Rural-Urban Differences in the Hypertension Cascade of Care in Northwestern Tanzania: A Community-Based Cross-Sectional Study.

Background: Hypertension is a leading modifiable risk factor for cardiovascular morbidity and mortality worldwide, yet substantial gaps persist in its detection and management in low- and middle-income countries. Understanding where attrition occurs along the hypertension care cascade is critical for identifying high-impact intervention points, particularly in settings undergoing rapid demographic and epidemiological transition. Methods: The original parent study informing this secondary analysis was a community-based cross-sectional analysis of adults aged 18 years and older in rural and urban districts of Northwestern Tanzania using data from a baseline non-communicable disease survey in 2019. Twelve districts across six regions were selected through a multistage cluster sampling approach. Hypertension care was assessed using a cascade-of-care framework comprising four sequential stages: prior blood pressure screening, prior diagnosis, access to antihypertensive medication, and blood pressure control at the time of screening. Analyses were stratified by rural-urban residence, with statistical comparisons accounting for clustering at the district level. Results: Among 6,957 participants, 26% reported ever having their blood pressure measured by a health professional, with no significant difference between rural and urban settings (28% vs. 24%, p = 0.09). Among those previously screened, 42% reported a prior diagnosis of hypertension, with a higher proportion among rural residents (45% vs. 39%, p = 0.001). Approximately half of diagnosed individuals reported access to antihypertensive medication, with no rural-urban differences. Among participants with medication access, 64% achieved blood pressure control, with comparable control rates across settings. Conclusion: The primary bottleneck in hypertension care in Northwestern Tanzania occurs at early detection, with uniformly low screening across rural and urban populations. Once identified and treated, effective blood pressure control is achievable. Strengthening early screening and care activation represents the greatest opportunity to improve hypertension outcomes and provides a critical pre-pandemic baseline to inform policy and programmatic interventions.