What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Elevated blood pressure and/or diabetes mellitus (n=921). Intervention: Elevated blood pressure vs. No elevated blood pressure or diabetes mellitus. Primary outcome: Retinopathy (aOR 19.13, 95% CI 8.52-42.94, p=<0.001).

October 26, 2023Open Access

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

Q: What are the key findings of this study?

Elevated blood pressure was associated with significantly increased odds of retinopathy (aOR 19.13) and renal impairment (aOR 1.80) compared to individuals without elevated blood pressure or diabetes.

Key Result

Elevated blood pressure was associated with significantly increased odds of retinopathy (aOR 19.13) and renal impairment (aOR 1.80) compared to individuals without elevated blood pressure or diabetes.

Study Design

Type

Cross-Sectional (n=921)

Blinding

Single-blind

Multicenter

Yes

Structured PICO

Does elevated blood pressure and/or diabetes mellitus increase the risk of target organ damage in adults in Lesotho?

Population

921 adults (median age 56, 60.3% female) with elevated blood pressure and/or diabetes mellitus, and matched comparators, screened for target organ damage in a community-based survey in Lesotho.

Exposure

Elevated blood pressure (≥ 140/90 mmHg) and/or diabetes mellitus (HbA1c ≥ 6.5% or random blood glucose ≥ 5.6 mmol/L)

Comparator

Age- and sex-matched survey participants with BP < 140/90 mmHg, HbA1c < 6.5%, and without previous diagnosis of elevated BP and/or DM

Outcome

Prevalence of target organ damage (retinopathy, left ventricular hypertrophy, renal impairment, and peripheral neuropathy)surrogate

There is a high prevalence of undiagnosed target organ damage among adults with elevated blood pressure and/or diabetes in Lesotho, highlighting the need for community-based screening and prevention.

Main Result

Odds Ratio: 19.13 (95% CI 8.52–42.94)

Absolute Event Rate: 34.6% vs 2.6%

p-value: p=<0.001

Limitations

Cross-sectional design precludes establishing causal inference and temporal associations.
Potential selection bias due to unbalanced missing values for evaluable retinal images between groups.
Measurement of blood creatinine and urine albumin were only done once, potentially resulting in over-diagnosis of renal impairment.
Foot calluses from walking in a mountainous rural area could have obscured monofilament evaluation, increasing peripheral neuropathy diagnosis.
Assessors for left ventricular hypertrophy, renal impairment, and peripheral neuropathy were not blinded, introducing potential observer bias.

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.

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