Abstract
Diabetes is a serious health problem with staggering morbidity and mortality rates documented to be rising at an alarming rate worldwide, more so in low income countries. The uncontrolled effect of high blood glucose and disease complications have protean multisytemic consequences. Concomitant Diabetes Mellitus (DM) and hypertension accelerates the progression of micro and macro vascular complications including nephropathy. In this prospective comparative study amongst Diabetic hypertensives, normotensive Diabetics and healthy non-diabetic normotensive controls, we evaluated the effect of co-existing hypertension with diabetes and normotensive DM on renal vascular impedance. Demographic, clinico-laboratory data and Duplex ultrasound impedance of the renal interlobar arteries were documented and data analyzed using Statistical Package for Social Sciences (SPSS) version 23 computer software. The Intra-renal Resistive index (RI) among Diabetic hypertensives (Mean = 0.72 ± 0.15), normotensive DM patients (Mean = 0.69±0.08) and control (Mean = 0.63 ± 0.08) were statistically significant, F (2, 89) = 10.94, p <0.001. The intra renal Doppler RI showed significant correlations with age (r = 0.236, p=0.019) and duration of diabetes (r = 0.333, p=0.003). The Pulsatility index showed statistical significant associations with age (r = 0.370, p<0.001), duration of diabetes (r = 0.338, p = 0.002) and serum creatinine (r = 0.208, p = 0.039). A unit increase in mean arterial blood pressure increases the risk of concomitant hypertension in DM patients by about 3% (AOR= 1.03, 95% CI 1.10; 1.33, p <0.001). Also, an increase by 1mg/dl in cholesterol level increases the risk of concomitant hypertension in DM patients by about 1% (AOR= 1.01, 95% CI 1.00; 1.02, p = 0.044). Altogether concomitant hypertension with DM causes slightly high renal vascular impedance, particularly the RI as well as mild renal dysfunction than in normotensive persons with diabetes. Particularly among cases with clinico-laboratory evidence of good glycaemic control as well as blood pressure management. The arterial blood pressure and cholesterol levels are predictors of concomitant Hypertensive Diabetic status in this study.
Highlights
Diabetes is a serious threat to population health
The World Health Organization (WHO) estimated the total burden of deaths from high blood glucose in 2012 to sum to about 3.7 million, including 1.5 million diabetes deaths, and an additional 2.2 million deaths from cardiovascular diseases, chronic kidney disease, and tuberculosis related to higherthan-optimal blood glucose [1]
The mean Systolic blood pressure of normotensive Diabetes Mellitus (DM) patients was significantly higher than the mean systolic pressure of the controls
Summary
Diabetes is a serious threat to population health. Over the last 3 decades there has been increase in trend in number of people with diabetes. In 2014, globally, 422 million adults aged over 18 years were living with diabetes. Federation (IDF) [2], this number is estimated to reach 592 million by 2035 with low and middle income countries contributing a substantial proportion. Sub-Saharan Africa is estimated to have 20 million people with diabetes. In sub-Saharan Africa, Nigeria has the highest number of people with diabetes with an estimated 3.9 million people (or an extrapolated prevalence of 4.99%) of the adult population aged 20-79-year-old [3]. Studies in Nigeria have reported that the prevalence of diabetes varies across different zones of the country but ranges from 2.2 - 9.8% [4 – 6]
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