Hypertension and renal failure in Kumasi, Ghana

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.
An article published by Human Hypertension
hypertension; renal disease; plasma creatinine; Ghanaians; West Africans
Human Hypertension (1999) 13, 37–40