Adherence to National Standard Treatment Guidelines in the management of hypertension and associated factors among healthcare providers at public district hospitals in Dar es Salaam, Tanzania

Hypertension affects 15-25% of adults in Tanzania, yet fewer than 30% of treated patients achieve blood pressure control. Poor control contributes to stroke, heart failure, and renal disease. The National Standard Treatment Guidelines (NSTGs), 6th edition (2021), provide guidance for management, but healthcare provider adherence to the guidelines remains unclear. A mixed-methods cross-sectional study was conducted at five public district hospitals in Dar es Salaam, Tanzania between 1st April and 31st May 2025. Quantitative data from patient records assessed healthcare provider adherence to pharmacological treatment, complication monitoring, and comorbidity screening, categorized as complete, partial, or non-adherent. Modified Poisson regression identified associated patient and provider factors. Qualitative data from 11 in-depth interviews were thematically analysed to explore barriers and facilitators to adherence. The median age of the 397 patients was 55 years (IQR: 52-61), 79.1% were female, 40.0% had at least one comorbidity, and 65.2% were overweight. Only 26.2% were managed with complete adherence to NSTGs. Higher adherence was associated with follow-up visits (aPR = 5.81; 95% CI: 1.59-21.27), Grade 1 hypertension (aPR = 3.87; 95% CI: 1.99-7.53), Grade 2 hypertension (aPR = 5.06; 95% CI: 1.52-16.73), comorbidities (aPR = 2.35; 95% CI: 1.25-4.41), specialist cadre (aPR = 7.00; 95% CI: 1.05-46.55), and provider experience of 5-10 years (aPR = 3.25; 95% CI: 1.17-9.03) and >10 years (aPR = 3.91; 95% CI: 1.20-12.73). Barriers included outdated guidelines, limited resources, staffing shortages, and inadequate training, while facilitators included mentorship, peer collaboration, accessible guidelines, and continuing medical education. Healthcare provider adherence to NSTGs in management of hypertension was low. Strengthening guideline implementation through updated recommendations, provider training, improved resource availability, and supportive supervision may enhance adherence and improve patient outcomes.