Auteurs : M’Buyamba-Kabangu JR, Biswika RT, Thijs L, Tshimanga GM, Ngalula FM, Disashi T, Kayembe PK, Richart T, M’Buyamba-Kayamba JR, Lepira FB, Staessen JA
Hypertension Unit, Department of Internal Medicine, University of Kinshasa Hospital, Kinshasa, DRC
Am J Hypertens. 2009 Jun;22(6):643-8. doi: 10.1038/ajh.2009.47. Epub 2009 Mar 12.
BACKGROUND: As a consequence of hypertension, sub-Saharan Africa faces an epidemic of cardiovascular disease.
METHODS: We assessed in-hospital mortality among patients admitted for hypertension-related diseases to two city hospitals in Mbuji Mayi, Congo. On admission, we obtained anthropometric measurements, blood pressure, information on cardiovascular risk factors, and on the awareness and treatment of hypertension. We modeled the probability of death, using stepwise logistic regression.
RESULTS: Of 401 consecutive patients (mean age, 54.3 years; 129 women), 118 (29.4 %) were unaware of their hypertension. Among 283 aware patients (70.6%), 126 (44.5%) were untreated. Systolic/diastolic blood pressure on admission averaged 178/106 mm Hg. In addition to hypertension, 390 patients (97.3%) had other cardiovascular risk factors, including a creatinine clearance below 60 ml/min/1.73 m(2) in 47 subjects (11.7%). Over 15 days (median) of hospitalization, 89 deaths (22.2%) occurred. The multivariable-adjusted probability of death increased with systolic blood pressure (odds ratio (95% confidence interval) for +10 mm Hg, 1.43 (1.15-1.77); P < 0.01), body mass index (+5 kg/m(2), 2.40 (1.39-4.17); P < 0.01), being aware vs. unaware of hypertension (3.17 (1.52-6.61); P < 0.01), and being untreated (2.33 (1.12-4.76); P < 0.05), but it decreased with age (+10 years, 0.65 (0.46-0.92); P < 0.05) and higher creatinine clearance (+10 ml/min/1.73 m(2), 0.71 (0.61-0.82); P < 0.001).
CONCLUSIONS: The in-hospital mortality among African patients hospitalized for hypertension-related disorders in a Congolese provincial capital city is over 20%. These findings underscore that screening and treatment for hypertension and the prevention of cardiovascular disease should be placed much higher on the political agenda in sub-Saharan Africa. Comment in – Hypertension in sub-Saharan Africa: what physicians can do! [Am J Hypertens. 2009]