Clinical Audit of Non-Selective Beta Blockers Titration in the Management of Portal Hypertension at a National Hospital in Tanzania

Swaleh Kitabu Pazi,1 Ally Hamisi Mwanga,2 Tuzo A Lyuu,1 Masolwa Ng’wanasayi,3 John Rwegasha,1 Ewaldo Vitus Komba,4 Igembe Nkandala5 1Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania; 2Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 3Department of Internal Medicine, Aga Khan Hospital, Dar es Salaam, Tanzania; 4Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 5Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, TanzaniaCorrespondence: Igembe Nkandala, Department of Internal Medicine, Catholic University of Health and Allied Sciences, P.O Box 1464, Mwanza, Tanzania, Tel +255 717 301956, Email igembe2002@yahoo.comBackground: Portal hypertension – a major complication of chronic liver disease – is associated with multiple complications that include ascites, varices, and hepatic encephalopathy; these complications can lead to substantial morbidity and mortality. Randomized control trials have demonstrated the efficacy of nonselective beta blockers (NSBB) for preventing primary and secondary gastroesophageal variceal bleeding. These drugs should be titrated to target the resting heart rate of 55– 60 beats per minute and the systolic blood pressure should not decrease < 90 mm Hg. The objective of this study was to perform an audit of the titration of nonselective beta blockers in patients with portal hypertension at the national referral hospital.Methods: The audit involved all adults aged 18 years and above with portal hypertension and evidence of esophageal varices who were regularly attending gastroenterology and hepatology clinics of Muhimbili National Hospital between January 2019 and December 2019. The patients’ clinical data were extracted from the electronic medical records. Permission to conduct the study was obtained from the hospital management.Results: Over the a