Division of Clinical Epidemiology, Department of Clinical Research, University Hospital and University of Basel, Totengässlein 3, 4053, Basel, Switzerland.
University of Basel, Basel, Switzerland.
J Epidemiol Glob Health. 2023 Dec;13(4):857-869. doi: 10.1007/s44197-023-00158-5. Epub 2023 Oct 26.
Prevalence of elevated blood pressure (BP) and diabetes mellitus (DM) is increasing in sub-Saharan Africa. Data on target organ damage such as retinopathy, left ventricular hypertrophy (LVH), renal impairment and peripheral neuropathy (PN) among persons with elevated BP and/or DM in sub-Saharan Africa remain scarce.
To determine at community-level the prevalence of retinopathy, LVH, renal impairment, and PN among adults with elevated BP and/or DM, and assess the association of elevated BP and/or DM with target organ damage in Lesotho.
During a household-based survey, a sub-sample of adults with elevated BP (≥ 140/90 mmHg) and/or DM (glycosylated hemoglobin ≥ 6.5%), as well as comparators (BP < 140/90 mmHg, HbA1c < 6.5%) were screened for retinopathy, LVH, renal impairment, and PN. We used multivariable logistic regression for inferential analysis.
Out of 6108 participants screened during the survey, 420 with elevated BP only, 80 with DM only, 61 with elevated BP and DM, and 360 comparators were assessed for target organ damage. Among those with elevated BP, and among those with DM with or without elevated BP, prevalence of retinopathy was 34.6% (89/257) and 14.4% (15/104); renal impairment was 45.0% (156/347) and 42.4% (56/132), respectively. Among those with elevated BP, 2.3% (7/300) and 65.7% (224/341) had LVH and left ventricular concentric remodeling, respectively. PN, only assessed among those with DM, was present in 32.6% (42/129). Elevated BP was associated with increased odds of retinopathy (aOR, 19.13; 95% CI, 8.52-42.94; P < 0.001) and renal impairment (aOR, 1.80; 95% CI, 1.27-2.55; P = 0.001). Presence of both elevated BP and DM was associated with an increased odds of retinopathy (aOR, 16.30; 95%CI, 5.69-46.68; P < 0.001), renal impairment (aOR, 2.55; 95% CI, 1.35-4.81; P = 0.004), and PN (aOR, 2.13; 95% CI, 1.04-4.38; P = 0.040).
We found a high prevalence of undiagnosed target organ damage among adults with elevated BP and/or DM during community-based screening. These findings emphasize the importance of regular prevention and screening activities in this setting.
在撒哈拉以南非洲，高血压（BP）和糖尿病（DM）的患病率不断上升。关于在该地区高血压和/或糖尿病患者中视网膜病变、左心室肥厚（LVH）、肾功能损害和周围神经病变（PN）等靶器官损害的数据仍然很少。
在社区层面确定高血压和/或糖尿病患者中视网膜病变、LVH、肾功能损害和 PN 的患病率，并评估在莱索托高血压和/或糖尿病与靶器官损害的关系。
在基于家庭的调查中，对高血压（≥140/90mmHg）和/或糖尿病（糖化血红蛋白≥6.5%）的成年人亚样本，以及血压<140/90mmHg 和糖化血红蛋白<6.5%的对照组进行筛查，以评估视网膜病变、LVH、肾功能损害和 PN。我们使用多变量逻辑回归进行推论分析。
在调查期间筛查的 6108 名参与者中，有 420 名仅患有高血压，80 名仅患有糖尿病，61 名患有高血压和糖尿病，360 名对照组进行了靶器官损伤评估。在患有高血压的患者中，以及患有糖尿病和/或高血压的患者中，视网膜病变的患病率分别为 34.6%（89/257）和 14.4%（15/104）；肾功能损害的患病率分别为 45.0%（156/347）和 42.4%（56/132）。在患有高血压的患者中，分别有 2.3%（7/300）和 65.7%（224/341）患有 LVH 和左心室向心性重构。仅在患有糖尿病的患者中评估的 PN 患病率为 32.6%（42/129）。高血压与视网膜病变（优势比，19.13；95%置信区间，8.52-42.94；P<0.001）和肾功能损害（优势比，1.80；95%置信区间，1.27-2.55；P=0.001）的发生几率增加有关。同时患有高血压和糖尿病与视网膜病变（优势比，16.30；95%置信区间，5.69-46.68；P<0.001）、肾功能损害（优势比，2.55；95%置信区间，1.35-4.81；P=0.004）和 PN（优势比，2.13；95%置信区间，1.04-4.38；P=0.040）的发生几率增加有关。
我们在社区为基础的筛查中发现，高血压和/或糖尿病患者中存在未确诊的靶器官损害的高患病率。这些发现强调了在这一环境中定期开展预防和筛查活动的重要性。
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