Hypertension and diabetes mellitus: a collision of two heavyweight non-communicable diseases

Abstract

Introduction: Patients living with type 2 diabetes mellitus (PLWD) are at an increased risk of developing hypertension (HPT). The presence of HPT in PLWD (PLWDH) accelerates diabetes-related complications (DRC). Scarce data exist from South Africa on the impact of HPT in PLWD.
Methods: Data werecaptured from Edendale Hospital diabetes clinic datasheets from January 1, 2019 to December 31, 2019 and analysed to determine differences in demographic, clinical and biochemical variables between PLWD and PLWDH.
Results: Data from 822 PLWD were analysed, the majority having HPT (713,86.74%). The prevalence of HPT, resistant HPT (RHPT) and the number of antihypertensives used increased with age and diabetes duration. PLWDH had statistically poorer lipid control (LC), higher creatinine, waist circumference (WC), increased prevalence of sensory peripheral neuropathy, non-proliferative and proliferative retinopathy, cerebrovascular accidents, proteinuria and renal impairment. The significant majority of PLWDH were not meeting diabetes targets (glycaemic, lipid, BMI, WC). The bulk of PLWDH were on combination antihypertensive therapy (p < 0.001) and performed significantly better than monotherapy for glycaemia, LC, BMI and WC. Proteinuria and blood pressure (BP) improved significantly as the number of antihypertensives increased. One-fifth (151, 18.37%) of PLWDH had RHPT; this was more common in females (p < 0.001). PLWD with RHPT had a significantly higher LDL cholesterol, BMI, and urine protein–creatinine ratio (p < 0.001). Over one-quarter (29.87%) of the PLWD without HPT had a BP over 140/90mmHg.
Conclusion: It was shown that HPT, RHPT and obesity are significant comorbidities in PLWD and increase the risk of DRC. The majority of PLWDH are not meeting targets, which places them at increased risk of DRC. BP, glycaemic and LC and proteinuria improved in those on combination antihypertensive therapy. A significant proportion of PLWD without HPT had elevated BP, and thus were potentially undiagnosed hypertensives needing intervention.