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

Abstract

ObjectivesGlobally, 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.MethodsBetween 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.ResultsWe 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).ConclusionIn 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.

Patterns of Emergency Care for Possible Acute Coronary Syndrome Among Patients with Chest Pain or Shortness of Breath at a Tanzanian Referral Hospital

“…The majority of patients were diagnosed with symptomatic hypertension or heart failure, two diagnoses that arguably require exclusion of ACS. Although not the focus of our study, the large numbers of ED patients we observed being diagnosed with heart failure or hypertension are consistent with what has been reported elsewhere in Tanzania [9,23], suggesting that these diseases warrant particular attention from public health officials. Less than 1% of enrolled patients received empiric treatment with aspirin, an inexpensive and widely available treatment known to reduce mortality in ACS.…”

Care cascades for hypertension and diabetes: Cross-sectional evaluation of rural districts in Tanzania

“…As 59% of those screened hypertensive were unaware of their condition, screening efforts to improve awareness are potentially very important to improve control. However, screening efforts alone would be insufficient to improve health outcomes as other studies have found that linkage to care after a hypertension diagnosis is very low in Tanzania [ 24 ]. This is supported by our findings that 39% of those who were aware of their hypertension were not engaged in care, and 29% of those engaged in care were not on any treatment.…”

Hypertension in an Emergency Department Population in Moshi, Tanzania; A Qualitative Study of Barriers to Hypertension Control

“…While not ideal, the ED has become a well-established source of healthcare for those with limited health care access and barriers to health maintenance. Indeed, recent studies from northern Tanzania found large numbers of patients with poorly controlled or undiagnosed hypertension presenting to the ED for care of their hypertension or hypertension-related complications [12,13]. Additionally, many patients with undiagnosed hypertension may present to the ED for unrelated complaints [12,13].…”