Prevalence, Types and Clinical Presentation of Heart Failure among Hypertensive Patients Seen at a Tertiary Hospital in Dar Es Salaam, Tanzania

Background: Heart failure (HF) is a common complication in patients with hypertension who may present as HF with preserved ejection fraction (HFpEF) or HF with reduced ejection fraction (HFrEF). These categories have different clinical presentations and may require special attention to diagnose, especially when the presentation is HFpEF. The aim of this study was to assess the prevalence, types and clinical presentation of HF among hypertensive patients being followed-up at a tertiary hospital in Tanzania. Methods: We included all known and newly diagnosed hypertensive adults (≥ 18 years) referred for echocardiogram examination at the Muhimbili National Hospital Mloganzila, between June and December 2019. A detailed cardiovascular history, physical, laboratory and echocardiogram examination was performed in all patients. HF was diagnosed according to the Framingham criteria and was further categorized as HFpEF (EF ≥ 50%) or HFrEF (EF < 50%), according to the echocardiography findings. Patients from these two groups were then compared in terms of demographic, clinical, laboratory and echocardiographic characteristics. The chi-square and Student's t test was used to compare categorical and continuous data respectively. A p-value of < 0.05 indicated a statistically significant difference. Results: Out of 633 hypertensive patients seen during the study period, 346 (54.7%) fulfilled the inclusion criteria and were enrolled. Mean ± SD age was 58.3 ± 12.4 years, and 60.4% were women. Mean ± SD systolic and diastolic BP was 152 ± 23 and 91 ± 15, respectively. A total of 102 (29.5%) patients were found to have HF. Three quarters of HF patients (74.5%) had HFpEF and the remaining (25.5%) had HFrEF. In comparison, patients with HFpEF were more likely to be outpatients, older, obese, and with higher mean BP and more concentric left ventricular hypertrophy when compared to those with HFrEF, all p < 0.05. Conclusion: The prevalence of HF among hypertensive patients seen at a tertiary hospital in Tanzania is 29.5%, majority of them having HFpEF. HFpEF differs from HFrEF in terms of BP levels, obesity status and some echocardiographic parameters. These factors need to be carefully examined when HF is suspected in otherwise less symptomatic patients.