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RÉSUMÉ
Introduction. L'hypertension artérielle (HTA) du sujet jeune est un problème de santé publique émergent en Afrique subsaharienne, mais ses caractéristiques spécifiques y sont peu documentées. Au Gabon, aucune étude récente n'a décrit le profil de l'HTA chez l'adulte de moins de 40 ans. Cette étude décrit les caractéristiques épidémiologiques, cliniques et le niveau de risque cardiovasculaire des patients hypertendus jeunes suivis au Centre Hospitalier Universitaire de Libreville. Méthodologie. Une étude rétrospective et descriptive a inclus tous les patients âgés de 18 à 39 ans, consultant pour hypertension artérielle (nouvellement diagnostiquée ou connue) dans le service de cardiologie du CHU de Libreville, de janvier 2019 à janvier 2023. Les données sociodémographiques, cliniques (grade d'HTA, signes fonctionnels), les facteurs de risque cardiovasculaire et les complications ont été recueillies et analysées. Résultats. Sur 807 patients hypertendus, 119 (14,7 %) étaient des adultes jeunes, d'âge médian 31 ans, avec une prédominance féminine (sex-ratio H/F 0,72). La tranche d'âge 30-39 ans concentrait 68,9 % des cas. Une HTA de grade III était observée chez 30 % des patients, et une HTA systolo-diastolique dans 63,9 % des cas. Le surpoids/obésité (30,3 %), le tabagisme (10,1 %) et le diabète (6 %) étaient les principaux facteurs de risque associés. Les complications étaient dominées par l'insuffisance rénale (6,7 %), la prééclampsie (4,2 %) et l'insuffisance cardiaque (2,5 %). Au total, 21 % des patients présentaient au moins une atteinte d'organe cible, et 37 % avaient un risque cardiovasculaire élevé ou très élevé. Conclusion. L'HTA du sujet jeune à Libreville est fréquente, sévère dans près d'un tiers des cas, et déjà compliquée, notamment sur le plan rénal, chez un patient sur cinq. Ces résultats imposent un renforcement du dépistage précoce et de la prévention primaire dès l'adolescence, afin de prévenir la morbi-mortalité cardiovasculaire prématurée.
ABSTRACT
Introduction. Hypertension (HTN) in young adults is an emerging public health concern in sub-Saharan Africa, yet its specific characteristics remain poorly documented. In Gabon, no recent study has described the profile of HTN in individuals under 40. This study aimed to determine the epidemiological and clinical characteristics, as well as the cardiovascular risk level, of young hypertensive patients followed at the Centre Hospitalier Universitaire de Libreville. Methods. A retrospective, descriptive study included all patients aged 18 to 39 years, consulting for hypertension (newly diagnosed or known) in the cardiology department of the Libreville University Hospital, from January 2019 to January 2023. Socio-demographic and clinical data (HTN grade, symptoms), cardiovascular risk factors, and complications were collected and analyzed. Results. Among 807 hypertensive patients, 119 (14.7%) were young adults, with a median age of 31 years and a female predominance (M/F sex-ratio 0.72). The 30-39 age group accounted for 68.9% of cases. Grade III hypertension was observed in 30% of patients, and systolo-diastolic HTN in 63.9%. Overweight/obesity (30.3%), smoking (10.1%), and diabetes (6%) were the main associated risk factors. Complications were dominated by renal failure (6.7%), pre-eclampsia (4.2%), and heart failure (2.5%). Overall, 21% of patients had at least one target organ damage, and 37% had a high or very high cardiovascular risk. Conclusion. Hypertension in young adults in Libreville is frequent, severe in nearly one-third of cases, and already complicated, particularly renal, in one in five patients. These findings mandate strengthening early screening and primary prevention starting in adolescence to prevent premature cardiovascular morbidity and mortality.
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References
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- 17- Chmiel C, Wang M, Senn O et al.Uncontrolled arterial hypertension in primary care – patient characteristics and associated factors. Swiss Med Wkly. 2012; 142:w13693
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References
1- Organisation Mondiale de la Santé. Panorama mondial de l’hypertension artérielle : « un tueur silencieux » responsable d’une crise de santé publique mondiale. OMS 2013; 2: 7-37.
2- Lim SS, Vos T, Flaxman AD et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012; 380 (9859): 2224 - 60.
3- Moran A, Forouzanfar M, Sampson U et al. The epidemiology of cardiovascular diseases in sub-saharan africa: the global burden of diseases, Injuries and risk factors 2010 study. Prog Cardiovasc Dis. 2013; 56 (3): 234-9.
4- Yusuf S, Rangarajan S, Teo K, Islam S et al. Cardiovascular risk and events in 17 low, middle, and high-income countries. N Engl J Med. 2014; 371(9): 818-27.
5- Kayima et al. Determinants of hypertension in a young adult ugandan population in epidemiological transition. BMC Public Health 2015 ; 15: 830.
6- Abdissa SG, Oli K, Feleke Y et al. Spectrum of cardiovascular diseases among Ethiopian patients at Tikur Anbessa specialized university teaching hospital, Addis Ababa. Ethiop Med J. 2014;52(1):9 -17.
7- Muhihi A, Njelekela M, Mpembeni R et al. Physical activity and cardiovascular disease risk factors among young and middle-aged men in urban Mwanza, Tanzania. Pan Afr Med J. 2012;11(11):20.
8- Jones ES, Esack I, Mangena P et al. Hypertension in adolescents and young adults referred to a tertiary hypertension clinic in Cape Town. South Africa. Medicine 2020;99:48.
9- Menta, Traore D, Ba HO, Dougnon O et al. HTA chez le sujet jeune de 18 à 35 ans dans le service de cardiologie du CHU Gabriel Toure //dx.doi.org/10.13070/rs.fr.1.1254 Research fr 2014;1:1254.
10- Zhang Y, Moran AE. Trends in the prevalence, awareness, treatment, and control of hypertension among young adults in the United States, 1999-2014. Hypertension. 2017;70(4): 736–42.
11- Ennis I, Gende O, Cingolani H. Prevalence of hypertension in 3154 young students. Medicina 1998;58:483-91.
12- Ouedraogo S, Zan AA, Ouedraogo E et al. Profil de l’hypertension artérielle dans un hôpital régional au Burkina Faso. Health Sci.Dis: Vol 22 (12) 2021 : 116-22.
13- Cooper R, Rotimi C, Ataman S et al. The prevalence of hypertension in seven populations of west African origin. Am J Public Health. 1997; 87:160-8.
14- Ejike CE,Ugwu CE,Ezeanyika LU et al. Blood pressure patterns in relation to geographic area of residence:a cross-sectional study of adolescents in Kogi state,Nigeria. BMC Public Health.2008 Dec 16; 8: 411.
15- Steichen O. Hypertension in black patients. Rev Prat. 2010; 60 :654-9.
16- Adedoyin RA, Mbada CE, Bisiriyu LA et al. Relationship of anthropometric indicators with blood pressure levels and the risk of hypertension in Nigerian adults.Int J Gen Med.2009 Nov 30;1:33-40.
17- Chmiel C, Wang M, Senn O et al.Uncontrolled arterial hypertension in primary care – patient characteristics and associated factors. Swiss Med Wkly. 2012; 142:w13693
18- Damasceno A, Mayosi BM, Sani M et al. The causes, treatment, and outcome of acute heart failure in 1006 africans from 9 countries. Arch Intern Med. 2012;172(18):1386–94.
19- Naicker S. Burden of end-stage renal disease in sub-Saharan Africa. Clin Nephrol.2010;74(1): S13–6.
20- Lewington S, Clarke R, Qizilbash N et al. Prospective studies C. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360:1903–13.
21- Bejot Y, Daubail B, Jacquin A et al. Trends in the incidence of ischaemic stroke in young adults between 1985 and 2011: the dijon stroke registry. J Neurol Neurosurg Psychiatry. 2014; 85:509–13.
22- Lewington S, Clarke R, Qizilbash N et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903-13.