[Hypertension, insulin resistance and chronic kidney disease in type 2 diabetes patients from South Kivu, DR Congo]

Abstract

Objective: To assess the frequency and determinants of high blood pressure (HBP) in a group of type 2 black diabetics living in the east of Democratic Republic of Congo.

Methodology: The medical records of 98 diabetic patients followed at the General Reference Hospital in Bukavu between 2005 and 2007 were collected and analyzed. Hypertension was defined as blood pressure≥140/90mmHg. Insulin sensitivity (HOMA S; %) was determined with the HOMA model, with insulin resistance (IR) representing HOMA S(-1) and defined from HOMA S values<50%). Patients were phenotyped regarding their cardiometabolic profile using metabolic syndrome criteria (minus that for HBP). The probability of hypertension was assessed by multiple logistic regression.

Results: There was an overall high prevalence of HBP (59.6%) and of chronic kidney disease (66%) contrasting with a low frequency of insulin resistance (5.2%) and obesity (18.6%). In addition, hypertension was not associated with insulin resistance [regression of SBP by % S: regression coefficient, 0.007 (-0.090-0.104) mmHg; correlation coefficient, 0.00; p = 0.89], [regression of DBP by % S: -0.004 (-0.053-0.045) mmHg; 0.00; 0.87]. There was no significant difference in prevalence of metabolic syndrome changed between hypertensive and normotensive patients [38.6% versus 33.3%, p = 0.60]. In multivariate analysis, overweight [OR adjusted = 3.20 (95%: 1.19-8.61), p = 0.02] and CKD [2.49 (0,98-6.34; 0.05] were found as major determinants of hypertension.

Conclusion: The metabolic syndrome is poorly predictive of an absolute decrease in insulin sensitivity in a type 2 diabetes population, in which the prevalence of hypertension was high, and that of insulin resistance low. Overweight independently of insulin resistance and chronic kidney disease common in type 2 diabetes in Sub-Saharan Africa in which the disease is poorly controlled may play a major role in the determinism of hypertension.