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Abstract
Introduction. Hypertension and type 2 diabetes (T2DM) are major risk factors for cardiovascular diseases (CVDs). The combination of hypertension and T2DM leads to a significant increase in CVD risk. There is limited data on the joint effect of hypertension and diabetes on the type and outcome of CVD in Africa. Objective. Determine the prevalence of hypertension and the impact of hypertension and T2DM on the first manifestation of CVD and the outcomes among patients with T2DM in Cameroon. Methods. We identified cases of three incident overt clinically manifest CVD complications (acute myocardial infarction [AMI], stroke, and heart failure. We compared hypertensive diabetics and non-hypertensive diabetics.
Results. Hypertension was present in 206 (77%) patients. The distribution of CVD was similar between hypertensive and non-hypertensive diabetic groups. Length of stay was longer in the non-hypertensive diabetic group (p=0.08). The duration of hospitalization of >7 days was significantly higher in the non-hypertensive group (p=0.01). Mortality was higher in the hypertensive group (p=0.12). The composite of hospital stays of >7 days and death occurred in 16 (6.1%, 95% CI: 3.5 – 9.8) patients and this was non-significantly higher in the hypertensive group. After adjusting for age and gender, patients with hypertension were twice likely to die as well as twice likely to have a composite of hospital stay of >7 days and death. Conclusion. Although hypertension was prevalent in about three quarters of patients with T2DM, the joint interaction of hypertension and diabetes did not significantly affect the type of CVD and the outcomes. There is need to treat and control hypertension among patients with diabetes mellitus.
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References
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- 12. Kerr EA, Heisler M, Krein SL, Kabeto M, Langa KM, Weir D, et al. Beyond comorbidity counts: how do comorbidity type and severity influence diabetes patients’ treatment priorities and self-management? J Gen Intern Med. 2007; 22: 1635–1640.
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- 14. Kaplan MH, Feinstein AR. The importance of classifying initial co-morbidity in evaluating the outcome of diabetes mellitus. J Chronic Dis. 1974; 27: 387–404.
- 15. Volpe M, Battistoni A, Savoia C, Tocci G. Understanding and treating hypertension in diabetic populations. Cardiovasc Diagn Ther 2015;5(5):353-363.
- 16. Hu G, Sarti C, Jousilahti P, Peltonen M, Qiao Q, Antikainen R, Tuomilehto J. The impact of history of hypertension and type 2 diabetes at baseline on the incidence of stroke and stroke mortality. Stroke. 2005 Dec;36(12):2538-43.
- 17. Lee MG, Jeong MH, Lee KH, Park KH, Sim DS, Yoon HJ, Yoon NS, Kim KH, Park HW, Hong YJ, Kim JH, Ahn Y, Cho JG, Park JC, Kang JC. Prognostic impact of diabetes mellitus and hypertension for mid-term outcome of patients with acute myocardial infarction who underwent percutaneous coronary intervention. J Cardiol. 2012 Oct;60(4):257-63
References
1. Collaborators GRF. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet (London, England). 2018;392(10159):1923.
2. Forouzanfar MH, Alexander L, Bachman VF, Biryukov S, Brauer M, Casey D, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: A systematic analysis for the Global Burden of Disease Study 2013. The Lancet. 2015;386: 2287–2323. pmid:26364544
3. Mills KT et al. Global Disparities of Hypertension Prevalence and Control: A Systematic Analysis of Population-Based Studies From 90 Countries. Circulation 134, 441–450 (2016).
4. Lin X, Xu Y, Pan X, Xu J, Ding Y, Sun X, et al. Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025. Scientific Reports 2020 10:1. 2020;10: 1–11. pmid:32901098
5. Sarwar N, Gao P, Seshasai SR, Gobin R, Kaptoge S, Di Angelantonio E, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010;375(9733):2215–22.
6. Chan JC, Lim L-L, Wareham NJ, Shaw JE, Orchard TJ, Zhang P, et al. The Lancet Commission on diabetes: using data to transform diabetes care and patient lives. Lancet. 2021;396(10267):2019–82.
7. Einarson TR, Acs A, Ludwig C, Panton UH. Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007–2017. Cardiovasc Diabetol. 2018;17(1):83.
8. Hinneh T, Akyirem S, Bossman IF, Lambongang V, Ofori-Aning P, Ogungbe O, et al. (2023) Regional prevalence of hypertension among people diagnosed with diabetes in Africa, a systematic review and meta-analysis. PLOS Glob Public Health 3(12): e0001931.
9. Sunkara N, Ahsan CH. Hypertension in diabetes and the risk of cardiovascular disease. Cardiovasc Endocrinol. 2017;6(1):33–8.
10. Nkoke C, Jingi AM, Djibrilla S, Abas A, Boombhi J, Menanga A, Dzudie A, Kingue S. Pattern and outcome of the first manifestation of cardiovascular disease among patients with type 2 diabetes mellitus in Cameroon: a cross-sectional study. BMC Cardiovasc Disord. 2024 Oct 26;24(1):593.
11. Tianyi FL, Agbor VN, Njamnshi AK. Prevalence, awareness, treatment, and control of hypertension in Cameroonians aged 50 years and older: A community-based study. Health Sci Rep. 2018 Apr 27;1(5):e44.
12. Kerr EA, Heisler M, Krein SL, Kabeto M, Langa KM, Weir D, et al. Beyond comorbidity counts: how do comorbidity type and severity influence diabetes patients’ treatment priorities and self-management? J Gen Intern Med. 2007; 22: 1635–1640.
13. Du Y, Heidemann C, Go¨wald A, Schmich P, Scheidt-Nave C. Prevalence and comorbidity of diabetes mellitus among non-institutionalized older adults in Germany—results of the national telephone health interview survey “German Health Update (GEDA)” 2009. BMC Public Health. 2013; 13
14. Kaplan MH, Feinstein AR. The importance of classifying initial co-morbidity in evaluating the outcome of diabetes mellitus. J Chronic Dis. 1974; 27: 387–404.
15. Volpe M, Battistoni A, Savoia C, Tocci G. Understanding and treating hypertension in diabetic populations. Cardiovasc Diagn Ther 2015;5(5):353-363.
16. Hu G, Sarti C, Jousilahti P, Peltonen M, Qiao Q, Antikainen R, Tuomilehto J. The impact of history of hypertension and type 2 diabetes at baseline on the incidence of stroke and stroke mortality. Stroke. 2005 Dec;36(12):2538-43.
17. Lee MG, Jeong MH, Lee KH, Park KH, Sim DS, Yoon HJ, Yoon NS, Kim KH, Park HW, Hong YJ, Kim JH, Ahn Y, Cho JG, Park JC, Kang JC. Prognostic impact of diabetes mellitus and hypertension for mid-term outcome of patients with acute myocardial infarction who underwent percutaneous coronary intervention. J Cardiol. 2012 Oct;60(4):257-63