Hypertension control in Harare municipal clinics.

Treatment of hypertension is a growing burden on urban health services in Zimbabwe. In 1980, the Harare Health Department began a separate registry, staffed by a nurse, for management of patients with stable hypertension (diastolic blood pressure (DBP less than 100 mmHg) on treatment). We evaluated this programme in a retrospective review of 437 medical records. The average age of patients was 17.5 years; two-thirds were women. Upon referral 324 patients (74 percent) had a DBP less than mmHg. Sixty-five percent of patients had no DBP greater than 100 mmHg during follow-up. Patients with DBP greater than 20 mmHg were more likely to be treated with two drugs, seen more often or referred (p less than 05). One-third of patients enrolled between 1980-1986 were lost to follow-up. Of those who did not default, few attended regularly. We conclude that a nurse can successfully manage patients with stable hypertension, although more aggressive treatment and improved compliance would have resulted in better control. At current levels of loss to follow-up, this programme is unlikely to have much effect on the public health impact of hypertension. The main challenge is to improve patient compliance.