Blood pressure control and associated factors among patients with type 2 diabetes mellitus and hypertension in Tororo hospital

Abstract

Introduction: The co – existence of hypertension and type 2 diabetes mellitus (T2DM) increases the risk of cardiovascular disease (CVD), nephropathy, retinopathy and dyslipidemia. In sub Saharan Africa, it was predicted that adults with diabetes and hypertension would more than double by 2025. In Uganda, the prevalence of hypertension among type 2 diabetes mellitus (T2DM) patients is 61.9%. This high prevalence could be due to a number of risk factors including the changing trends in lifestyle, the knowledge on blood pressure (BP) control, and the knowledge on anti hypertensive medications, smoking, alcohol and physical inactivity. T2DM patients with hypertension are at an increased risk of developing uncontrolled blood pressure (UBP) due poor adherence secondary to high pill burden and drug – drug interactions. Presently the prevalence and factors associated with UBP among patients with T2DM and hypertension in Uganda are not well documented. Main Objective: To establish the prevalence of uncontrolled blood pressure and associated factors among patients with T2DM and hypertension at Tororo General Hospital Diabetic clinic Methods: Between February – April 2020, we performed a hospital based cross – sectional study among patients with T2DM, aged 18 years and above, and on anti – hypertensive medication. We enrolled 261 participants were enrolled into the study by consecutive sampling. Descriptive statistics was used to document the prevalence of uncontrolled blood pressure and multiple logistic regressions were used to assess the factors associated with uncontrolled blood pressure in STATA version 15 for windows. Results: In a population dominated by males (56.7%) and with a mean age (49.5; SD 12.5), we found a prevalence of uncontrolled blood pressure of 54.5% (95% confidence interval (CI): 48.3 – 60.4%). The factors that were significantly associated with uncontrolled blood pressure were being of female sex with an adjusted odds ratio (aOR) of 0.52 (0.29 – 0.92), having a past history of smoking with aOR of 3.59 (1.02 – 12.69), widowed marital status with aOR of 6.28 (1.65 – 23.9) and poor adherence to anti – hypertensive medication with aOR of 0.28 (0.16 – 0.49). Conclusion: We found a high prevalence of uncontrolled blood pressure in this population. Interventions to help achieve the optimal blood pressure levels among patients with T2DM and hypertension should target the male sex and poor adherence. Also the role of family social support needs to be emphasized in this population especially for patients who have been widowed by loss of either partner. More research needs to be done on the association between smoking and blood pressure control and lastly clear clinical guidelines on management of blood pressure among patients with T2DM and hypertension need to be established.