Hypertension and renal failure in Kumasi, Ghana
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Date
1999-01-13
Journal Title
Journal ISSN
Volume Title
Publisher
Human Hypertension
Abstract
Hypertension is common in West Africa and likely to
become more common as urbanisation increases. There
are at present few facilities for the detection and management
of hypertension so the influence it has on overall
morbidity and mortality in the population is not clear.
The objectives of the study were to assess: (a) renal disease
and blood pressure related admissions and deaths
among acute medical admissions to Komfo Anokye
Teaching Hospital, Kumasi, during an 8-month period;
and (b) the burden of renal disease among out-patient
hypertensives at the same hospital. Ward admission
books were examined in the four acute medical wards
to ascertain admission diagnosis and cause of death
(two 4-month periods in 1995 and 1996). Clinical assessment
(blood pressure, plasma creatinine, proteinuria)
was also made of 448 consecutive out-patient hypertensives
seen between March 1995 and April 1996. Five
Keywords: hypertension; renal disease; plasma creatinine; Ghanaians; West Africans
Introduction
Hypertension is an increasing problem in people of
West African descent living in the western world.1,2
Studies in the United States3,4 and Britain5,6 have
shown hypertension to be very common and its
complications (stroke, heart failure, renal failure) a
major cause of morbidity and mortality in black subjects
in these countries.
There are few data on the prevalence of hypertension
in West Africa. Studies suggest that the prevalence
of hypertension is higher in urban than rural
areas.7–9 Increasing urbanisation in West Africa is
associated with an increasing prevalence of hypertension9
so the burden of hypertension and its
related complications on morbidity and mortality
will rise. Indeed, hypertensive renal damage is the
main cause of end-stage renal failure in black populations
both in the UK10 and in West Africa.11,12
There is a lack of primary care facilities for the
detection of hypertension in West Africa and clinics
Correspondence: Dr JB Eastwood, Department of Renal Medicine,
St George’s Hospital Medical School, Cranmer Terrace, London
SW17 ORE, UK
Received 27 March 1998; revised 25 July 1998; accepted 31
July 1998
hundred and ninety-three (17.9%) of 3317 acute medical
admissions were ascribable to a cardiovascular cause
(hypertension, heart failure, stroke); 171 (28.8%) of
these died. One hundred and sixty-six (5.0%) had renal
disease of whom 45 (27.1%) died, usually of end-stage
renal disease. Among the 448 hypertensive out-patients,
30.2% (110 out of 365) had a plasma creatinine
.140 mmol/l (48 > 400 mmol/l) and 25.5% (96 out of 376)
had proteinuria. Eighty-nine of the 448 had a diastolic
blood pressure >115 mm Hg; in this group 38 (42.7%)
had a plasma creatinine of .140 mmol/l (and 18 or 20.2%
>400 mmol/l). In conclusion, cardiovascular and renal
disease are important contributors to morbidity and
mortality among acute medical admissions to a large
city hospital in Ghana. Among out-patient hypertensives
renal disease is an important complication, especially in
those with the more severe hypertension.
Description
An article published by Human Hypertension
Keywords
hypertension; renal disease; plasma creatinine; Ghanaians; West Africans
Citation
Human Hypertension (1999) 13, 37–40