Department of Internal Medicine, King Edward VIII Hospital and Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa.
S Afr Med J. 2021 Feb 1;111(2):159-165. doi: 10.7196/SAMJ.2021.v111i2.15056.
Hypertension (HPT) and its complications continue to pose a global threat and contribute to premature mortality worldwide. The adverse interactions between HPT, obesity and COVID-19 are currently being witnessed globally and represent a collision of pandemics. Understanding the burden that this non-communicable disease (NCD) poses in KwaZulu-Natal (KZN) Province, South Africa (SA), would help in developing improved public healthcare strategies.
To describe the burden of HPT in all the districts of KZN over a 6-year period.
HPT data are routinely collected from all KZN public health facilities (both clinics and hospitals) as part of the District Health Information System (DHIS). In this retrospective study, we accessed HPT records from the DHIS over a period of 6 years (2014 - 2019, inclusive). Data collected included the number of patients screened, diagnosed and initiated on therapy for HPT, together with the number of obese patients.
The slopes for HPT screening were positive at both clinics and hospitals in KZN (considerably more at clinics than hospitals, with a difference in elevations of slopes of p<0.001), with a significantly greater percentage of the population having been screened at rural clinics than at hospitals (difference in elevation of slopes p<0.001). A significantly greater number of patients aged <40 years (p<0.001) were being screened for HPT at clinics than at hospitals (2017/18, 2018/19, 2019/20), while hospitals screened considerably more patients aged ≥40 years in 2017 - 2018 (p<0.001). The numbers of new hypertensives diagnosed and having treatment initiated were on an upward slope at both clinics and hospitals, with clinics having a greater elevation of slope than hospitals (p<0.001), irrespective of patient age. A significantly greater number of patients aged ≥40 years (p<0.05) were diagnosed with HPT at both clinics and hospitals in KZN (2017/18, 2018/19, 2019/20). KZN clinics remained the first port of call for known hypertensives throughout the study period. Obesity was prevalent at both clinic and hospital level, although figures were significantly higher at clinics. Over 80% of the obesity burden was carried by the rural clinics and hospitals.
Screening, diagnosis, treatment initiation and chronic management of HPT occur mainly at rural clinic level. The SA government needs to heed these findings and redirect resources (staffing and equipment) to this level. The prevalence of obesity was highest at rural healthcare facilities (clinics more than hospitals). More needs to be done to combat the obesity pandemic if we are to win the battle against NCDs (HPT and diabetes mellitus). A significant number of patients aged <40 years are being screened for HPT, which bodes well for the province, as early diagnosis and treatment of HPT are vital to prevent complications.
高血压（HPT）及其并发症仍然是全球威胁，并导致全球过早死亡。目前，全球范围内正在见证 HPT、肥胖症和 COVID-19 之间的不良相互作用，这代表着大流行病的碰撞。了解这种非传染性疾病（NCD）在南非夸祖鲁-纳塔尔省（KZN）造成的负担将有助于制定改进的公共医疗保健策略。
描述过去 6 年中 KZN 所有地区的 HPT 负担情况。
HPT 数据作为区卫生信息系统（DHIS）的一部分，定期从 KZN 的所有公共卫生设施（诊所和医院）收集。在这项回顾性研究中，我们在过去 6 年（2014-2019 年）访问了 DHIS 中的 HPT 记录。收集的数据包括筛查、诊断和开始接受 HPT 治疗的患者人数，以及肥胖患者的人数。
KZN 的诊所和医院的 HPT 筛查率呈上升趋势（诊所的上升趋势明显高于医院，两者之间的坡度差异具有统计学意义（p<0.001）），农村诊所的筛查人口比例明显高于医院（坡度差异具有统计学意义（p<0.001））。在诊所中，筛查 HPT 的 <40 岁的患者比例显著高于医院（p<0.001）（2017/18 年、2018/19 年、2019/20 年），而医院在 2017-2018 年筛查了更多 >40 岁的患者（p<0.001）。在诊所和医院，新诊断的高血压患者和开始接受治疗的患者数量均呈上升趋势，诊所的斜率上升幅度大于医院（p<0.001），而不论患者年龄如何。在 KZN 的诊所和医院，>40 岁的患者中诊断出 HPT 的比例明显更高（p<0.05）（2017/18 年、2018/19 年、2019/20 年）。在整个研究期间，KZN 的诊所仍然是已知高血压患者的第一站。肥胖症在诊所和医院都很普遍，尽管诊所的数字明显更高。肥胖症的负担超过 80%由农村诊所和医院承担。
HPT 的筛查、诊断、治疗开始和慢性管理主要发生在农村诊所层面。南非政府需要注意到这些发现，并将资源（人员配备和设备）重新分配到这一级别。肥胖症在农村医疗设施（诊所多于医院）中最为普遍。如果我们要赢得与非传染性疾病（高血压和糖尿病）的斗争，就需要采取更多措施来对抗肥胖症大流行。相当数量的 <40 岁的患者正在接受 HPT 筛查，这对该省来说是个好兆头，因为早期诊断和治疗 HPT 对于预防并发症至关重要。
