Hypertension burden and challenges across the hypertension treatment cascade among adults enrolled in HIV care in northern Tanzania

Abstract

Failure to address hypertension among people living with HIV (PLWH) may undermine the significant progress made toward reducing mortality among this high‐risk population in sub‐Saharan Africa (SSA). Here, the authors report hypertension prevalence, diagnosis, and treatment among patients enrolled in HIV care in Tanzania. Patients attending an HIV clinic were consecutively screened for hypertension. Hypertension was defined as follows: a single blood pressure measurement ≥160 mm Hg systolic or ≥100 mm Hg diastolic, two measurements at separate visits ≥140 mm Hg systolic or ≥90 mm Hg diastolic, or self‐reported hypertension diagnosis. The authors screened 555 patients, and 19.6% met hypertension criteria. Among a subset of 91 hypertensive participants, 44 (48.4%) reported previous blood pressure measurements, 32 (35.2%) were aware of diagnosis, 10 (11.0%) reported current antihypertensive use, and none had controlled blood pressure. Addressing barriers along the hypertension treatment cascade must be a top priority to improve cardiovascular outcomes among PLWH in SSA.

Hypertension Care for People With HIV in Tanzania: Provider Perspectives and Opportunities for Improvement

“…9 However, a recent study in northern Tanzania examining a cohort of hypertensive patients enrolled in HIV care revealed that more than half of all participants had never had a previous blood pressure measurement, two-thirds were unaware of their diagnosis, 90% were not on antihypertensive treatment, and none had controlled blood pressure suggesting a discordance between real-world practice and treatment guidelines. 10 Challenges across the hypertension continuum of care among PWH in SSA are likely multifactorial. [11][12][13] A qualitative study examining perspectives of hypertension care among hypertensive patients receiving HIV treatment in northern Tanzania identified poor patient knowledge as a predominant barrier to hypertension care.…”

“…9 However, a recent study in northern Tanzania examining a cohort of hypertensive patients enrolled in HIV care revealed that more than half of all participants had never had a previous blood pressure measurement, two-thirds were unaware of their diagnosis, 90% were not on antihypertensive treatment, and none had controlled blood pressure suggesting a discordance between real-world practice and treatment guidelines. 10 …”

“It’s because I think too much”: Perspectives and experiences of adults with hypertension engaged in HIV care in northern Tanzania

“…Despite this increased burden of disease, most patients with hypertension in SSA are not on treatment [ 10 ]. These concerning trends are also present among PLHIV [ 11 ]: a recent study in northern Tanzania found that among a cohort of hypertensive patients enrolled in HIV care, 65% were unaware of their diagnosis, 90% were not on antihypertensive treatment and all had uncontrolled blood pressure [ 12 ].…”

Knowledge, attitudes, and preventive practices regarding ischemic heart disease among HIV‐positive individuals in northern Tanzania

“…Patients with both HIV and IHD have trouble navigating siloed care systems for their HIV and cardiovascular needs in SSA. PLWH are rarely screened for cardiovascular risk factors such as hypertension during HIV follow-up visits, experience delays in IHD risk factor diagnosis, do not receive referrals or linkages to cardiovascular care, and rarely speak to a single provider about co-occurring conditions [7,8]. These barriers, combined with financial and social barriers to adequate care, lead to poor understanding of cardiovascular risks and lower adherence to cardiovascular medications in PLWH in SSA [7][8][9][10][11].…”

“…PLWH are rarely screened for cardiovascular risk factors such as hypertension during HIV follow-up visits, experience delays in IHD risk factor diagnosis, do not receive referrals or linkages to cardiovascular care, and rarely speak to a single provider about co-occurring conditions [7,8]. These barriers, combined with financial and social barriers to adequate care, lead to poor understanding of cardiovascular risks and lower adherence to cardiovascular medications in PLWH in SSA [7][8][9][10][11]. Understanding barriers to IHD prevention and care is critical to improving IHD morbidity and mortality among HIV-infected patients.…”