Prevalence of hypertension, overweight, and obesity in type 2 DM patients attending a tertiary health care facility in Enugu, Nigeria

Ijeoma Jacinta Nwagbara; Joel C Onyeanusi; Innocent S I Ogbu; Chikaodili Nwando Obi-Ezeani

doi:10.4103/jihs.jihs_23_21

ORIGINAL ARTICLE

Year : 2021 | Volume : 9 | Issue : 2 | Page : 70-74

Prevalence of hypertension, overweight, and obesity in type 2 DM patients attending a tertiary health care facility in Enugu, Nigeria

Ijeoma Jacinta Nwagbara¹, Joel C Onyeanusi¹, Innocent S I Ogbu¹, Chikaodili Nwando Obi-Ezeani²
¹ Department of Medical Laboratory Sciences, University of Nigeria, Enugu Campus, Enugu State, Nigeria
² Department of Chemical Pathology, Chukwuemeka Odumegwu Ojukwu University, Awka, Anambra State, Nigeria

Date of Submission	14-Aug-2021
Date of Acceptance	20-Jan-2022
Date of Web Publication	15-Mar-2022

Correspondence Address:
Dr. Chikaodili Nwando Obi-Ezeani
Department of Chemical Pathology, Chukwuemeka Odumegwu Ojukwu University, Awka, Anambra State
Nigeria

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jihs.jihs_23_21

Abstract

Context: Diabetes mellitus (DM) is one of the noncommunicable diseases with an increased worldwide prevalence which differs from country to country. Hypertension and obesity may coexist in diabetes, thus enhancing complications and morbidities. Aim: The study determined the prevalence of hypertension, overweight, and obesity in type 2 DM patients attending a tertiary health care facility in Enugu, Nigeria. Setting and Design: A total of 296 type 2 DM patients attending the diabetes clinic at Enugu State University Teaching Hospital, Parklane, Enugu, were recruited for this study. Subjects and Methods: Blood pressure, weight, height, waist and hip circumferences were measured according to standard methods, waist to hip ratio and body mass index (BMI) were calculated. 3 ml of fasting blood sample was collected for blood glucose analysis. Statistical significance was considered at P < 0.05. Results: Of the 296 patients, 176 (59.5%) were female, whereas 120 (40.5%) were male. BMI was significantly higher in females when compared with the males (P = 0.002). The prevalence of hypertension was 36.8%, 35.2% in females and 39.2% in males. 26.7% were obese (30.1% females and 21.7% males) while 43.9% were overweight (42.6% females and 45.8% males). The prevalence rates of hypertension, overweight, and obesity were high in patients aged 56 years and above. Overweight and obese hypertensive patients had the prevalence rates of 45.9% and 40.4%, respectively. Conclusion: Hypertension and overweight or obesity persist in type 2 diabetic patients. The high prevalence of hypertensive overweight/obese diabetes patients calls for stringent measures through lifestyle modifications such as weight reduction, physical activity and dietary intake.

Keywords: Diabetes mellitus, hypertension, obesity, overweight

How to cite this article:
Nwagbara IJ, Onyeanusi JC, I Ogbu IS, Obi-Ezeani CN. Prevalence of hypertension, overweight, and obesity in type 2 DM patients attending a tertiary health care facility in Enugu, Nigeria. J Integr Health Sci 2021;9:70-4

How to cite this URL:
Nwagbara IJ, Onyeanusi JC, I Ogbu IS, Obi-Ezeani CN. Prevalence of hypertension, overweight, and obesity in type 2 DM patients attending a tertiary health care facility in Enugu, Nigeria. J Integr Health Sci [serial online] 2021 [cited 2023 Jun 10];9:70-4. Available from: https://www.jihs.in/text.asp?2021/9/2/70/339650

Introduction

Diabetes mellitus (DM) is a chronic metabolic disorder characterized by hyperglycemia (elevated blood glucose levels) as well as altered carbohydrate, protein, and fat metabolism resulting from either the inability of the pancreas to produce sufficient insulin or inability of the pancreas to produce insulin effectively.^[1]

DM is one of the noncommunicable diseases with an increased worldwide prevalence which differs from country to country. The developing countries are the mostly affected compared to their developed counterparts, which may be as a result of the sub-optimal health-care delivery with resultant increase in DM associated morbidity and mortality recorded in these parts of the world.

In Nigeria, the prevalence of DM was estimated at 8%–10%, and type 2 DM is mostly common in endocrinology clinics^[2] accounting for about 90%–95% of DM cases.

Hypertension, also known as high blood pressure (BP), is defined as a medical condition with repeatedly elevated systolic and diastolic BP (DBP) values of above 140 mmHg and 90 mmHg, respectively, using a sphygmomanometer.^[3] Hypertension in diabetes may enhance the risks of diabetic complications including macrovascular and microvascular. These complications include heart diseases, stroke, retinopathy, neuropathy, and nephropathy. Hypertension in diabetes varies among different cultures, races, and groups of people.^[4]

In addition to hypertension, obesity is another risk factor associated with prevalence DM^[5] and adverse cardiovascular outcomes. Obesity and overweight have also been linked with poor control of BP and blood glucose levels in type 2 diabetes patients.^[6] Cardiovascular diseases may account for 75% and 70%–80% of hospitalizations and deaths, respectively, and is the major cause of morbidity and mortality among diabetes patients.^[7]

Studies have reported occurrence or co-existence of hypertension and obesity in diabetic patients; however, the prevalence of hypertension, overweight, and obesity in patients attending diabetes clinic in Enugu State University Teaching Hospital (ESUTH), Parklane has not been explored. This study therefore is aimed at determining the prevalence of hypertension, overweight and obesity in type 2 DM patients attending the diabetes clinic at ESUTH, Parklane, Enugu State.

Subjects and Methods

Study participants

This was a cross-sectional descriptive study involving two hundred and ninety six (296) type 2 DM patients attending the diabetes clinic at ESUTH, Parklane, Enugu State, Nigeria. All confirmed type 2 diabetic patients attending the diabetes clinic at ESUTH, Parklane, and who gave written informed consent were enrolled in the study. Diabetes patients on insulin therapy, pregnant and lactating mothers as well as critically ill patients were excluded from the study.

A questionnaire was used to collect data on age, gender, BP, weight (Wt), height (Ht), waist circumference (WC), and hip circumference (HC) were all measured.

Ethical consideration

The ethical approval for this study was obtained from ESUTH Research Ethics Committee and conformed to all the ethical requirements of the Helsinki declaration.

Blood pressure measurement

This was measured using a stethoscope and standard sphygmomanometer by a trained nurse. The measurements were taken in a sitting position after the patients were allowed to rest for 5 min. The systolic BP (SBP) was taken at the onset of the korotkoff (tapping) sound, and the DBP reading taken at the disappearance of the sound.

Hypertension was diagnosed when a patient has a SBP of ≥140 mmHg and DBP of ≥90 mmHg on at least two occasions or on antihypertensive medication.

Anthropometric measurements

Weight was measured using a weighing scale and recorded in kilogram (kg), height was measured using a stadiometer and recorded in meters (m). Body mass index (BMI) was calculated as the weight in kg divided by the square of the height (kg/m²). BMI was categorized into three; normal weight = 18.5–24.9 kg/m², overweight = 25-29.9 kg/m² and obesity = ≥30 kg/m².^[8]

WC was measured using a nonelastic tape placed at the midpoint between the costal border and the top of the iliac crest.^[9] HC was measured at the level of the greater trochanter.^[10] Both WC and HC were used to calculate the waist to hip ratio (WHR).

Sample collection

Three milliliters of fasting blood sample were collected from the antecubital vein according to standard venipuncture method,^[11] dispensed into fluoride oxalate tube for blood glucose analysis.

Biochemical analysis

Fasting plasma glucose (FPG) was analyzed using glucose oxidase method as described by Trinder.^[12]

Statistical analysis

Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 23.0 (SPSS Inc, Chicago, IL, USA), and expressed as mean ± standard deviation for numerical variables, and counts and percentages (%) for the categorical variables. Statistical significance was considered at P < 0.05.

Results

The demographic, anthropometrics, and clinical data of the study participants are shown in [Table 1]. Of the 296 type 2 DM patients, 176 (59.5%) were females while 120 (40.5%) were males. The mean age, BMI, WC and WHR were 59.2 ± 10.7 years, 28.0 ± 5.6 kg/m², 96.2 ± 10.8 cm and 1.0 ± 0.1, respectively. The mean values of SBP, DBP, FPG and duration of diabetes were 134.2 ± 18.5 mmHg, 84.8 ± 10.9 mmHg, 8.8 ± 3.1 mmol/l and 6.1 ± 4.5 years, respectively.

Table 1: Demographic, anthropometric and clinical data of study participants

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In [Table 2], there were no significant differences in the mean values of age, WC, WHR, SBP, DBP, FPG, and duration of diabetes in the female and male diabetic patients (P > 0.05), however, BMI was significantly higher in females when compared with the males (P = 0.002).

Table 2: Age, anthropometric, blood pressure and fasting plasma glucose of study participants with respect to gender

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In [Table 3], 109 out of 296 type 2 DM patients had hypertension, giving a prevalence rate of 36.8%. Hypertension was recorded in 62 (35.2%) and 47 (39.2%) females and males, respectively. In addition, 79 (26.7%) patients were obese, 53 (30.1%) females and 26 (21.7%) males, whereas 130 (43.9%) patients were overweight, 75 (42.6%) females and 55 (45.8%) males.

Table 3: Gender distribution of study participants based on blood pressure and body mass index

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In [Table 4], the prevalence of hypertension was 6 (14.3%) in patients ≤45 years, 19 (29.2%) and 58 (53.2%) respectively in age groups 46–55 years and 56–65 years, and 18 (28.1%) and 8 (50.0%) in age group 66–75 years and ≥76 years respectively. The prevalence of overweight and obesity were 16 (38.1%) and 11 (26.2%) respectively in patients ≤45 years, 23 (35.4%) and 14 (21.5%), respectively, in age group 46–55 years, 53 (48.6%) and 39 (35.8%) respectively in age group 56–65 years, 35 (54.7%) and 7 (10.9%) respectively in age group 66–75 years, and 3 (18.7%) and 8 (50.0%) in patients ≥76 years.

Table 4: Age distribution of study participants based on blood pressure and body mass index

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In [Table 5], 50 (45.9%) hypertensive type 2 DM patients were overweight while 44 (40.4%) were obese.

Table 5: Body mass index and blood pressure of study participants

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Discussion

This study determined the prevalence of hypertension, overweight, and obesity in patients with type 2 DM which may be helpful in the care and management of these patients.

The prevalence rates of hypertension, overweight, and obesity were 36.8%, 43.9%, and 26.7%, respectively. The male patients had higher prevalence of hypertension (39.2%) and overweight (45.8%) but lower prevalence of obesity (21.7%) than the females with prevalence rates of 35.2%, 42.6%, and 30.1%, respectively.

The prevalence of hypertension is this study was either lower or higher than the previously reported prevalence rates both within and outside Nigeria. Unadike et al.^[13] and Anizor and Azinge^[14] reported prevalence rates of 54.2% and 57.4% in diabetes patients in Benin City and Delta State, Nigeria, respectively. However, these two studies involved both types 1 and 2 diabetes patients, and Onuoha et al.^[15] reported a prevalence rate of 44% in type 2 diabetes patients in Owerri, Imo State, Nigeria. Prevalence rates of 32% have been reported in Turkey by Satman and Yilmaz,^[16] 39% in Taiwan,^[17] 55% in Southern Ethiopia,^[18] 25.6% in India^[19] and recently 59.5% in Northwest Ethiopia.^[20] The difference between the prevalence of hypertension recorded in this study and other studies may be attributed to ethnic or racial variations, characteristics of the study population such as educational level, socio-economic status or compliance with medications. It has been shown that firm BP control results in reduction in accompanying long-term diabetic complications in type 2 DM.^[21]

This study also recorded higher prevalence of hypertension in the diabetic males (39.2%) than in the females (35.2%), and this corresponds with the reports of Unadike et al.^[13] and Akalu and Beltsi^[20] who respectively reported hypertension prevalence rates of 50.8% and 64.9% in males, and 49.2% and 51.6% in females with type 2 DM. Venugopal and Mohammed^[19] however reported hypertension prevalence rates of 43.75% and 56.25% in males and females with type 2 diabetes patients in India.

The prevalence of overweight and obesity in this study was 43.9% and 26.7%, respectively. In addition, the male type 2 diabetic patients had higher and lower prevalence of overweight (45.8%) and obesity (21.7%), respectively, than the female Type 2 diabetic patients with prevalence rates of 42.6% and 30.1%, respectively. This is in line with the work done by Basukala et al.^[22] who also reported higher prevalence of obesity in female Type 2 diabetic patients in Kathmandu, Nepal. The higher prevalence of obesity in the females may be attributed to hormonal factors, physical inactivity or sedentary lifestyles, multi-parity, dietary intake or socio-cultural factors which vary widely. Higher rates of overweight and obesity have also been reported in developing countries.^[23] Although there was no significant difference in WHR and WC of male and female patients, the BMI in female patients was however greater than that of the males. Female type 2 diabetes patients may therefore be at higher risk of cardio-metabolic disorders.

The present study likewise recorded highest prevalence rates of hypertension (53.2%) in patients aged between 56 and 65 years, overweight (54.7%) in patients aged between 66 and 75 years, and obesity (50.0%) in patients ≥75 years. Consequently, hypertension, overweight, and obesity were more prevalent in patients aged 56–65 years, 66–75 years, and ≥76 years, respectively. Increased age may therefore be associated with the higher prevalence rates in this age groups, and this may be linked to the vascular changes which follow aging as arterial thickening and stiffness increases with age, and thickening of the intima compromises the integrity of the endothelium, reducing bioavailability of vasodilators like nitric oxide.^[24] Furthermore, hormonal changes and reduced physical activity or sedentary lifestyle may contribute to obesity as one ages. Tseng^[14] had earlier reported a higher prevalence of hypertension in older obese population than those with normal weight. Mansour^[4] also observed that the prevalence of hypertension increased with age in Iraqi diabetic patients.

In the hypertensive type 2 diabetic patients, 13.8% had normal weight, 45.9% were overweight while 40.4% were obese, which points to higher prevalence of hypertension in overweight and obese Type 2 diabetic patients than in patients with normal weight. This coincides with the study done by Anizor and Azinge^[18] on type 2 diabetes patients in Delta State, Nigeria. Isezuo and Ezunu^[25] in their study in Africa reported that 44.9% of Type 2 diabetes patients had both hypertension and obesity. Notably, the co-existence of diabetes, hypertension, and obesity or overweight may increase the risk of complications, morbidities, and mortalities.

Conclusion

From the findings of this study, it can be concluded that hypertension and overweight or obesity persist in type 2 diabetic patients. The higher rate of hypertensive overweight or obese diabetic patients calls for stringent measures through lifestyle modifications such as weight reduction, physical activity, and dietary intake.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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