Cardiovascular Journal of Africa: Vol 29 No 4 (July/August 2018)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 4, July/August 2018 218 AFRICA
Hypertension among newly diagnosed diabetic patients
at Mulago National Referral Hospital in Uganda:
a cross sectional study
Martin Muddu, Edrisa Mutebi, Isaac Ssinabulya, Samuel Kizito, Charles Kiiza Mondo
Abstract
Background: The prevalence of hypertension in patients with
diabetes is approximately two-fold higher than in age-matched
subjects without the disease and, conversely, individuals with
hypertension are at increased risk of developing diabetes
compared with normotensive persons. Up to 75% of cases
of cardiovascular disease (CVD) in patients with diabetes are
attributed to hypertension. Diabetics who have hypertension
are more likely to develop complications and die, and appro-
priate blood pressure control in these individuals reduces the
risk. This study sought to determine the prevalence and factors
associated with hypertension among newly diagnosed adult
diabetic patients in a national referral hospital in Uganda.
Methods: In this cross-sectional study, conducted between
June 2014 and January 2015, we recruited 201 newly diagnosed
adult diabetic patients. Information on patients’ socio-demo-
graphics was obtained using a pre-tested questionnaire, while
biophysical profile, blood pressure measurement, biochemical
testing and echocardiographic findings were obtained by the
research team for all the participants. Bivariate and multi-
variate logistic regression analyses were used to investigate the
association of several factors with hypertension.
Results: Of the 201 patients recruited, 102 were male (50.8%)
and the mean age was 46 ± 15 years. The majority of patients
(159) had type 2 diabetes mellitus (DM) (79.1%) with a mean
HbA1c level of 13.9 ± 5.3%. The prevalence of hypertension
was 61.9% (95% CI: 54.8–68.6%). Knowledge of hypertension
status was at 56 (27.7%) patients, 24 (44.4%) hypertensives
were on treatment, and 19 (33.9%) were using ACE inhibi-
tors/angiotensin receptor blockers. The independent factors
associated with hypertension were being employed (OR 0.37,
95% CI: 0.16–0.90, p = 0.029) and being overweight or obese
(OR 11.6, 95% CI: 4.29–31.2, p < 0.0001).
Conclusion: The prevalence of hypertension was high in this
population of newly diagnosed diabetics, few patients had
knowledge of their hypertension status and few were on
appropriate treatment. Both modifiable and non-modifiable
risk factors were associated with hypertension in this group.
Therefore routine assessment, treatment and control of
hypertension among diabetics is necessary to prevent cardio-
vascular complications and death. There is also a need to
address the modifiable risk factors.
Keywords: hypertension, newly diagnosed, diabetes, Uganda
Submitted 21/5/16, accepted 5/3/18
Published online 20/4/18
Cardiovasc J Afr 2018; 29: 218–224
DOI: 10.5830/CVJA-2018-015
The burden of non-communicable diseases (NCDs) is increasing
rapidly in sub-Saharan Africa. 1 It is anticipated that NCDs
may account for 46% of deaths in sub-Saharan Africa by 2030,
compared to 28% in 2008.1 Hypertension and diabetes mellitus
(DM) are of particular concern; however, precise epidemiological
data are rare.1-4 One of the commonest NCDs experienced during
this early stage of the epidemiological transition is hypertension.
It is predicted that more than 125 million adults in sub-Saharan
Africa alone will have hypertension by 2025,5,6 and in Uganda,
hypertension is the most reported NCD.7-10
Increasing urbanisation and associated lifestyle changes
as well as improvements in life expectancy have contributed
to a surge in NCDs, including hypertension.1,5 Likewise, the
prevalence of DM is on a rise in sub-Saharan Africa and will
more than double by 2025.11
The prevalence of hypertension in patients with diabetes
is approximately two-fold higher than in age-matched
subjects without the disease,12-14 and conversely, individuals
with hypertension are at increased risk of developing diabetes
compared with normotensive persons. Furthermore, up to
75% of cases of cardiovascular disease (CVD) in patients
with diabetes can be attributed to hypertension.15 CVD,
especially stroke, accounts for up to 80% of all deaths in the
diabetic population and three-quarters of these deaths occur in
sub-Saharan Africa.16,17
The high burden of hypertension in diabetics has led to an
increase in the risk and prevalence of cardiac abnormalities in
diabetes.18 Also, life expectancy in sub-Saharan Africa has risen
in the past 50 years. Many more people living with diabetes are
therefore exposed to the risk of hypertension for long periods
for the complications to develop and for them to experience the
clinical syndromes of CVD.19
Diabetics who have hypertension are more likely to develop
complications and die, and appropriate blood pressure control
in these individuals reduces the risk. The lower the systolic
blood pressure, the lower the risk of complications. 12 There is an
additional risk reduction with angiotensin converting enzyme
inhibitors (ACE inhibitors) and β -blockers over and above that
associated with lowering of blood pressure.12
In patients with type 2 DM, hypertension is associated with
left ventricular hypertrophy (LVH),20,21 which is an independent
Department of Medicine, College of Health Sciences, Makerere
University, Mulago Hospital Complex, Mulago, Uganda
Martin Muddu, MB ChB, MMed,
Edrisa Mutebi, MB ChB, MSc, MMed
Isaac Ssinabulya,MB ChB, MMed
Charles Kiiza Mondo, MB ChB, MMed, PhD
Clinical Epidemiology Unit, College of Health Sciences,
Makerere University, Mulago, Uganda
Samuel Kizito, MB ChB, MSc