Background: Cardiovascular disease is a disorder of cardiac and blood vessels which includes myocardial infarction, heart failure and stroke. Annually 17.7 million deaths in the world were caused by cardiovascular disease. Of these 80 % death were in sub-Saharan Africa.  Ethiopia had also 22% of cardiovascular complications among hypertensive clients. Though hypertension is the leading cause for cardiovascular complications, there is limited evidence on different factors which could cause cardiovascular complications. On top of this, time to develop different cardiovascular complications among hypertensive clients is not adequately investigated in Ethiopia in general and in Tigray in particular.

Objective: The aim of this study was to assess time to develop cardiovascular complications and its predictors among adult hypertensive clients at Ayder Comprehensive Specialized Hospital, Tigray, Northern Ethiopia, 2018.

Method: Five years retrospective cohort study was conducted on 578 hypertensive clients who had follow –up at Ayder comprehensive specialized hospital. Medical records review was used to collect the required variables. Data were entered and cleaned using Epi-data manager version 4.2 and analysed by SPSS version 23 and STATA version 13. Every independent variable was tested in log-rank test against dependent variable and all variables with P-value <0.25 were taken to the Cox regression model. Then Cox-regression analysis was performed to estimate the hazard ratio and finally, statistical significance was declared at P-values < 0.05.

Result: A total of 578 records of hypertensive clients were taken from cardiac follow -up and followed for total months of 60 and for 28 months median time. From the total of 578 of hypertensive clients considered, 25.4% of them developed complications while the rest 74.6% were censored. The overall survival and hazard probability was 64%, and 36% at 95% CI, (60% - 69.8%), 95% CI, (30.2%-39.9%) respectively in 60 months follow up time. The incidence rate was 8.25 per 1000 per person month. After adjustment, the independent significant predictors of cardiovascular complications among hypertensive clients were age [AHR(95% CI ) = 1.03 (1.016-  1.046) ], baseline  cardiovascular complication [AHR=3.03 (95%CI=  (2.009- 4.870) ], protein urea [AHR=3.9(95%CI=  1.3- 11.68) ],  baseline systolic blood pressure [AHR(95% CI)=1.01(1.003,2.012) ], and  baseline diastolic blood pressure [AHR (95%CI= 1.013 (1.005, 2.021)].

Conclusion: The major predictors that affect the cardiovascular complications are; baseline cardiovascular complication, diastolic blood pressure, systolic blood pressure, proteinuria and age. Early screening and treatment is the basic to prevent and control of CVC among hypertensive clients.

Key words: Ayder Comprehensive Specialized Hospital, Ethiopia, Cardiovascular complications, Hypertension, Survival analysis