{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T22:30:37Z","timestamp":1792017037222,"version":"4.4.0"},"reference-count":46,"publisher":"BMJ","issue":"11","funder":[{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000098","name":"NIH Clinical Center","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000098","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2017,10,16]]},"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Sub-Saharan Africa is particularly vulnerable to the growing global burden of hypertension, but epidemiological studies are limited and barriers to optimal management are poorly understood. Therefore, we undertook a community-based mixed-methods study in Tanzania to investigate the epidemiology of hypertension and barriers to care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In Northern Tanzania, between December 2013 and June 2015, we conducted a mixed-methods study, including a cross-sectional household epidemiological survey and qualitative sessions of focus groups and in-depth interviews. For the survey, we assessed for hypertension, defined as a single blood pressure \u2265160\/100\u2009mm Hg, a two-time average of \u2265140\/90\u2009mm Hg or current use of antihypertensive medications. To investigate relationships with potential risk factors, we used adjusted generalised linear models. Uncontrolled hypertension was defined as a two-time average measurement of \u2265160\/100\u2009mm Hg irrespective of treatment status. Hypertension awareness was defined as a self-reported disease history in a participant with confirmed hypertension. To explore barriers to care, we identified emerging themes using an inductive approach within the framework method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We enrolled 481 adults (median age 45 years) from 346 households, including 123 men (25.6%) and 358 women (74.4%). Overall, the prevalence of hypertension was 28.0% (95% CI 19.4% to 38.7%), which was independently associated with age &gt;60 years (prevalence risk ratio (PRR) 4.68; 95%\u2009CI 2.25 to 9.74) and alcohol use (PRR 1.72; 95% CI 1.15 to 2.58). Traditional medicine use was inversely associated with hypertension (PRR 0.37; 95% CI 0.26 to 0.54). Nearly half (48.3%) of the participants were aware of their disease, but almost all (95.3%) had uncontrolled hypertension. In the qualitative sessions, we identified barriers to optimal care, including poor point-of-care communication, poor understanding of hypertension and structural barriers such as long wait times and undertrained providers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In Northern Tanzania, the burden of hypertensive disease is substantial, and optimal hypertension control is rare. Transdisciplinary strategies sensitive to local practices should be explored to facilitate early diagnosis and sustained care delivery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-018829","type":"journal-article","created":{"date-parts":[[2017,11,10]],"date-time":"2017-11-10T00:45:25Z","timestamp":1510274725000},"page":"e018829","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":72,"title":["Epidemiology of hypertension in Northern Tanzania: a community-based mixed-methods study"],"prefix":"10.1136","volume":"7","author":[{"given":"Sophie W","family":"Galson","sequence":"first","affiliation":[{"name":"Division of Emergency Medicine, Department of Surgery, Duke University, Durham, North Carolina, USA"},{"name":"Duke Global Health Institute, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine A","family":"Staton","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Surgery, Duke University, Durham, North Carolina, USA"},{"name":"Duke Global Health Institute, Durham, North Carolina, USA"},{"name":"Division of Global Neurosurgery and Neuroscience, Department of Neurosurgery, Duke Global Health Institute, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis","family":"Karia","sequence":"additional","affiliation":[{"name":"Kilimanjaro Christian Medical University College, Moshi, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kajiru","family":"Kilonzo","sequence":"additional","affiliation":[{"name":"Department of Medicine, Kilimanjaro Christian Medical Center, Moshi, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Lunyera","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uptal D","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Medicine, Duke Clinical Research Institute , Duke University, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian T","family":"Hertz","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Surgery, Duke University, Durham, North Carolina, USA"},{"name":"Duke Global Health Institute, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John W","family":"Stanifer","sequence":"additional","affiliation":[{"name":"Duke Global Health Institute, Durham, North Carolina, USA"},{"name":"Division of Nephrology, Department of Medicine, Duke University, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,11,9]]},"reference":[{"key":"2025120619153766000_7.11.e018829.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61696-1"},{"key":"2025120619153766000_7.11.e018829.2","unstructured":"WHO | A global brief on hypertension. 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