Determinants of hypertension among diabetic patients in Public Hospitals of the Central Zone, Tigray, Ethiopia 2018: unmatched case-control study

Abstract

Introduction Hypertension, among diabetic patients, is a worldwide public-health challenge and a leading modifiable risk factor for other cardiovascular diseases. The main purpose of this study was to identify determinants of hypertension among diabetic patients. Methods Data were collected from January to March 2018 using an interviewer-administered structured questionnaire. Data collectors and supervisors were trained before the period of data collection. The questionnaire was pretested on 5% of the sample at Suhul hospital. Bivariable logistic regression was employed to examine the crude associations between the outcome variable and determinant variables. This was followed by multivariable analysis to examine the determinants of hypertension among diabetic patients by selecting variables which had p value ≤0.2 in the bivariable analysis. Results The age range of the respondents was 18-80 years, with the median age of 51.56±14.92 years. Not attending diabetes mellitus education sessions (AOR=2.61, 95% CI (1.12,6.1), duration since diagnosis with diabetes (AOR=8.52; 95% CI (1.97, 36.84), poor glycemic control (AOR=22.99, 95CI (5.92,89.28), overweight (AOR=4.84, 95%CI (1.42,16.51), and non-adherence to diabetes medication (AOR=4.66, 95% CI (2.22,9.79), diet (AOR=9.70,95% CI (3.34,28.22), exercise (AOR= 5.47, 95% CI (2.35,12.75), and self-monitoring blood glucose (AOR=6.62, 95% CI (3.16, 13.86) were found to be the determinants of hypertension among diabetic patients. Conclusion This research concludes that longer duration with diabetes, nonattendance of diabetes education sessions, poor glycemic control, and not-adherence to antidiabetic medications, diet, exercise and self-monitoring blood glucose were found to be the determinants of hypertension among diabetic patients.

<p>Hypertension and Its Associated Factors Among Type 2 Diabetes Mellitus Patients at Debre Tabor General Hospital, Northwest Ethiopia</p>

“…Different studies showed that an increase in the duration of T2 DM is associated with an increased prevalence of hypertension. 20,28,37,38 On the contrary, the prevalence of HTN in this study is lower than the findings reported in Jordan (72.4%) 38 and Iraq (89.6%). 20 The higher prevalence in these studies is most likely due to the cut point used for the diagnosis of hypertension, which was defined at a lower level of blood pressure (>130/80 mmHg).…”

“…So the higher BMI in Jordan might be the possible cause for the higher prevalence of hypertension because high BMI is associated with increased risk of hypertension. 20,28,[38][39][40][41][42] The higher prevalence of hypertension reported in three Moroccan regions (70.4%) 29 is perhaps related to the fact that most diabetics were aged 60 years old and over, having a high risk of hypertension. 29,43,44 The odds of getting HTN among T2DM patients was higher in the age group of 50-59 years than the age group of <50 years.…”

“…Consistently, other studies reported that the duration of T2DM has a direct relationship with the prevalence of hypertension. 20,28,38 This might be because as the duration of T2DM increases the effect of hyperglycemia, dyslipidemia, and insulin resistance will be more pronounced. 53 As the duration gets longer, changes caused by diabetes mellitus, such as micro-vascular damage, sympathetic damage, an enhanced renin-angiotensin system, and decreased insulin sensitivity will get worse and aggravate hypertension.…”

“…This finding is in agreement with different studies in different countries. 20,28,[38][39][40][41] The possible justification for the association between BMI and hypertension is due to the reason that obesity increases salt and water reabsorption in the kidney by directly activating mineralocorticoid receptors. This leads to an increase in blood volume and finally hypertension.…”

“…We used pre-tested interviewer-administered questionnaire to collect the data. The questionnaire were adapted from relevant literatures 19,20,24,25,[28][29][30][31] and reviewed by clinicians in diabetes care to ensure its content validity. It was initially prepared in English by language experts, and translated into the local language (Amharic) and then retranslated to English by another expert to ensure its consistency.…”