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SA JOURNAL OF DIABETES & VASCULAR DISEASE
RESEARCH ARTICLE
VOLUME 15 NUMBER 2 • NOVEMBER 2018
57
Hypertension among newly diagnosed diabetic patients
at Mulago National Referral Hospital in Uganda:
a cross sectional study
Martin Muddu, Edrisa Mutebi, Isaac Ssinabulya, Samuel Kizito, Charles Kiiza Mondo
Correspondence to: Martin Muddu
Department of Medicine, College of Health Sciences, Makerere
University, Mulago Hospital Complex, Mulago, Uganda
e-mail:
muddu.martin@gmail.comEdrisa Mutebi, Isaac Ssinabulya, Charles Kiiza Mondo
Department of Medicine, College of Health Sciences, Makerere
University, Mulago Hospital Complex, Mulago, Uganda
Samuel Kizito
Clinical Epidemiology Unit, College of Health Sciences,
Makerere University, Mulago, Uganda
Previously published in
Cardiovasc J Afr
2018;
29
(4): 218–224
S Afr J Diabetes Vasc Dis
2018;
15
: 57–63
Abstract
Background:
The prevalence of hypertension in patients
with diabetes is approximately two-fold higher than in
age-matched subjects without the disease and, conversely,
individuals with hypertension are at increased risk of
developing diabetes compared with normotensive persons.
Up to 75%of cases of cardiovascular disease (CVD) in patients
with diabetes are attributed to hypertension. Diabetics who
have hypertension are more likely to develop complications
and die, and appropriate blood pressure control in these
individuals reduces the risk. This study sought to determine
the prevalence and factors associated with hypertension
among newly diagnosed adult diabetic patients in a national
referral hospital in Uganda.
Methods:
In this cross-sectional study, conducted between
June 2014 and January 2015, we recruited 201 newly
diagnosed adult diabetic patients. Information on patients’
socio-demographics was obtained using a pre-tested
questionnaire, while biophysical profile, blood pressure
measurement, biochemical testing and echocardiographic
findings were obtained by the research team for all the
participants. Bivariate and multivariate logistic regression
analyses were used to investigate the association of several
factors with hypertension.
Results:
Of the 201 patients recruited, 102 were male (50.8%)
and the mean age was 46 ± 15 years. The majority of patients
(159) had type 2 diabetes mellitus (DM) (79.1%) with a mean
HbA
1c
level of 13.9 ± 5.3%. The prevalence of hypertension
was 61.9% (95%CI: 54.8–68.6%). Knowledge of hypertension
status was at 56 (27.7%) patients, 24 (44.4%) hypertensives
were on treatment, and 19 (33.9%) were using ACE
inhibitors/angiotensin receptor blockers. The independent
factors associated with hypertension were being employed
(OR 0.37, 95% CI: 0.16–0.90,
p
= 0.029) and being overweight
or obese (OR 11.6, 95% CI: 4.29–31.2,
p
< 0.0001).
Conclusion:
The prevalence of hypertension was high in this
population of newly diagnosed diabetics, few patients had
knowledge of their hypertension status and few were on
appropriate treatment. Both modifiable and non-modifiable
risk factors were associated with hypertension in this
group. Therefore routine assessment, treatment and control
of hypertension among diabetics is necessary to prevent
cardiovascular complications and death. There is also a need
to address the modifiable risk factors.
Keywords:
hypertension, newly diagnosed, diabetes, Uganda
The burden of non-communicable diseases (NCDs) is increasing
rapidly in sub-Saharan Africa.
1
It is anticipated that NCDs may
account for 46% of deaths in sub-Saharan Africa by 2030,
compared to 28% in 2008.
1
Hypertension and diabetes mellitus
(DM) are of particular concern; however, precise epidemiological
data are rare.
1-4
One of the commonest NCDs experienced during
this early stage of the epidemiological transition is hypertension.
It is predicted that more than 125 million adults in sub-Saharan
Africa alone will have hypertension by 2025,
5,6
and in Uganda,
hypertension is the most reported NCD.
7-10
Increasing urbanisation and associated lifestyle changes as well
as improvements in life expectancy have contributed to a surge in
NCDs, including hypertension.
1,5
Likewise, the prevalence of DM is on
a rise in sub-Saharan Africa and will more than double by 2025.
11
The prevalence of hypertension in patients with diabetes is
approximately two-foldhigher than inage-matched subjectswithout
the disease,
12-14
and conversely, individuals with hypertension are at
increased risk of developing diabetes compared with normotensive
persons. Furthermore, up to 75% of cases of cardiovascular disease
(CVD) in patients with diabetes can be attributed to hypertension.
15
CVD, especially stroke, accounts for up to 80% of all deaths in
the diabetic population and three-quarters of these deaths occur in
sub-Saharan Africa.
16,17
The high burden of hypertension in diabetics has led to an
increase in the risk and prevalence of cardiac abnormalities in
diabetes.
18
Also, life expectancy in sub-Saharan Africa has risen
in the past 50 years. Many more people living with diabetes are
therefore exposed to the risk of hypertension for long periods for
the complications to develop and for them to experience the clinical
syndromes of CVD.
19
Diabetics who have hypertension are more likely to develop
complications and die, and appropriate blood pressure control
in these individuals reduces the risk. The lower the systolic blood
pressure, the lower the risk of complications.
12
There is an additional
risk reduction with angiotensin converting enzyme inhibitors (ACE
inhibitors) and
β
-blockers over and above that associated with
lowering of blood pressure.
12