Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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

Sophie W Galson  1   2 , John W Stanifer  2   3 , Julian T Hertz  1   2 , Gloria Temu  4 , Nathan Thielman  2   5 , Temitope Gafaar  2 , Catherine A Staton  1   2   6
Affiliations

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

Sophie W Galson et al. PLoS One. .

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.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Study enrollment.
See this image and copyright information in PMC

References

    1. IHME. Institute for Health Metrics and Evaluation (IHME) 2015 [May 17, 2017]. Available from: http://vizhubhealthdataorg/gbd-compare.
    1. WHO. WHO | A global brief on hypertension. WHO. 2013. /entity/cardiovascular_diseases/publications/global_brief_hypertension/e....
    1. Abegunde DO, Mathers CD, Adam T, Ortegon M, Strong K. The burden and costs of chronic diseases in low-income and middle-income countries. Lancet (London, England). 2007;370(9603):1929–38. Epub 2007/12/08. 10.1016/s0140-6736(07)61696-1 . - DOI - PubMed
    1. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet (London, England). 2006;367(9524):1747–57. Epub 2006/05/30. 10.1016/s0140-6736(06)68770-9 . - DOI - PubMed
    1. Mosha NR, Mahande M, Juma A, Mboya I, Peck R, Urassa M, et al. Prevalence,awareness and factors associated with hypertension in North West Tanzania. Global health action. 2017;10(1):1321279 Epub 2017/06/10. 10.1080/16549716.2017.1321279 . - DOI - PMC - PubMed

Publication types