The Burden of Hypertension in the Emergency Department and Linkage to Care in Moshi, Tanzania; a Prospective Cohort Study

Background: Globally, hypertension affects one billion people and disproportionately impacts the developing world. Sub-Saharan Africa has a high prevalence of hypertension with a low rate of awareness and compliance with treatment. The current model of community-based screening does not always ensure follow-up for treatment initiation. In high-income countries, emergency department (ED)-based screening has been successful at capturing undiagnosed/uncontrolled hypertension cases.

Methods: Between July 2017 and March 2018 we conducted a prospective cohort study of hypertensive patients in the emergency department of Kilimanjaro Christian Medical Center (KCMC) in Moshi, Tanzania. Adults patients with a triage blood pressure > 140/90 were recruited, completed a demographic and knowledge, attitudes and practices (KAP) survey and were followed for one month. Hypertension was defined as a single blood pressure ≥ 160/100 mmHg or a three-time average of ≥ 140/90 mmHg. Successful follow-up was defined as seeing a medical doctor within one month of the ED visit. Basic demographics were performed and to investigate relationships with potential risk factors and failure to follow-up, generalized linear models were used.

Results: We enrolled 595 adults (mean age 59.6) including 175 men (39.2%) and 271 women (60.7%). Of the 600 patients enrolled, 590 (99%) meet our definition for hypertension. Overall, the prevalence of hypertension was 10.3 % (95% CI 9.5,11.0) and 303 (56.2%) of participants failed to follow-up with a primary care physician within 1 month of the ED visit. Successful follow-up was independently associated with understanding that hypertension requires lifelong treatment (RR 1.11; 95% CI 1.03,1.21) and inversely associated with being worried about a future with hypertension (RR 0.80; 95% CI .64,1.00). The majority (78.6%) of the participants were aware of their disease, but many 223 (37.2%) had uncontrolled hypertension and 265 (44%) had evidence of end-organ damage.

Conclusion: The emergency department in Moshi Tanzania experiences a high burden of hypertensive patients, the majority of which fail to follow-up within one month of the ED visit. Multi-disciplinary strategies should be employed to improve linkage to care for high-risk patients from the emergency department.