Predictors of isolated systolic hypertension among type 2 diabetes mellitus patients in Jimma University Specialized Hospital, Southwest Ethiopia

BMC Research Notes 12, Article number: 510 (2019) | Download Citation

Abstract

Objectives

Systolic blood pressure rise among T2DM patients was main risk factor for cardiovascular disease. Objective of this study was to identify predictors of isolated systolic hypertension among T2DM patients at Jimma University Specialized Hospital, 2016. We conducted cross sectional study using simple random sampling and interviewer administered questionnaire. Isolated systolic hypertension is SBP ≥ 140 mmHg and < 90 mmHg. Data entered and analyzed using Epi Data and SPSS respectively. Predictor factor was declared at p < 0.05.

Results

A total of 315 T2DM took part. Prevalence of ISH was 27.6% [95% CI (22.7, 32.5%)]. One hundred sixty and two (51.4%) patients were males with mean age of 54.1 from 22 to 87 years. Male sex [AOR = 2.4, 95% CI 1.21–4.72, p = 0.012], unemployment [AOR = 3.22, 95% CI 1.48–7.03, p = 0.003], age of 47–55 [AOR = 2.63, 95% CI 1.03–6.70, p = 0.044], single [AOR = 2.26, 95% CI 1.13–4.51, p = 0.021], ≤ Grade 8 [AOR = 2.94, 95% CI 1.10–7.85, p = 0.03] and income (ETB) 501–800 [AOR = 21.9, 95% CI 7.62–63.1, p < 0.001], 801–1500 [AOR = 5.78, 95% CI 2.55–13.1, p < 0.001] and > 1500 [AOR = 4.23, 95% CI 1.74–10.30, p = 0.001] were significant factors of ISH. The health sector has to establish preventive strategies for ISH among T2DM patients by giving special attention to predictor factors.

Introduction

Hypertension is the common comorbidity of diabetes mellitus (DM) [1]. It is prevalent in developing countries [2], major risk for coronary disease [3]. Isolated systolic hypertension (ISH) is common form of hypertension bringing morbidity and mortality mainly among elderly [4]. ISH is SBP ≥ 140 mmHg and DBP < 90 mmHg. According to JNC-VI; grade 1 ISH (SBP < 160 mmHg), grade 2 (SBP < 180 mmHg) and grade 3 (SBP ≥ 180 mmHg) [5]. Raised SBP among T2DM patients was the major risk factor for cardiovascular diseases [6]. Diabetes patients experienced high vascular resistance explained by vascular remodeling and increased fluid volume related to hyperglycemia [7]. Vascular problems are explained by hypertension among T2DM [8].

Decreasing of SBP by 10 mmHg lead to 12% reductions of diabetes complications [9, 10]. SBP increases after 50–60 years due to age-related changes in vasculature [11]. ISH mainly affects those 50 years and above [12]. Arterial stiffness is accountable for pathogenesis of hypertension [13, 14]. It is common in DM patients caused by endothelial dysfunction leading to inflammation [15, 16]. ISH is associated with ageing leading to morbidity and mortality due to cerebrovascular disturbance [4]. There was 85.6% prevalence of hypertension among DM patients in Benghazi [17]. ISH ranges from 20.3% in primary care patients to 35% in general population [18]. A study in Saudi revealed 7.6% of ISH among adults associated with education, obesity, DM, and dyslipidemia [19]. Prevalence of 43.6% was reported in Nigerian adults associated with increased age [20]. ISH is common in obese, males, low education level and smokers [21]. A study in Ghana revealed 37.4% ISH which was predicted by patient’s age [22]. In DM patients, ISH is associated with older age, male sex, DM duration and overweight [17]. For 5th–6th decades of life SBP and DBP increased with age and onwards SBP continues to increase [23, 24]. There were limited studies globally and none was found in Ethiopia on predictors of ISH. So this study aimed to identify predictors of ISH among T2DM, to add information to scientific community and put baseline for Ethiopia.