Dyslipidemia in blood pressure control among adult hypertensive patients in Kiambu County Hospital Kenya

Introduction: Hypertension is one of the most common non-communicable diseases with about 40% global prevalence in adults and 46% in Africa. Dyslipidemia, among other factors may lead to poor blood pressure control in hypertensive patients. Dyslipidemia occurs when someone has abnormal levels of lipids in their blood However, the role of dyslipidemia in predicting hypertension has not received adequate attention. Objectives: This study aims to determine the relationship between dyslipidemia and blood pressure control among hypertensive patients in Kiambu County Hospital Kenya. Methods: This was a cross-sectional analytical study assessing independent association between blood pressure control and dyslipidemia in a cohort of 251 hypertensive patients in a hospital set up. Multiple logistic regression model was applied to determine factors associated with poor blood pressure control. Results: In total, 251 hypertensive patients, mean age 55.7 years, females-majority (80.9%) were considered in the study. The mean systolic blood pressure was 145.1±22.4mmHg and 87.4±13.0mmHg for diastolic blood pressure. Blood pressure was poorly controlled in 56.6% of the patients. High LDL levels was diagnosed in 82.1% of the patients, 23.1% low HDL levels, 31.9% high triglycerides and 59.8% high total cholesterol levels. Patients with poorly controlled hypertension (68.7%) recorded significantly higher mean total cholesterol (221.4 mg/dl) compared to193.4 mg/dl in the wellcontrolled group (mean 193.4 mg/dl), p<0.001, compared to 38.6% in those with desirable level of total cholesterol, (P<0.001. Similarly, LDL were significantly higher in the poorly controlled group (mean 142.3 mg/dl) compared to the well-controlled group (mean 121.4 mg/dl), p=0.001. Triglycerides and HDL were not significantly associated to hypertension control (p>0.05). Conclusion: Dyslipidemia was recorded in 68% of adult hypertensive patients and was significantly associated with development of of inadequate blood pressure control. Low density lipids ( LDL) was significantly higher in the poorly controlled group where 68.7% of the patients with high level of total cholesterol had poorly controlled blood pressure. Lifestyle modification, routine lipid profile testing among hypertensive patients, early treatment on high lipid level patients, change of lifestyle and use of statin were recommended for dyslipidemia treatment. Keyword: Hypertension, cardiovascular, blood pressure, diastolic, systolic,non-communicable,disease Introduction Globally, non-communicable diseases (NCD) are the leading cause of mortality and requires chronic care management[1]. Globally, cardiovascular diseases are recorded to be the greatest cause of mortality among the NCD at 30% [2]. Poor blood pressure control, tobacco use, unhealthy diet high in carbohydrates and low density lipoproteins (LDL), sedentary lifestyle and excessive use of alcohol are some of the risk factors that increase the risk of NCD. These factors normally lead to high blood pressure, obesity, raised cholesterol and elevated blood glucose [3]. Many people in the populations are not aware that they have hypertension or other NCDs and those who are aware have poorly controlled hypertension [4]. According to World Health Organization data (WHO 2014) hypertension deaths in Kenya reached 1,995 or 0.60% of total deaths. The age adjusted Death Rate is 12.49 per 100,000 of population and ranks Kenya number 120 in the world (WHO, 2014). The role of dyslipidemia in predicting hypertension has not received much attention despite the increasing rate of non-communicable diseases. Dyslipidemia, among other factors has in several studies been shown to lead to poor blood pressure control. Early detection and management of dyslipidemia is key in optimizing blood pressure control and reducing the cardiovascular risk [5]. In resource limited settings, Kiambu included, uptake of routine lipid profiles among hypertensive patients remains low largely due to unavailability and prohibitive cost. Efforts have been made to avert this challenge by increasing patient’s access to National Hospital Insurance Fund (NHIF) cover to cater for such costly tests. The East and Central Africa MEDICAL JOURNAL . Dyslipidemia in blood pressure control among adult hypertensive patients in Kiambu County Hospital Kenya Monica N. Nderitu1, Jonathan Wala2, Otieno O. Otieno3 NDERITU NYAMBURA <nyamburanderitu@students.ku. ac.ke Affiliations: 2. Department of Internal Medicine, Kenyatta University 3. Department of Health Management and Informatics, Kenyatta University Volume 4 Number 1 November 2020