Impact of Hypertension on Heart Failure in Morocco (2018–2023): A Comparative Study between a Hospitalized Cohort and a Hypertensive Outpatient Population

Abstract

Background: Hypertension (HTN) is the leading modifiable risk factor for heart failure (HF) worldwide, particularly in low- and middle-income countries where blood pressure control remains suboptimal. Despite extensive international evidence, local data from Sub-Saharan Africa, including Morocco, remain limited. Objective: To evaluate the impact of HTN on the clinical profile and outcomes of hospitalized HF patients in Morocco (2018–2023), and to compare their characteristics with those of a hypertensive outpatient cohort. Methods: We conducted a retrospective observational study (2018–2023) including two cohorts at Ibn Rochd University Hospital, Casablanca: a hospital-based cohort of 3867 patients admitted with HF, and an outpatient cohort of 226 patients followed for HTN. HF patients were stratified according to the presence or absence of HTN. Demographic, clinical, biological, and outcome variables were compared. Sampling was consecutive and exhaustive. Ethical approval was obtained (IRB No. 2023/45). Results: The prevalence of HTN among hospitalized HF patients was 38% (1466/3867). Compared to HF without HTN, hypertensive HF patients were significantly older (67 ± 11 vs. 61 ± 12 years, p<0.001), more often female (46% vs. 29%, p<0.01), and had higher rates of diabetes (40.4% vs. 19.2%, p<0.001) and dyslipidemia (15.4% vs. 6.4%, p<0.001). Smoking was less prevalent (22.6% vs. 32.1%, p<0.05). In-hospital mortality was slightly higher in the HF + HTN group (7.7% vs. 6.3%, p=0.04). Compared with outpatients, hypertensive inpatients were older, had more comorbidities, more frequent target organ damage, and worse outcomes. Conclusion: HTN is a major determinant of HF in Morocco, associated with older age, female predominance, greater comorbidity burden, and worse outcomes. Strengthening early detection, strict BP control, and community-based strategies is essential to reduce HF burden.