Evaluation of the stepped care therapy among patients with severe hypertension (BP≥ 180/110 mmHg) at Muhimbili outpatient clinics and the costs of treatment.

Abstract

To evaluate the practical adequacy, of the recommended hypertension treatment guidelines for Tanzania, estimate the direct medical cost of treatment when the guidelines are adhered to and establish factors affecting its implementation in Dar es Salaam. Prospective registration of all hypertensive patients attending medical outpatient clinics from 1st January to 3rd July 1995. One hundred patients with severe hypertension were selected and given supervised antihypertensive drugs for a period of six months. Study drugs used were bendrofluazide, propranolol and hydrallazine. A cross sectional survey was carried out among prescribers in Dar es Salaam city hospitals. Muhimbili Medical Centre and Dar es Salaam City hospitals, Tanzania. Hypertensives attending Muhimbili medical outpatient clinics. Doctors in Dar es Salaam city hospitals. Sixteen percent of newly referred patients were hypertensive while 58 % of all hypertensive patients had severe hypertension. Of the 100 patients on supervised treatment, 63 % attained the target blood pressure, 18 % did not complete follow up and 19 % did not reach the target blood pressure with the three study drugs. The average annual cost of supplying the proposed drugs to an estimated number of patients with severe hypertension in Tanzania was l (TShs.4,572,453,039.00) 34% and (TShs. 13,882,523,770.00) 104% of the entire Ministry of Health budget for the year 1995/96 by whole sale government and retail prices respectively.

iii The cost of investigations ranged from 37.3 % to 53.7 % of the total treatment cost per new patient per year. From a prescribers survey, 94.2% knew how to diagnose hypertension. But differed widely about when to initiated drug therapy. Traditional antihypertensive, e.g. methyldopa, bendrofluazide, propranolol and brinerdine were favoured when it came to drug preference. Conclusion: The magnitude of hypertension among our hospital medical outpatients is a large one. On treatment with the proposed drugs we can control majority of our patients. But the cost of treating even those with severe hypertension alone is so enormous that the government cannot afford. The guidelines should therefore be adapted as they seem workable but with modification to enable both the patient and the government share the costs of treatment. ••