Hypertension and HIV in Northern Tanzania

Abstract

Background: Hypertension, a leading risk for cardiovascular mortality, is an important co-morbidity among people living with HIV (PLWH). Understanding the epidemiologic patterns of hypertension and barriers to hypertension care is a critical first step in developing interventions to improve cardiovascular outcomes among PLWH in sub-Saharan Africa (SSA). Methods: Semi-structured in-depth interviews were conducted with 13 hypertensive patients engaged in HIV care in northern Tanzania. Patients attending a single HIV clinic in Moshi, Tanzania were screened consecutively for hypertension. Hypertension was defined as having at least one of the following: 1) a self-reported diagnosis of hypertension, 2) a single blood pressure measurement > 160 mmHg systolic or > 100 mmHg diastolic, or 3) two measurements at separate visits, obtained at least one week apart of > 140 mmHg systolic or > 90 mmHg diastolic. All screened participants completed a short demographic survey. Participants who met criteria for hypertension were invited to complete a knowledge, attitudes and practices survey that included questions about previous hypertension history. Results: The data revealed a range of themes including poor understanding of hypertension causes, limited hypertension knowledge, perceived overlap and comparisons between hypertension and HIV, delays in hypertension diagnosis and linkage to care, shortcomings of provider communication and counseling, reluctance to use antihypertensive medication, lack of integration of hypertension and HIV care, and multiple barriers to hypertension care. Over an 8-week period, 555 patients were screened for hypertension. Hypertension prevalence was 19.6% (20.3% among women and 16.8% among men). The median age of patients with hypertension was 50 (IQR 43 – 57 years), compared to 42 (IQR 35 – 49 years) years for normotensive patients. Older age (OR 1.07, 95% CI 1.04 – 1.09, p<0.001) and higher body mass index (BMI) (OR 1.13, 95% CI 1.09 – 1.18, p<0.001) were independently associated with hypertension. Among the 91 patients with hypertension who completed additional questions about their hypertension history, 44 (48%) reported having a prior blood pressure check, 32 (35%) were previously aware of their hypertension diagnosis, and only 21 (23%) reported ever taking antihypertensive drugs. Of the 10 patients (11%) reporting current antihypertensive use, none had a controlled blood pressure. Conclusions: Participants described multiple, intersecting challenges related to hypertension management. Hypertension prevalence among patients engaged in HIV care was high. Despite a high burden of disease, the rates of screening, awareness, treatment and control were unacceptably low. Multifaceted strategies that address barriers to care along the hypertension care continuum and that are integrated within HIV care are urgently needed to improve cardiovascular outcomes among PLWH in SSA.