Renal risk profiling in newly diagnosed hypertensives in an urban population in Nigeria

Abstract

Introduction: Hypertension is a cause and consequence of chronic kidney disease globally. The other factors that work in concert with hypertension to cause CKD are yet to be clearly elucidated. Studies have identified proteinuria, dyslipidemia, obesity, smoking and family history of CKD as renal risk factors. Due to the high morbidity and mortality associated with occurrence of CKD including the enormous financial burden involved in its management, the knowledge of prevention and understanding of the risk factors for development of CKD is highly essential. Therefore, Identifying well defined risk factors that display strong graded association with the occurrence and progression of CKD can help in elucidating potential targets for disease modification. Objective: The aim of this study was to determine the prevalence of renal risk factors and their impact on kidney function in newly diagnosed hypertensive Nigerians.Methods: This was a case control study of two hundred and fifty newly diagnosed hypertensive Nigerians recruited from two contiguous hospitals in an urban setting in south western Nigeria. Another group of two hundred and fifty apparently healthy age and sex matched normotensive Nigerians in the same community were recruited as controls.Results: Seventy (28%) of the newly diagnosed hypertensives had estimated glomerular filtration rate of less than 60ml/min, while 42.4% and 18.8% of the subjects and the controls had microalbuminuria respectively. The newly diagnosed hypertensives had significantly higher prevalence of analgesic use (86.4% versus 41.6%, p < 0.001), alcohol consumption (20.8% versus 12%, p = 0.008), use of canned salted food (18.8% versus 8.4%, p= 0.001) and central obesity (36.1% versus 26.8%, p= 0.025) compared to controls.Conclusion: There is a significant occurrence of modifiable renal risk factors in newly diagnosed hypertensives and this offers a platform for instituting preventive strategies in the community.Keywords: Renal risk, hypertensives, urban population, Nigeria.

High prevalence of undiagnosed hypertension among men in North Central Nigeria: Results from the Healthy Beginning Initiative

“…Even though our study did not assess intensity of use, current alcohol use was associated with higher odds of hypertension in the adjusted regression model. Our findings agree with previous studies that found alcohol intake and/or binge drinking was associated with hypertension among Nigerians [ 50 , 62 , 63 ]. The high prevalence of alcohol use in this study population, which is similar to what obtains in the general population [ 64 ] suggests that alcohol use is another modifiable risk factor that can be targeted for both primary and secondary prevention of hypertension in Nigeria.…”

“…Studies reviewing adult medical inpatient admissions consistently place hypertension and its complications among the top five causes of hospital admission and mortality [45][46][47][48]. Additionally, there is evidence that many hypertensive patients already have end organ damage at presentation for initial care in Nigeria [49,50]. These findings suggest that many Nigerians with hypertension may be receiving their diagnosis late, and suffering avoidable morbidity and mortality as a result.…”

Obesity and CKD in Sub-Saharan Africa: A Narrative Review

“…In a Nigerian community study including around 1,500 participants, Olanrewaju et al 54 found that obesity defined using the waist-to-hip ratio, not waist circumference or BMI, was associated with CKD (odds ratio, 1.5; 95% confidence interval, 1.10-2.05) ( Table 1 ). 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 In a cross-sectional study among teachers in South Africa, waist circumference was significantly associated with CKD, and in Senegal, a higher BMI was associated with CKD. 55 , 56 When participants with CKD were compared with those without CKD in a cross-sectional study from the Cape Town Vascular and Metabolic Health study, a significantly higher BMI (30.4 vs 28.2 kg/m 2 ), waist circumference (99 vs 90.8 cm), and visceral adipose tissue (228.4 vs 174.9 cm 2 ) were reported, but there was no significant difference in subcutaneous adipose tissue.…”

Hypertensive target organ damage and its relationship with platelet indices

“…10 Guagnano et al and Ferroni et al found a positive linear association between platelet activation and presence of microalbuminuria in their study this is attributed to high blood pressure and the endothelial dysfunction, which causes activation of platelets this will manifest as increased MPV and PDW. 15 Endothelial dysfunction in hypertensives with microalbuminuria are reflected by decreased levels of NO and increased plasma levels of ICAM-1 in the patients with microalbuminuria. 15 Cause of microalbuminuria can be traced to structural and functional transformational process in the glomeruli (endothelium, glomerular basal membrane, podocytes) that are associated with increased permeability.…”

“…15 Endothelial dysfunction in hypertensives with microalbuminuria are reflected by decreased levels of NO and increased plasma levels of ICAM-1 in the patients with microalbuminuria. 15 Cause of microalbuminuria can be traced to structural and functional transformational process in the glomeruli (endothelium, glomerular basal membrane, podocytes) that are associated with increased permeability. Interestingly, this permeability disorder is not limited to the renal vessels but can be observed in the entire vascular system.…”