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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 4, July/August 2018
AFRICA
221
were employed, participants who were never married and those
who were currently married, overweight and obesity, increase in
waist:hip ratio, LVH and diastolic dysfunction (Table 4). After
adjusting for the patients’ gender, age, employment, marital
status, BMI, waist:hip ratio, LVH and diastolic dysfunction,
the only significant factors associated with hypertension were
being employed (OR 0.37, 95% CI: 0.16–0.90,
p
=
0.029), and
overweight and obesity (OR 11.6, 95% CI: 4.29–31.2,
p
<
0.0001).
Discussion
The prevalence of hypertension among newly diagnosed
diabetics was high in this group, with more than six patients out
of 10 having hypertension. This is in keeping with earlier studies,
which found that the prevalence of hypertension in patients with
diabetes was approximately two-fold higher than in age-matched
subjects without the disease,
12-14
and conversely, individuals
with hypertension were at increased risk of developing diabetes
compared with normotensive persons.
15
In Uganda, the prevalence of hypertension among
non-diabetics ranges between 20 and 35%, with a higher
prevalence in the urban areas.
10,34-37
This is consistent with
evidence from other parts of sub-Saharan Africa that indicated
the prevalence of hypertension was between 20 and 50%.
7,35,37-40
Therefore, the prevalence we found of 62% in diabetic subjects
is approximately twice the current prevalence of hypertension in
non-diabetic patients in Uganda.
Unfortunately only one-quarter of all those who are
hypertensive know their status, and this is evident from other
studies in the region, which found that the majority of patients
with hypertension in sub-Saharan Africa did not know they were
hypertensive and very few were on treatment, yet hypertension is
the leading cause of stroke in Africa. In another cross-sectional
study in Uganda, awareness of hypertension was low, at less than
30%.
7
This low awareness could be explained by the fact that only
27.8% of the population ever has their blood pressure measured
in Uganda. Awareness of hypertension largely depends on the
capacity of the health system to provide diagnostic services
for hypertension to the general population.
40
Unfortunately,
the healthcare system in Uganda is largely constrained by
communicable diseases and NCDs have not received the attention
they deserve.
7
In order to increase awareness, there is a need to
screen all adults at an appropriate opportunity when they come
into contact with the health system. This could even be done
through outreaches and community programmes.
7,41,42
Table 4. Logistic regression for factors associated with hypertension among 201 newly diagnosed diabetic patients at Mulago Hospital
Factors
Hypertension
Crude OR (95% CI)
p
-value
Adjusted OR (95%)
p
-value
Absent,
n
(%)
Present,
n
(%)
Gender
Male
48 (47.1)
54 (52.9)
1
Female
27 (27.3)
72 (72.7)
2.37 (1.32–4.27)
0.004
Age
<
40 years
37 (63.8)
21 (36.2)
1
1
> 40 years
38 (26.6)
105 (73.4)
4.87 (2.54–9.34)
<
0.0001
2.49 (0.62–9.95)
0.197
Employment
Unemployed
39 (31.5)
85 (68.6)
1
1
Employed
35 (46.1)
41 (53.9)
0.54 (0.30–0.97)
0.039
0.37 (0.16–0.90)
0.029
Marital status
No longer married
17 (32.1)
36 (67.9)
1
1
Never married
22 (75.9)
7 (24.1)
7.25 (2.84–18.5)
<
0.0001
2.86 (0.69–11.9)
0.149
Currently married
36 (30.3)
83 (69.8)
6.66 (2.38–18.6)
<
0.0001
1.37 (0.28–6.63)
0.703
HbA
1c
Normal
4 (26.7)
11 (73.3)
1
Abnormal
62 (38.0)
101 (61.9)
0.59 (0.18-1.94)
0.387
Microalbuminuria
Normal
30 (37.5)
50 (62.5)
1
Abnormal
37 (38.3)
58 (61.1)
0.94 (0.51-1.74)
0.844
BMI
Normal weight
66 (56.4)
51 (43.6)
1
1
Overweight, obesity
9 (10.7)
75 (89.3)
10.8 (4.9–23.6)
<
0.0001
11.6 (4.29–31.2)
<
0.0001
Waist:hip ratio
Normal
59 (42.1)
81 (57.9)
1
1
Abnormal
16 (26.2)
45 (73.8)
2.05 (1.06–3.97)
0.034
1.03 (0.39–2.73)
0.949
Ejection fraction
> 50%
56 (35.4)
102 (64.6)
1
<
50%
19 (44.2)
24 (55.8)
0.69 (0.35–1.38)
0.295
LVH
Absent
49 (56.9)
37 (43.0)
1
1
Present
26 (26.5)
89 (77.4)
4.53 (2.46–8.35)
<
0.0001
1.97 (0.88–4.38)
0.098
Diastolic function
Normal
46 (51.1)
44 (48.9)
1
1
Impaired
29 (26.1)
82 (73.9)
2.96 (1.64–5.34)
<
0.0001
0.94 (0.40–2.18)
0.885
HbA
1c
: glycated haemoglobin, BMI: body mass index, LVH: left ventricular hypertrophy.