Background Hypertension and diabetes mellitus (DM), are highly prevalent worldwide health non-communicable diseases, and are associated with chronic complications. The co-existence of both conditions accelerates the related complications and increases morbidities and mortalities. A cross-sectional study was conducted in Nahr an Nil State (River Nile State) in Sudan between May and August 2018 to identify the prevalence of hypertension and risk factors among patients with DM in that region. Results The median (interquartile) age of the 1,973 enrolled patients was 58.0 (50.0‒65.0) years, and 818 (45.6%) were males. The median (interquartile) duration of diabetes was 5.0 (3.0‒9.0) years. Of the 1,973 enrolled participants, 21.7%, 1.3%, 37.1%, and 39.9% were normal weight, underweight, overweight, and obese, respectively. Of 1,973 854 (47.6%) patients also had hypertension. Logistic regression analyses showed that elderly patients (adjusted odds ratio [AOR] = 1.03, 95%; confidence interval [CI] = 1.02‒1.04), males (AOR = 2.96, 95%; CI = 2.15‒4.07), employed patients (AOR = 1.92, 95%; CI = 1.38‒2.70), obese patients (AOR = 1.59, 95%; CI = 1.21‒2.08), and patients with diabetic foot (DF) (AOR = 2.45, 95%; CI = 1.72‒3.47) were at higher risk for hypertension. Conversely, patients with Type 2 DM (T2DM) (AOR = 0.63, 95%; CI = 0.50‒0.80) were at lower risk for hypertension. There was no significant association between overweight, uncontrolled DM, and hypertension. Conclusion This study showed a high prevalence of hypertension among patients with DM. Notably, older age, male gender, employment, duration of DM, DF, underweight, and obesity were significant predictors of hypertension among patients with DM.

BackgroundAlthough the exact pathophysiology of preeclampsia is not well understood, autonomic nervous system imbalance is suggested as one of the main factors.AimsTo investigate heart rate variability (HRV) and autonomic modulations in Sudanese pregnant women with preeclampsia.Subjects and MethodsA case-control study (60 women in each arm) was conducted at Omdurman Maternity Hospital—Sudan, during the period from June to August, 2014. Cases were women presented with preeclampsia and healthy pregnant women were the controls. Studied groups were matched for important determinants of HRV. Natural logarithm (Ln) of total power (TP), high frequency (HF), low frequency (LF) and very low frequency (VLF) were used to determine HRV. Normalized low and high frequencies (LF Norm and HF Norm) were used to evaluate sympathetic and parasympathetic autonomic modulations respectively.ResultsPatients with preeclampsia achieved significantly higher LF Norm [49.80 (16.25) vs. 44.55 (19.15), P = 0.044] and LnLF/HF [0.04 (0.68) vs. -0.28 (0.91), P = 0.023] readings, but lower HF Norm [49.08 (15.29) vs. 55.87 (19.56), P = 0.012], compared with healthy pregnant women. Although all other HRV measurements were higher in the patients with preeclampsia compared with the controls, only LnVLF [4.50 (1.19) vs. 4.01 (1.06), P = 0.017] and LnLF [4.01 (1.58) vs. 3.49 (1.23), P = 0.040] reached statistical significance.ConclusionThe study adds further evidence for the dominant cardiac sympathetic modulations on patients with preeclampsia, probably secondary to parasympathetic withdrawal in this group. However, the higher LnVLF and LnLF readings achieved by preeclamptic women compared with the controls are unexpected in the view that augmented sympathetic modulations usually depresses all HRV parameters including these two measures.

Labor necessitates continuous adjustments of cardiac autonomic reflexes by alternate activation of the sympathetic and parasympathetic nervous systems. The division of the autonomic nervous system (ANS) that predominates during the first stage of labor is unclear and needs to be further investigated. The study aimed to compare heart rate variability (HRV) in pregnant women in the third trimester with those during the first stage of labor. We conducted a case–control study at Saad Abul Ela Maternity Hospital, Khartoum, Sudan. Forty-five women with singleton, live neonates in the first stage of labor and 45 women in the third trimester (but not in labor) were enrolled as case and control groups, respectively. Data on the medical history, obstetrics history, and clinical examinations that were performed in all of the studied women were obtained using prearranged questionnaires. Cardiac autonomic modulation (CAM) of the heart was examined in both groups based on time and frequency domain HRV indices. There were no significant differences in age, parity, body mass index, and hemoglobin levels between the two groups. Pregnant women in labor had significantly higher LnSDNN, LnRMSSD, LnTP, LnVLF, LnLF, LnHF, LF Norm, and LnLF/HF ratio, but lower HF Norm compared with controls (P < 0.001). These findings remained unchanged when possible confounders were controlled for using regression analysis. Our findings suggest a significant increase in indictors of sympathetic CAM, namely LF Norm and LnLF/HF, during labor. Sympathetic hypertonia associated with labor is unlikely to increase the risk of cardiac events because sympathetic CAM simultaneously increases with global HRV. Increased HRV during labor may be explained by parasympathetic activation as indicated by higher LnHF and LnRMSSD at the time of delivery.

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