Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Dec;13(4):857-869.
doi: 10.1007/s44197-023-00158-5. Epub 2023 Oct 26.

High Rates of Undiagnosed Target Organ Damage Among Adults with Elevated Blood Pressure or Diabetes Mellitus in a Community-Based Survey in Lesotho

Emmanuel Firima  1   2   3 , Lucia Gonzalez  4   5   6 , Moazziz Ali Khan  7 , Molulela Manthabiseng  8 , Mamoronts'sane P Sematle  8 , Matumaole Bane  8 , Makhebe Khomolishoele  8 , Ikhetheleng Leisa  8 , Lefokotsane Retselisitsoe  8 , Thilo Burkard  9   10 , Eleonara Seelig  5   11 , Tristan Lee  4   5 , Frédérique Chammartin  4   5 , Ravi Gupta  8 , Bailah Leigh  12 , Maja Weisser  5   13   14 , Alain Amstutz #  4   5 , Niklaus Daniel Labhardt #  15   16
Affiliations

High Rates of Undiagnosed Target Organ Damage Among Adults with Elevated Blood Pressure or Diabetes Mellitus in a Community-Based Survey in Lesotho

Emmanuel Firima et al. J Epidemiol Glob Health. 2023 Dec.

Abstract

Introduction: Prevalence of elevated blood pressure (BP) and diabetes mellitus (DM) is increasing in sub-Saharan Africa. Data on target organ damage such as retinopathy, left ventricular hypertrophy (LVH), renal impairment and peripheral neuropathy (PN) among persons with elevated BP and/or DM in sub-Saharan Africa remain scarce.

Aim: To determine at community-level the prevalence of retinopathy, LVH, renal impairment, and PN among adults with elevated BP and/or DM, and assess the association of elevated BP and/or DM with target organ damage in Lesotho.

Methods: During a household-based survey, a sub-sample of adults with elevated BP (≥ 140/90 mmHg) and/or DM (glycosylated hemoglobin ≥ 6.5%), as well as comparators (BP < 140/90 mmHg, HbA1c < 6.5%) were screened for retinopathy, LVH, renal impairment, and PN. We used multivariable logistic regression for inferential analysis.

Results: Out of 6108 participants screened during the survey, 420 with elevated BP only, 80 with DM only, 61 with elevated BP and DM, and 360 comparators were assessed for target organ damage. Among those with elevated BP, and among those with DM with or without elevated BP, prevalence of retinopathy was 34.6% (89/257) and 14.4% (15/104); renal impairment was 45.0% (156/347) and 42.4% (56/132), respectively. Among those with elevated BP, 2.3% (7/300) and 65.7% (224/341) had LVH and left ventricular concentric remodeling, respectively. PN, only assessed among those with DM, was present in 32.6% (42/129). Elevated BP was associated with increased odds of retinopathy (aOR, 19.13; 95% CI, 8.52-42.94; P < 0.001) and renal impairment (aOR, 1.80; 95% CI, 1.27-2.55; P = 0.001). Presence of both elevated BP and DM was associated with an increased odds of retinopathy (aOR, 16.30; 95%CI, 5.69-46.68; P < 0.001), renal impairment (aOR, 2.55; 95% CI, 1.35-4.81; P = 0.004), and PN (aOR, 2.13; 95% CI, 1.04-4.38; P = 0.040).

Conclusion: We found a high prevalence of undiagnosed target organ damage among adults with elevated BP and/or DM during community-based screening. These findings emphasize the importance of regular prevention and screening activities in this setting.

Keywords: Arterial hypertension; Diabetes mellitus; Left ventricular hypertrophy; Lesotho; Non-communicable chronic diseases; Peripheral neuropathy; Renal impairment; Retinopathy.

PubMed Disclaimer

Conflict of interest statement

NDL reports having received travel grants to attend scientific conferences from Gilead Sciences and ViiV Healthcare. In 2022 and 2023, his division received honoraria from ViiV Healthcare, The Research Council of Norway, and the Swiss National Science Foundation. He has received grants from Swiss National Science Foundation, Fondation Botnar, Botnar Center for Child Health, the Swiss Agency for Development and Cooperation, and Moritz Straus Stiftung. All other authors have no relevant competing interests to declare.

Figures

Fig. 1
Fig. 1
Flow diagram of study population. * Additional data between 01/11/2022 to 30/11/2022; BP: blood pressure, calculated as mean of last 2 of 3 measurements; RBG random blood glucose; HbA1c glycated hemoglobin; DM diabetes mellitus; ACR albumin creatinine ratio; echo echocardiography
Fig. 2
Fig. 2
Overall prevalence of target organ damage in different subgroups. More information in supplemental material S3 table. BP blood pressure; DM diabetes mellitus; Ret retinopathy; LVH left ventricular hypertrophy; RI Renal impairment; PN peripheral neuropathy
Fig. 3
Fig. 3
Risk map for progression of renal impairment in the study population. Cells are coded by Kidney Disease: Improving Global Outcomes (KDIGO) [37]. Data are percentages and represent the proportion of all participants within each cell. Risk levels are color-coded as follows: green, low risk (if no other marker of kidney disease); yellow, moderately increased risk; orange, high risk; red, very high risk of progression of renal impairment. eGFR estimated glomerular filtration rate. G eGFR category; A albumin category
Fig. 4
Fig. 4
Risk map for progression of renal impairment among a elevated BP alone; b DM alone; c both elevated BP and DM; and d comparator group. Cells are coded by Kidney Disease: Improving Global Outcomes (KDIGO) [37]. Data are percentages and represent the proportion of participants in each diagnostic group within each cell. Risk levels are color-coded as follows: green, low risk (if no other marker of kidney disease); yellow, moderately increased risk; orange, high risk; red, very high risk of progression of renal impairment [37]. eGFR estimated glomerular filtration rate. G eGFR category; A albumin category; BP blood pressure; DM diabetes mellitus
See this image and copyright information in PMC

References

    1. Cho NH, Shaw JE, Karuranga S, et al. IDF diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018;138:271–281. doi: 10.1016/j.diabres.2018.02.023. - DOI - PubMed
    1. Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16(4):223–237. doi: 10.1038/s41581-019-0244-2. - DOI - PMC - PubMed
    1. Sun H, Saeedi P, Karuranga S, et al. IDF Diabetes Atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183:109119. doi: 10.1016/j.diabres.2021.109119. - DOI - PMC - PubMed
    1. Zhou B, Perel P, Mensah GA, Ezzati M. Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nat Rev Cardiol. 2021;18(11):785–802. doi: 10.1038/s41569-021-00559-8. - DOI - PMC - PubMed
    1. Roth GA, Mensah GA, Johnson CO, et al. Global burden of cardiovascular diseases and risk factors, 1990–2019. J Am Coll Cardiol. 2020;76(25):2982–3021. doi: 10.1016/j.jacc.2020.11.010. - DOI - PMC - PubMed

Publication types