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RESEARCH ARTICLE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
60
VOLUME 15 NUMBER 2 • NOVEMBER 2018
Discussion
The prevalence of hypertension among newly diagnosed diabetics
was high in this group, with more than six patients out of 10 having
hypertension. This is in keeping with earlier studies, which found
that the prevalence of hypertension in patients with diabetes was
approximately two-foldhigher than inage-matched subjectswithout
the disease,
12-14
and conversely, individuals with hypertension were at
increased risk of developing diabetes compared with normotensive
persons.
15
In Uganda, the prevalence of hypertension among non-diabetics
ranges between 20 and 35%, with a higher prevalence in the urban
areas.
10,34-37
This is consistent with evidence from other parts of sub-
Saharan Africa that indicated the prevalence of hypertension was
between 20 and 50%.
7,35,37-40
Therefore, the prevalence we found
of 62% in diabetic subjects is approximately twice the current
prevalence of hypertension in non-diabetic patients in Uganda.
Unfortunately only one-quarter of all those who are hypertensive
know their status, and this is evident from other studies in the
region, which found that the majority of patients with hypertension
in sub-Saharan Africa did not know they were hypertensive and
very few were on treatment, yet hypertension is the leading cause
of stroke in Africa. In another cross-sectional study in Uganda,
awareness of hypertension was low, at less than 30%.
7
This low awareness could be explained by the fact that only
27.8% of the population ever has their blood pressure measured in
Uganda. Awareness of hypertension largely depends on the capacity
of the health system to provide diagnostic services for hypertension
to the general population.
40
Unfortunately, the healthcare system in
Uganda is largely constrained by communicable diseases and NCDs
have not received the attention they deserve.
7
In order to increase
awareness, there is a need to screen all adults at an appropriate
opportunity when they come into contact with the health system.
This could even be done through outreaches and community
programmes.
7,41,42
Furthermore, among those who knew they had hypertension,
less than half were on treatment. This is similar to what earlier
studies found, and this carries a great risk for the complications
of diabetes, especially CVDs such as stroke, LVH, myocardial
infarction, as reported by the United Kingdom Prospective Diabetes
Study (UKPDS). In one cross-sectional study among people with
hypertension in Uganda, less than 10% were controlled. In
another retrospective study conducted in an urban diabetes clinic
in Kampala, optimal blood pressure control, defined as ≤ 140/80
mmHg, was noted in 56% of the patients.
43
This corroborates the notion that blood pressure control among
adult diabetic patients in Uganda is sub-optimal. This calls for the
Table 4.
Logistic regression for factors associated with hypertension among 201 newly diagnosed diabetic patients at Mulago Hospital
Hypertension
Factors
Absent,
n
(%)
Present,
n
(%)
Crude OR (95% CI)
p
-value
Adjusted OR (95%)
p
-value
Gender
Male
48 (47.1)
54 (52.9)
1
Female
27 (27.3)
72 (72.7)
2.37 (1.32–4.27)
0.004
Age
< 40 years
37 (63.8)
21 (36.2)
1
1
> 40 years
38 (26.6)
105 (73.4)
4.87 (2.54–9.34)
< 0.0001
2.49 (0.62–9.95)
0.197
Employment
Unemployed
39 (31.5)
85 (68.6)
1
1
Employed
35 (46.1)
41 (53.9)
0.54 (0.30–0.97)
0.039
0.37 (0.16–0.90)
0.029
Marital status
No longer married
17 (32.1)
36 (67.9)
1
1
Never married
22 (75.9)
7 (24.1)
7.25 (2.84–18.5)
< 0.0001
2.86 (0.69–11.9)
0.149
Currently married
36 (30.3)
83 (69.8)
6.66 (2.38–18.6)
< 0.0001
1.37 (0.28–6.63)
0.703
HbA
1c
Normal
4 (26.7)
11 (73.3)
1
Abnormal
62 (38.0)
101 (61.9)
0.59 (0.18-1.94)
0.387
Microalbuminuria
Normal
30 (37.5)
50 (62.5)
1
Abnormal
37 (38.3)
58 (61.1)
0.94 (0.51-1.74)
0.844
BMI
Normal weight
66 (56.4)
51 (43.6)
1
1
Overweight, obesity
9 (10.7)
75 (89.3)
10.8 (4.9–23.6)
< 0.0001
11.6 (4.29–31.2)
< 0.0001
Waist:hip ratio
Normal
59 (42.1)
81 (57.9)
1
1
Abnormal
16 (26.2)
45 (73.8)
2.05 (1.06–3.97)
0.034
1.03 (0.39–2.73)
0.949
Ejection fraction
> 50%
56 (35.4)
102 (64.6)
1
< 50%
19 (44.2)
24 (55.8)
0.69 (0.35–1.38)
0.295
LVH
Absent
49 (56.9)
37 (43.0)
1
1
Present
26 (26.5)
89 (77.4)
4.53 (2.46–8.35)
< 0.0001
1.97 (0.88–4.38)
0.098
Diastolic function
Normal
46 (51.1)
44 (48.9)
1
1
Impaired
29 (26.1)
82 (73.9)
2.96 (1.64–5.34)
< 0.0001
0.94 (0.40–2.18)
0.885
HbA
1c
: glycated haemoglobin, BMI: body mass index, LVH: left ventricular hypertrophy