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Hypertension and renal failure in Kumasi, Ghana
J Plange-Rhule1, R Phillips, J W Acheampong
1Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
Insights
Hypertension and related cardiovascular and renal diseases significantly impact hospital admissions and deaths in Ghana. Renal disease is a major complication for out-patient hypertensives, particularly those with severe hypertension.
Area of Science:
- Cardiology
- Nephrology
- Public Health
Background:
- Hypertension is prevalent in West Africa, with increasing urbanization likely to exacerbate this trend.
- Limited facilities for hypertension detection and management obscure its impact on public health in the region.
- The study addresses the need to clarify the morbidity and mortality associated with hypertension in Ghana.
Purpose of the Study:
- To assess renal disease and blood pressure-related admissions and deaths among acute medical patients.
- To determine the prevalence and impact of renal disease in out-patient hypertensive individuals.
- To evaluate the burden of hypertension-related complications in a Ghanaian hospital setting.
Main Methods:
- Retrospective review of admission diagnosis and cause of death from ward books for acute medical admissions.
- Prospective clinical assessment of out-patients including blood pressure, plasma creatinine, and proteinuria.
- Analysis of data from Komfo Anokye Teaching Hospital, Kumasi, over an 8-month period (1995-1996).
Main Results:
- Cardiovascular causes (hypertension, heart failure, stroke) accounted for 17.9% of acute medical admissions, with a 28.8% mortality rate.
- Renal disease was present in 5.0% of admissions, with a 27.1% mortality rate, often due to end-stage renal disease.
- Among hypertensive out-patients, 30.2% had elevated plasma creatinine and 25.5% had proteinuria. Severe hypertension (diastolic BP ≥115 mm Hg) was associated with significantly higher rates of renal impairment.
Conclusions:
- Cardiovascular and renal diseases are significant contributors to morbidity and mortality in acute medical admissions in Ghana.
- Renal disease is a critical complication among out-patient hypertensives, especially in cases of severe hypertension.
- The findings highlight the urgent need for improved hypertension management and renal disease screening in the region.
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 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 micromol/l (48 > or = 400 micromol/l) and 25.5% (96 out of 376) had proteinuria. Eighty-nine of the 448 had a diastolic blood pressure > or =115 mm Hg; in this group 38 (42.7%) had a plasma creatinine of >140 micromol/l (and 18 or 20.2% > or =400 micromol/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.