Abstract:

Introduction: Rates of hospitalization and death related cardiovascular diseases are higher in patient with low socioeconomic status, due to poor outpatient follow-up and medication non-adherence. In a previous study at Bugando Medical Center, 2% of patients attending the outpatient clinic had hypertensive urgency, of which 19.3%were admitted to the hospital or had died within 6months. Among those hospitalized 72.4% had moderate to poor drug adherence. This shows the importance of intervention in the management of patients with hypertensive urgency to reduce hospitalization and deaths.

Methodology: in this interventional study, a population of 50 patients with hypertensive urgency (BP>180/120mmhg) seen at the Medical Outpatient Department (OPD) at two hospital in Mwanza were recruited. Patients with established cardiovascular diseases were excluded. We followed the participants every month in the clinic and escalated antihypertensive medications according to international guidelines until the blood pressure was reduced to <140/90mmhg. Counseling on medication adherence, diet and exercise was provided at each appointment. Participants who missed clinic appointments were called and encouraged to come back to the clinic. The primary outcome of this study was blood pressure control. Secondary outcomes included hospital admission and/or death and clinic attendance. Comparisons were made with the outcome in the prior observational study at BMC.

Results: we found that 75% of the study participant attained blood pressure control at 6months. The mean systolic blood pressure from end line was 137+16.2mmhg compared to the baseline 195.3+14.5hg. This systolic BP difference of 53.2mmhg (95%CI52.8TO 63.7) was statistically significant (47) =21.8, p=0. In the intervention group, patients at any point during the study period were 74% less likely to die and/or be hospitalized than historical control patients after considering patients’ age and gender. Among all recruited participants, 6(12%) were admitted, out of which 4(8%) were successful discharged while 2(4%) died on admission. Only 2(4%) were admitted due to cardiac reasons.

Conclusion: Participants with hypertensive urgency in the intervention group at any time point during the study period were less likely to die and/or hospitalized than historical control patients after considering patients age and gender. Major cardiovascular events were decreased compare to historical control. Having no medical insurance and being obese were not significant predictors of the outcome.