Relationship between hypertension, diabetes and proteinuria in rural and urban households in Yemen

Abstract

Little information is available on the meanings of proteinuria in low-resource settings. A population-based, cross-sectional survey was performed in Yemen on 10 242 subjects aged 15–69 years, stratified by age, gender and urban/rural residency. Hypertension is defined as systolic blood pressure (BP) of ⩾140 mm Hg and/or diastolic BP of ⩾90 mm Hg, and/or self-reported use of antihypertensive drugs; diabetes is diagnosed as fasting glucose of ⩾126 mg dl−1 or self-reported use of hypoglycaemic medications; proteinuria is defined as ⩾+1 at dipstick urinalysis. Odds ratios (ORs) for associations were determined by multivariable logistic regression models. Prevalence (weighted to the Yemen population aged 15–69 years) of hypertension, diabetes and proteinuria were 7.5, 3.7 and 5.1% in urban, and 7.8, 2.6 and 7.3% in rural locations, respectively. Proteinuria and hypertension were more prevalent among rural dwellers (adjusted ORs 1.56; 95% confidence limit (Cl) 1.31–1.86, and 1.23; 1.08–1.41, respectively), diabetes being less prevalent in rural areas (0.70; 0.58–0.85). Differently from hypertension and diabetes, proteinuria was inversely related with age. Most importantly, 4.6 and 6.1% of urban and rural dwellers, respectively, had proteinuria in the absence of hypertension and diabetes. The approach of considering kidney damage as a consequence of hypertension and diabetes might limit the effectiveness of prevention strategies in low-income countries.

Cardiovascular risk assessment in low-resource settings

“…Data are expressed as percentage of urban or rural individuals, the absolute number being reported in brackets [112].…”

Cardiovascular health in migrants

“…The integration of screening for chronic kidney disease with cardiovascular health programs might indeed increase health awareness among migrant communities. [97][98][99][100] Several recent studies are providing evidence that most forms of renal impairment can be prevented or delayed. 101,102 It is thus important to ensure that best practice with respect to BP and diabetes care is implemented for all patients.…”

Need for Better Blood Pressure Measurement in Developing Countries to Improve Prevention of Cardiovascular Disease

“…After adjustment for age, urban/rural location, and education category, women were more frequently aware of their hypertensive status (OR 1.29; 95% CI, 1.01–1.64), were more likely to be treated with drugs (OR 1.31; 95% CI, 1.03–1.68), and achieved better BP control (OR 1.75; 95% CI, 1.15–2.67) than men. 44 The favourable effect of urbanization on women with respect to hypertension control has also been consistently observed in different world regions. 45 …”

“…The first point is that we now have evidence that kidney damage hazards (death, CV death, and end-stage renal disease [ESRD]) may be independent of diabetes and hypertension. 75 , 76 Data from Nepal, Bolivia, 77 and Yemen 44 showed that more than 5% of people aged younger than 60 years without previous history of diabetes and hypertension had microalbuminuria/proteinuria. The second point is that in China, where the prevalence of proteinuria is high, 78 glomerulonephritis (mainly post-infectious) is a major cause of CKD.…”