Predictors of survival among hypertensive patients attending outpatient clinics within rural districts of Iringa region from 2020-2023.

Abstract

ABSTRACT Background: Hypertension in Tanzania accounts for 25.9% of cardiovascular disease risk factors despite the availability of specialized clinics, even in rural areas, to manage the disease and associated complications. Thus, evaluating outcomes of clinical care provided for a rural hypertensive cohort may give insight into how well clinical care promotes survival with hypertension without debilitating effects. Objective: To describe the three-year survival outcomes of hypertensive patients attending a Non-communicable Disease clinic in rural Iringa from 2020-2023. Methodology: This study analyzed a registry-based retrospective cohort identifying clinical outcomes of diagnosed adult hypertensive patients within rural health facilities in the Iringa district council. The study population was all hypertensive patients on follow-up visits in 9 health centres and district hospitals in the Iringa district council. Using epi-info, the data was analyzed, survival predictors were estimated using the Kaplan-Meier estimator, and the Log-rank test was used for comparisons. The Cox proportional hazards model was used to identify independent effects of the predictors of survival. Results: Between 2020 and 2023, the clinics enrolled 1194 participants (76% (n=910) were women) for hypertensive-related disorders. The mean age of patients was 61±5.4 SD years (IQR 18 -89 years); of these, 83.6% (n=998) were hypertensive-only patients, and 16.4% (n=196) were both diabetic-hypertensive. Out of 718 returning patients, 31.3 % (n¬=225): (95%CI: 28 - 35) patients reached optimum BP in the first six months, and 11.5% (n=21) (95% CI: 17 – 36) reached BP at thirty-six months respectively. Significant predictors of survival with optimum blood pressure control were living closer to the district hospital, those who had a hypertensive crisis at the initial assessment, and having fewer follow-up visits. Conclusion: The findings underscore the need to provide primary health care services closer to the community residential areas within rural settings. In this community, the patients with a severe hypertensive crisis were more likely responsive to treatment compared to others, and compliance to clinical attendance decreased with time, irrespective of the availability of care.