Hypertension, Race, and Renal Insufficiency

Tierney, William M.; Luft, Friedrich C.; Dumler, Francis; Pettinger, William A.; Jeffries, William B.; Lee, Hing Chung; Batuman, Vecihi; Goldfarb, David S.; Rostand, Stephen G.; Rutsky, Edwin A.; Brown, Grace; Dustan, Harriet P.; Kirk, Katharine A.

doi:10.1056/nejm198909073211017

Cited by 2 publications

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“…Complications in diabetes occur as a result of the injurious effects of hyperglycemia 4. Long-term complications of diabetes can be broadly classified into two major categories: macrovascular (eg, peripheral arterial disease, stroke, and coronary artery disease) and microvascular (eg, retinopathy, neuropathy, and nephropathy) 4. Other complications experienced by diabetic patients include skin complications, gastroparesis, dental infections, and depression 5.…”

Section: Introductionmentioning

confidence: 99%

“…Other complications experienced by diabetic patients include skin complications, gastroparesis, dental infections, and depression 5. Common cardiovascular disease (CVD) events experienced by patients with diabetes include coronary heart diseases, myocardial infarction, stroke, cerebrovascular diseases, erectile dysfunction, and peripheral vascular diseases 4–6…”

Section: Introductionmentioning

confidence: 99%

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Predictors of poor glycemic control in type 2 diabetic patients attending public hospitals in Dar es Salaam

Kamuhabwa¹,

Charles²

2014

DHPS

103

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BackgroundTanzania has recently experienced a significant rise in the burden of diabetes, and it is estimated that more than 400,000 people are living with diabetes. A major concern in the management of diabetes is the occurrence of diabetic complications that occur as a result of poor glycemic control. Identification of the factors associated with poor glycemic control is important in order to institute appropriate interventions for the purpose of improving glycemic control and prevention of chronic complications.AimThe aim of this study was to determine the level of glycemic control and explore the factors associated with poor glycemic control among patients with type 2 diabetes mellitus (T2DM).MethodologyA cross-sectional study was carried out at the diabetic clinics for T2DM patients at the national and municipal hospitals in Dar es Salaam. A total of 469 patients were enrolled over a period of 8 weeks from March 2013 to May 2013. Patients’ information such as sociodemographic characteristics, self-care management behaviors, and medication adherence were obtained through interviews. Blood pressure, weight, and height were measured during the day of the interview. All available last readings for fasting blood glucose (FBG) measurements, lipid profile, and other clinical characteristics were obtained from patients’ records.ResultsThe mean age of patients was 54.93 years. The majority (63.5%) of patients were females and only eight patients had records of lipid profile measurements. Out of 469 patients, 69.7% had FBG of ≥7.2 mmol/L, indicating poor glycemic control. Females aged between 40 years and 59 years had significantly higher poor glycemic control (76.1%) as compared with their male counterparts. Thirty-eight percent of patients had poor medication adherence, which was associated with poor glycemic control. The proportion of poor glycemic control increased with age. A significantly high proportion of poor glycemic control was observed in patients who had had the disease for more than 20 years since diagnosis. Factors associated with poor glycemic control included lack of health insurance, using more than one oral hypoglycemic agent, normal body mass index, obesity, and nonadherence to diabetic medications.ConclusionPatients in this study had generally poor glycemic control. From these findings it is recommended that diabetic patients should be routinely screened for lipid profile to determine levels of cholesterol, triglycerides, and low-density lipoproteins, which are risk factors for cardiovascular events. An education program should be developed to educate patients on the importance of medication adherence and weight management for better glycemic control.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predictors of poor glycemic control in type 2 diabetic patients attending public hospitals in Dar es Salaam

Kamuhabwa¹,

Charles²

2014

DHPS

103

View full text Add to dashboard Cite

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Hypertension in Blacks

Cooper

1997

American Journal of Hypertension

196

115

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The excess of hypertension among blacks has been recognized since early in this century and explains a substantial portion of the black health disadvantage. In a cohort study begun in the 1970s, hypertension accounted for 20% of all-cause mortality among blacks, compared to 10% among whites. National data on trends in hypertension (140/90 mm Hg or treatment) prevalence from 1960 to 1990 suggest a decline from 44% to 32%, although differences in survey technique likely account for this pattern. During this period the prevalence ratio of black:white remained constant at 1.5, suggesting that secular trends in causal factors, if any, effected both groups equally. Recent data demonstrate a gradient in risk across the African diaspora, with standardized prevalences of 14% in West Africa and 26% in the Caribbean, compared to 33% in the US. This pattern parallels the gradient in known risk factors, with obesity alone accounting for a third of the excess in the US compared to Africa. Why the black excess of hypertension in the US? Despite widespread speculation, unique characteristics of hypertension among blacks have yet to be established. Consistent evidence demonstrates a similar impact of the known risk factors in all population groups. Epidemiologic evidence likewise suggests that a similar risk of complications exists with blood pressure elevation among blacks and whites, level for level. Although the genetic epidemiology of hypertension is still in its infancy, no clear cross-population differences are yet apparent. Pathophysiologic traits that are known to be part of the causal etiologic pathway have not been shown to vary across groups. Unique features of this condition among blacks are likely to be restricted to the different mixes and intensities of risk factors. In the absence of evidence to support the hypothesis, it is perhaps surprising that credence continues to be given to the notion of black exceptionalism. Am J

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Hypertension, Race, and Renal Insufficiency

Cited by 2 publications

References 13 publications

Predictors of poor glycemic control in type 2 diabetic patients attending public hospitals in Dar es Salaam

Predictors of poor glycemic control in type 2 diabetic patients attending public hospitals in Dar es Salaam

Hypertension in Blacks

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