Hypertension prevalence and care in an urban and rural area of Tanzania

Objective To describe the prevalence, detection, treatment and control of hypertension in an urban and rural area of Tanzania. Design Two linked cross-sectional population-based surveys. Setting A middle-income urban district of Dar es Salaam (IIala) and a village in the relatively prosperous rural area of Kilimanjaro (Shari). Participants Seven hundred and seventy adults (> 15 years) in llala and 928 adults in Shari were studied. Results Hypertension prevalence (blood pressure > 140 and/or 90 mmHg, or known hypertensives receiving anti-hypertensive treatment) was 30% (95% confidence interval, 25.1-34.9%) in men and 28.6% (24.3-32.9%) in women in llala, and 32.2% (27.7-36.7%) in men and 31.5% (27.8-35.2%) in women in Shari. Age-standardized hypertension (to the New World Population) prevalence was 37.3% (32.2-42.5%) among men and 39.1% (34.2-44.0%) in women in Illala, and 26.3% (22.4-30.4%) in men and 27.4% (24.4-30.4%) in women in Shari. In both areas, just under 20% of hypertensive subjects were aware of their diagnosis, approximately 10% reported receiving treatment and less than 1% were controlled (blood pressure < 140/90 mmHg). Hypertensive subjects were older, had greater body mass indices and waist: hip ratios, and had more risk factors for hypertension and its complications (smoking, heavy alcohol consumption, physical inactivity, obesity and diabetes) than non-hypertensives. Conclusions There is a high prevalence of hypertension in rural and urban areas of Tanzania, with low levels of detection, treatment and control. This demonstrates the need for cost-effective strategies for primary prevention, detection and treatment of hypertension and the growing public health challenge of non-communicable diseases in Sub-Saharan Africa.