High prevalence of uncontrolled hypertension among patients with type 2 diabetes mellitus: a hospital-based cross-sectional study in southwestern Uganda

Abstract

Introduction most patients with diabetes mellitus are prone to uncontrolled blood pressures despite effective medical therapies; only about 30% of hypertensive patients have their blood pressures controlled. Poor control of hypertension is associated with increased risk for cardiovascular mortality and morbidity. We aimed to determine the prevalence and associated factors of uncontrolled hypertension among patients with type 2 diabetes mellitus (T2DM) attending ambulatory care at Mbarara Regional Referral Hospital, Southwestern Uganda. Methods we conducted a cross-sectional study from January to April 2019, among hypertensive T2DM patients. We used a structured questionnaire to obtain data on socio-demographic and clinical characteristics. We defined uncontrolled hypertension in participants with blood pressure ≥140/90mmHg and performed binary logistic regression to determine factors associated with uncontrolled hypertension. Results we analyzed data of 206 hypertensive participants with concomitant T2DM, with a median age of 54 (IQR, 49-60) years, and median duration of diabetes of 4 (IQR, 3-8) years; 71% were female. The prevalence of uncontrolled hypertension was 82.5% (170/206). Isolated systolic hypertension (aOR=7.58; 95%CI: 2.18-26.36, P=0.001) and left ventricular hypertrophy (LVH) (aOR=5.38; 95%CI: 1.11-26.10, P=0.037) were significantly associated with uncontrolled hypertension. Conclusion this study revealed a high prevalence of uncontrolled hypertension among T2DM patients in Southwestern Uganda. Isolated systolic hypertension and LVH were the key factors associated with uncontrolled hypertension. We recommend optimization therapy to reduce the burden of uncontrolled hypertension among patients with T2DM especially in those with isolated systolic hypertension, and left ventricular hypertrophy, who are at higher cardiovascular risk.

Predictors of non-adherence to antihypertensive medications: A cross-sectional study from a regional hospital in Afghanistan

“…In this study, we found that 71.2% of the patients had poor control of their BP. This finding is consistent with previous studies conducted in Afghanistan [ 4 , 10 ] and other developing countries [ 7 – 9 ]. There are several examples in the literature that non-adherence to AHMs also plays a significant role in the suboptimal control of hypertension [ 9 – 11 ].…”

“…This finding is consistent with previous studies conducted in Afghanistan [ 4 , 10 ] and other developing countries [ 7 – 9 ]. There are several examples in the literature that non-adherence to AHMs also plays a significant role in the suboptimal control of hypertension [ 9 – 11 ]. In Afghanistan, the high prevalence of uncontrolled hypertension compounded with poor adherence to AHMs raises causes for concern and action.…”

“…The rate of blood pressure (BP) control differs between countries. In resource-poor countries such as India, Ethiopia, and Uganda, the level of controlled BP among treated patients was 17.5% [ 7 ], 47.9% [ 8 ], and 18% [ 9 ], respectively. In Afghanistan (with its healthcare system still recovering from years of conflict), the national prevalence of uncontrolled hypertension is ~80%, warranting immediate attention [ 4 , 10 ].…”

“…Adherence to AHMs varies globally, influenced by sociodemographic factors and lifestyle choices [11][12][13][14][15][16][17][18], leading to marked regional disparities in adherence levels. Moreover, adherence to AHMs is suboptimal, particularly in the developing world [9,[11][12][13][14][15]. For instance, a recent study involving 27 million populations found that the global prevalence of no-adherence to AHMs was high, ranging from 27% to 40% [11].…”

High Prevalence of Uncontrolled Hypertension Among Afghan Hypertensive Patients: A Multicenter Cross-Sectional Study

“…For instance, a recent systematic review and meta-analysis of community based non-interventional studies from India found that the pooled prevalence of uncontrolled hyperextension was as high as 82.5% and had significantly poor control rates in the eastern region. 17 from several other LMICs reported uncontrolled hypertension in 82.5% of the study participants in Uganda, 28 and 52.1% in Ethiopia. 14 Variation in the prevalence of uncontrolled hypertension reported in pertinent literatures can be attributed to variation in socioeconomic status, geographic locations, research methodology, dietary habits of study participants, and other non-explored factors.…”