enrolled 598 adults (mean age 59.6 years), of whom 539 (90.1%) completed the study. The majority (78.6%) of participants were aware of having hypertension. Many (223; 37.2%) had uncontrolled hypertension. Overall, only 236 (43.8%) of participants successfully followed-up within one month. Successful follow-up was associated with a greater understanding that hypertension requires lifelong treatment (RR 1.11; 95% CI 1.03,1.21) and inversely associated with greater anxiety about the future (RR 0.80; 95% CI 0.64,0.99).

In a northern Tanzanian tertiary care ED, the burden of hypertension is high, with few patients receiving optimal outpatient care follow-up. Multi-disciplinary strategies are needed to improve linkage to care for high-risk patients from ED settings.

Partial Text

Cardiovascular disease is the leading cause of global morbidity and mortality [1, 2]. Sub-Saharan Africa (SSA) is particularly vulnerable to the growing global burden of cardiovascular disease, which disportionately impacts low-and-middle income countries (LMICs)[3]. Among the risk factors for cardiovascular disease, hypertension is the most pervasive and contributes the greatest attributable risk to overall cardiovascular death [4]. Currently, the prevalence of hypertension in SSA is estimated to to be as high as 40%, with fewer than 10% of affected individuals receiving optimal blood pressure control [5, 6]. Even more alarming, by the year 2025, as many as 125 million people in SSA will have hypertension [7]; yet, the region is starkly underprepared to address this growing public health crisis [8].

In an ED-setting in northern Tanzania, we observed a high burden of elevated blood pressure, with substantial proportions of both uncontrolled hypertension and proteinuria. Additionally, we observed a large proportion of individuals seeking routine prescription refills for anti-hypertensive medications in the ED setting. Despite the high burden, follow-up rates from the ED were low, and anxiety about a future with hypertension was associated with lack of follow-up care.




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