Blood Pressure and Blood Glucose Control and Associated Factors Among Adults with Hypertension at Three Public Hospitals in Southern Ethiopia

Prevalence of uncontrolled hypertension and contributing factors in Ethiopia: a systematic review and meta-analysis

Background

Uncontrolled hypertension (HTN) is a major risk factor for cardiovascular and cerebrovascular disease. The prevalence of HTN in the Ethiopian adult population is almost 20%.This study aimed to determine the prevalence of uncontrolled HTN and its contributing factors among patients with HTN in Ethiopia undergoing treatment.

Methods

Electronic bibliographic databases such as PubMed, Google Scholar, Hinari (Research4Life), Embase, and Scopus were searched for original records in the English language that assessed HTN control in Ethiopia and were available before 29 June 2023. The data were extracted using a format prepared in Microsoft Excel and exported to the software STATA 17.0 for analysis. The study protocol was registered at PROSPERO with the reference number CRD42023440121.

Results

A total of 26 studies with 9,046 patients with HTN were included in the systematic review and meta-analysis, of which 11 studies were used to assess factors contributing to uncontrolled blood pressure (BP) in patients in Ethiopia. The estimated prevalence of uncontrolled HTN in the population of Ethiopia is 51% [95% confidence interval (CI), 42%-60%]. The subgroup analysis, based on the assessment tools, region, and follow-up period, revealed that the prevalence of uncontrolled BP was highest following the guidelines of the American Heart Association/American College of Cardiology (AHA/ACC) (89%; 95% CI: 87%-91%) and in Addis Ababa (58%; 95% CI: 40%-76%), and the lowest proportion of uncontrolled BP was in the 3-month follow-up period (34%; 95% CI: 29%-39%). The presence of diabetes mellitus showed the highest impact (pooled odds ratio: 5.19; CI: 1.41-19.11) for uncontrolled HTN. The univariate meta-regression method confirmed that the sample size, year of publication, and subgroups were not sources of heterogeneity in the pooled estimates. Egger's regression test did not indicate the presence of publication bias.

Conclusion

More than half of the hypertensive patients in Ethiopia have uncontrolled BP. Diabetes mellitus, advanced age, male sex, and the presence of comorbidities are among the factors contributing to uncontrolled HTN in Ethiopia. The concerned bodies working in this area should implement interventional strategies and recommendations that might be helpful in achieving optimal BP in hypertensive patients.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023440121, PROSPERO (CRD42023440121).

Blood pressure control and its associated factors in patients with hypertension and type 2 diabetes

In this retrospective study, the medical records of hypertensive patients with type 2 diabetes attending two major hospitals were reviewed to find the factors associated with poor blood pressure control in patients who have diabetes as a comorbid disease with hypertension. Binary regression analysis was conducted to find the factors independently associated with BP control. A total of 522 participants were included in the study. Most of the participants had uncontrolled hypertension (63.4%) and uncontrolled type 2 diabetes (51.3%). Regression results revealed that having retinopathy (OR=1.468 (95% CI: 1.020-2.113), p<0.05), and not receiving dipeptidyl-peptidase 4 (DPP4) inhibitors were independently associated with uncontrolled BP (OR=0.633 (95%CI 0.423-0.946), p<0.05). Therefore, greater efforts should be exerted to improve BP control in hypertensive patients with type 2 diabetes, particularly in those suffering from retinopathy.

Assessment of Glycemic Control in Patients With Diabetes in Northern Sudan Using Calculated HbA1c

BACKGROUND

Diabetes mellitus (DM) significantly burdens health services worldwide. As a simple and cost-effective method, the mathematical calculation of HbA1c is coming to be of value in areas with scarce resources. This study aimed to use calculated HbA1c to ascertain the prevalence of uncontrolled DM and correlate it with the risk factors for DM.

METHODS

In the River Nile State of northern Sudan, a cross-sectional study was conducted in five leading cities from May to August 2021. Patients diagnosed and recorded as having type 2 or type 1 DM were included in this study. Enzymatic methods were used to assess fasting blood glucose (FBG). We used the mean of three FBG readings for three months to calculate HbA1c using the equation {HbA1c = (FBG mg/dl) x 0.03+2.6}, which was used to compute the estimated mediocre blood sugar over the course of three months.

RESULTS

A total of 2047 diabetic patients from northern Sudan were studied for their DM control. Nearly two-thirds (65.2%) had uncontrolled DM. Of the patients studied, uncontrolled DM was significantly positively associated with older age, history of ischemic heart disease, and being a housewife. Multivariate regression analysis showed significant correlations between uncontrolled DM, an inactive lifestyle, and obesity.

CONCLUSION

The prevalence of uncontrolled DM among known patients with diabetic in northern Sudan is high (65.2%). The inactive lifestyles of housewives and freelance workers, having type 1 DM, and being hypertensive and obese are risk factors significantly associated with uncontrolled DM and its related complications.