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PLoS One. 2019 Jan 25;14(1):e0211287. doi: 10.1371/journal.pone.0211287. eCollection 2019.

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

Author information

1
Department of Surgery, Division of Emergency Medicine, Duke University, Durham, North Carolina, United States of America.
2
Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
3
Department of Medicine, Division of Nephrology, Duke University, Durham, North Carolina, United States of America.
4
Department of Medicine, Kilimanjaro Christian Medical College Hospital, Kilimanjaro, Tanzania.
5
Department of Medicine, Duke University, Durham, North Carolina, United States of America.
6
Department of Neurosurgery, Division of Global Neurosurgery and Neuroscience, Durham, North Carolina, United States of America.

Abstract

OBJECTIVES:

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.

METHODS:

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.

RESULTS:

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).

CONCLUSION:

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.

Conflict of interest statement

The authors have declared that no competing interests exist.

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