Time to review policy on screening for, and managing, hypertension in South Africa: Evidence from primary care

Margaret Thorogood, Jane Goudge, Chodziwadziwa Whiteson Kabudula, Felix Limbani, Jacqueline Roseleur, Francesc Xavier Gómez-Olivé

Research output: Contribution to journalArticlepeer-review

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Background Current policy in South Africa requires measurement of blood pressure at every visit in primary care. The number of patients regularly visiting primary care clinics for routine care is increasing rapidly, causing long queues, and unmanageable workloads. Methods We used data collected during a randomised control trial in primary care clinics in South Africa to estimate how changes in policy might affect workloads and improve identification of undiagnosed hypertension. Results The prevalence of raised blood pressure increased with age; 65% of individuals aged over 60 years had a raised blood pressure, and 49% of them were not on any treatment. Over three months, eight health facilities saw 8,947 individual chronic disease patients, receiving 22,323 visits from them. Of these visits, 60% were related to hypertension, with or without HIV, and a further 35% were related to HIV alone. Long waits for blood pressure checks caused friction at all levels of the clinics. Blood pressure machines frequently broke down due to heavy use, and high blood pressures readings were often ignored. If chronic disease patients without a diagnosis of hypertension had their blood pressure checked only once a year, the number of checks would be reduced by more than 80%. Individuals with hypertension had a blood pressure check on average once every 7 weeks, but South African guidelines recommend that this should be done every 3 months at most. Conclusions The numbers of chronic disease patients in primary care clinics in South Africa is rising rapidly. New policies for measuring blood pressure in these patients attending clinics are urgently needed.

Original languageEnglish
Article numbere0208983
Number of pages13
JournalPLoS One
Issue number1
Publication statusPublished - 10 Jan 2019
Externally publishedYes

Bibliographical note

Copyright:©2019 Thorogood et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproductionin any medium, provided the original author and source are credited.


  • hypertension
  • blood pressure
  • primary care
  • primary hypertension
  • HIV diagnosis and management
  • nurses
  • screening guidelines
  • South Africa


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