HYPERTENSION AND DIABETES RESEARCH GROUP
RESEARCH FOCUS
All aspects of research on Hypertension and Diabetes Mellitus ranging from animal bench studies to bedside clinical investigation
STATEMENT OF INTENT
Cardiovascular diseases (CVD) have steadily taken up the premiere position as a significant cause of mortality and morbidity, and, the number one cause of non-communicable disease in the world. During the 19th century, CVD was responsible for only 10% of deaths worldwide, but this fraction increased significantly to 30% in the last decade of the 20th century, with 45% in the high income countries and 26% in the low and middle income countries (LIMIC).1 In the early 21st century, there is indication that mortality due to CVD is declining in the high income countries and increasing in virtually every other region of the world including Africa.2
Hypertension and Diabetes mellitus are two most commonly studied and most frequent cause of cardiovascular morbidity. The number of people who have hypertension rose from 600 million in 1980 to I billion in 2008 and is projected to reach 1.5 billion by 2025. What is worrying is that the prevalence of hypertension is highest in the African region at 46% of adults aged 25years and above, while the lowest prevalence of 35% is found in the Americas.1 In Nigeria the prevalence of hypertension has been put at 22.7% with a higher rate of 32.7% found in the urban areas. 4Overall, low income countries have a higher prevalence of hypertension at 40%, with the higher income countries having about 35%.1
The worldwide prevalence of diabetes will leap from an estimated 2.8% in year 2000 to a projected number of 4.4% in the year 2030.3This increase will occur mainly from India, Sub-Saharan Africa and Middle East. In Africa the prevalence varies from 1% in rural to 7% in urban sub-Saharan Africa. The highest prevalence rates of 13.1% have been found in South Africa. 4In Nigeria, prevalence rates of Diabetes mellitus vary from as low as 0.65% in Mangu, Northern Nigeria to 11% in Lagos, Southern Nigeria.3
Diabetes mellitus and hypertension are two common diseases that coexist frequently. The prevalence of hypertension in diabetic individuals appears to be approximately twofold than in the nondiabetic population5,6 Similarly there is evidence that the development of diabetes is almost 2.5 times as likely in persons with hypertension than in normotensive counterparts.7,8
When hypertension is found in type 2 diabetic persons there is often a clustering of risk factors such as microalbuminuria, central obesity, insulin resistance, dyslipidaemia, hypercoagulation, increased inflammation and left ventricular hypertrophy. 9These risk factors predispose to the development of cardiovascular diseases by 75% and increase the risks of coronary heart disease, stroke, nephropathy and retinopathy.10
The relationship between diabetes and hypertension is further demonstrated by mortality data from death certificates which show that hypertension was implicated in 44% of deaths coded to diabetes and diabetes was involved in 10% of deaths coded to hypertension.11 Indeed 35-75% of diabetic complications are attributed to hypertension and the absence of hypertension is the usual finding in long-term survivors of diabetes.12
When hypertension is found in type 2 diabetic persons there is often a clustering of risk factors such as microalbuminuria, central obesity, insulin resistance, dyslipidaemia, hypercoagulation, increased inflammation and left ventricular hypertrophy. 9These risk factors predispose to the development of cardiovascular diseases by 75% and increase the risks of coronary heart disease, stroke, nephropathy and retinopathy.10
The relationship between diabetes and hypertension is further demonstrated by mortality data from death certificates which show that hypertension was implicated in 44% of deaths coded to diabetes and diabetes was involved in 10% of deaths coded to hypertension.11 Indeed 35-75% of diabetic complications are attributed to hypertension and the absence of hypertension is the usual finding in long-term survivors of diabetes.12
There are enough data about the benefits of good control of hypertension and blood glucose as well as the availability of therapies for diabetes and hypertension control but outcomes remain less than optimal. 13 However the outcome of management of hypertension and diabetes mellitus has not been optimal. 13 Ekwunife et al had reported that the proportion of hypertensive patients on treatment in Nigeria was 21% and blood pressure was controlled in only 9% of those treated ( 5% in men and 17.5% in women). 14
Inspite of advances in diabetes care and diabetes care facilities, desired outcome are not good and linked to this, patient satisfaction is not optimal. Some of the reasons why patient satisfaction and desired outcome are not adequate include i. inadequate attention to biological aspects of diabetes ii inadequate or inappropriate pharmacology iii psycho-social-cultural reasons.15,16
The barriers to control of hypertension can be divided into three: i. patient related ii. physician controlled iii. Health provider related.
Animal research will be pivotal in the research of our group. Our study may be useful in developing some latent antihypertensive and antidiabetic drugs in our local herbal medicines.
The Group will research on all these identified need areas with a view to improving care and reducing morbidity and mortality of patients who have diabetes and hypertension particularly in Nigeria where peculiar challenges of inadequate funding and health infrastructure, corruption and high adult illiteracy compound and magnify the problem and negatively impact on the national development index.
REFERENCES
1. Mathers CD, Lopez A, Stein D, et al : Deaths and disease burden by cause : Global burden of disease estimates for 2001 by World Bank country groups. Disease Control Priorities Project Working Paper 18 April 2004. Revised January 2005 (http://www.dcp2.org/file/33/wp18.pdf).
2. Gaziano JM, Fundamentals of Cardiovascular Disease : In Libby P, Bonow RO, Mann DL et al editors, Braunwald’s Heart Disease : A Textbook of cardiovascular Medicine, 8th edition, Saunders Elsevier 2008 : 1-21.
3. Wild S, Roglic G, Green A et al. Global Prevalence of Diabetes: Estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27:5:1047-1053.
4. Motala AA. Diabetes Trends in Africa. Diabetes metab Res Rev 2002; 18:514-520.
5. Teuscher A, Egger M, Herman JB: Diabetes and Hypertension: Blood pressure in clinical diabetic patients and a control population. Arch Intern Med 1989; 149:1942-1945.
6. Klein BEK, Klein R, Moss SE: Blood pressure in a population of diabetic persons diagnosed after 30 years of age. Am J Public Health 1984; 74:336-339.
7. National High Blood Pressure Education Program Working Group report on hypertension in diabetes. Hypertension 1994; 23:2:145-158.
8. Sowers JR, Epstein M, Frohlich ED, “Diabetes, hypertension and cardiovascular disease: an update” Hypertension 2001; 37:4:1053-1059.
9. Sowers JR, Epstein M, Frohlich ED, “Diabetes, hypertension and cardiovascular disease: an update” Hypertension 2001; 37:4:1053-1059.
10. Adler AI, Stratton IM, Neil HAW, Yudkin JS, Matthews DR, Cull CA et al. “Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36) : prospective observational study “ BMJ 2000;321 :7:258:412-419.
11. Bild D, Teutsch SM. The control of hypertension in persons with diabetes: Apublic health approach. Public Health Rep 1987; 102:522-529.
12. Horan MJ. Diabetes and hypertension in National Diabetes Data Group: Diabetes in America : Diabetes Data Compiled 1984. US Dept of Health and Human Services, publication No (NIH) 85-1468,1985,chap XVII,XVII-I-XVII-21.
13. Chinenye S, Young E. State of Diabetes Care in Nigeria: A Review. The Nig Health J 2011;11:4:101106.
14. Ekwunife OI, Udeogaranya Po, Nwatu IL. Prevalence, awareness, treatment and control of hypertension in a Nigerian population. Health 2010;7:731-735.
2. Gaziano JM, Fundamentals of Cardiovascular Disease : In Libby P, Bonow RO, Mann DL et al editors, Braunwald’s Heart Disease : A Textbook of cardiovascular Medicine, 8th edition, Saunders Elsevier 2008 : 1-21.
3. Wild S, Roglic G, Green A et al. Global Prevalence of Diabetes: Estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27:5:1047-1053.
4. Motala AA. Diabetes Trends in Africa. Diabetes metab Res Rev 2002; 18:514-520.
5. Teuscher A, Egger M, Herman JB: Diabetes and Hypertension: Blood pressure in clinical diabetic patients and a control population. Arch Intern Med 1989; 149:1942-1945.
6. Klein BEK, Klein R, Moss SE: Blood pressure in a population of diabetic persons diagnosed after 30 years of age. Am J Public Health 1984; 74:336-339.
7. National High Blood Pressure Education Program Working Group report on hypertension in diabetes. Hypertension 1994; 23:2:145-158.
8. Sowers JR, Epstein M, Frohlich ED, “Diabetes, hypertension and cardiovascular disease: an update” Hypertension 2001; 37:4:1053-1059.
9. Sowers JR, Epstein M, Frohlich ED, “Diabetes, hypertension and cardiovascular disease: an update” Hypertension 2001; 37:4:1053-1059.
10. Adler AI, Stratton IM, Neil HAW, Yudkin JS, Matthews DR, Cull CA et al. “Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36) : prospective observational study “ BMJ 2000;321 :7:258:412-419.
11. Bild D, Teutsch SM. The control of hypertension in persons with diabetes: Apublic health approach. Public Health Rep 1987; 102:522-529.
12. Horan MJ. Diabetes and hypertension in National Diabetes Data Group: Diabetes in America : Diabetes Data Compiled 1984. US Dept of Health and Human Services, publication No (NIH) 85-1468,1985,chap XVII,XVII-I-XVII-21.
13. Chinenye S, Young E. State of Diabetes Care in Nigeria: A Review. The Nig Health J 2011;11:4:101106.
14. Ekwunife OI, Udeogaranya Po, Nwatu IL. Prevalence, awareness, treatment and control of hypertension in a Nigerian population. Health 2010;7:731-735.
15. Chinenye S, Young EE. State of diabetes care in Nigeria: A review. Niger Health J 2011; 11:101-109.
16. Hart JT. Rule of halves: Implications of increasing diagnosis and reducing dropout for future workload and prescribing costs in primary care. Br J gen Pract 1992; 42:116-119.
16. Hart JT. Rule of halves: Implications of increasing diagnosis and reducing dropout for future workload and prescribing costs in primary care. Br J gen Pract 1992; 42:116-119.
CURRENT RESEARCH TOPICS
1. Assessment of Barriers to the control of Hypertension among patients attending Cardiology Clinics in University of Nigeria Teaching Hospital Enugu.
2. The burden of Diabetes Mellitus on Patients attending the Diabetic Clinic in University of Nigeria Teaching Hospital Enugu
MEMBERSHIP OF GROUP
1. Dr Raphael Anakwue – Senior Lecturer, Consultant Cardiologist and Clinical Pharmacologist
2. Prof Obinna Onwujekwe-Professor of Health Economics and Pharmaco-economics
3. Dr Ekene Young-Lecturer, Consultant Endocrinologist
4. Mr Chijioke Okoli, Lecturer, Health Economist
5. Dr Chika Ndiokwelu-Consultant nutritionist
6. Mr Ifeanyi Chikezie-Health Economist
7. Mr Charles Ezenduka-Pharmacist and Health Economist
1. Assessment of Barriers to the control of Hypertension among patients attending Cardiology Clinics in University of Nigeria Teaching Hospital Enugu.
2. The burden of Diabetes Mellitus on Patients attending the Diabetic Clinic in University of Nigeria Teaching Hospital Enugu
MEMBERSHIP OF GROUP
1. Dr Raphael Anakwue – Senior Lecturer, Consultant Cardiologist and Clinical Pharmacologist
2. Prof Obinna Onwujekwe-Professor of Health Economics and Pharmaco-economics
3. Dr Ekene Young-Lecturer, Consultant Endocrinologist
4. Mr Chijioke Okoli, Lecturer, Health Economist
5. Dr Chika Ndiokwelu-Consultant nutritionist
6. Mr Ifeanyi Chikezie-Health Economist
7. Mr Charles Ezenduka-Pharmacist and Health Economist
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