title: Uncontrolled Hypertension and Its Determinants in Patients with Concomitant Type 2 Diabetes Mellitus (T2DM) in Rural South Africa.
abstract: BACKGROUND
  Paucity of data on the prevalence, treatment and control of hypertension in individuals living with type 2 diabetes mellitus (T2DM) in the rural communities of South Africa may undermine efforts to reduce the morbidity and mortality associated with cardiovascular diseases. This study examines the socio-demographic and clinical determinants of uncontrolled hypertension among individuals living with T2DM in the rural communities of Mthatha, South Africa.
  
  
  METHODS
  This cross-sectional study involved a serially selected sample of 265 individuals living with T2DM and hypertension at Mthatha General Hospital, Mthatha. Uncontrolled hypertension was defined as systolic blood pressure greater than or equal to 140 mmHg and diastolic blood pressure greater than or equal to 90mmHg in accordance with the Eight Joint National Committee Report (JNC 8) (2014). We performed univariate and multivariate logistic regression analyses to identify the significant determinants of uncontrolled hypertension.
  
  
  RESULTS
  Of the total participants (n = 265), the prevalence of uncontrolled hypertension was 75.5% (n = 200). In univariate analysis of all participants, male gender (p = 0.029), age≥65 years (p = 0.016), unemployed status (p<0.0001), excessive alcohol intake (p = 0.005) and consumption of western-type diet (p<0.0001) were positively associated with uncontrolled hypertension. In multivariate logistic regression (LR method) analysis, unemployed status (p<0.0001), excessive alcohol intake (p = 0.007) and consumption of western-type diet (p<0.0001) were independently and significantly associated with uncontrolled hypertension. There is significant association between increasing number and classes of anti-hypertensive drugs and uncontrolled hypertension (p = 0.05 and 0.02, respectively).
  
  
  CONCLUSIONS
  Prevalence of uncontrolled hypertension was high in individuals with concomitant hypertension and T2DM in the study population. Male sex, aging, clinic inertia, unemployed status and nutritional transitions are the most important determinants of uncontrolled hypertension in T2DM in Mthatha, South Africa. Treatment to blood pressure targets, though feasible in our setting, would require concerted efforts by addressing these determinants and clinic inertia.
authors.affiliation: Department of family medicine, Walter Sisulu University, East London, South Africa.
authors.forename: Oladele Vincent
authors.initials: OV
authors.lastname: Adeniyi
authors.affiliation: Department of family medicine, Walter Sisulu University, Mthatha, South Africa.
authors.forename: Parimalaranie
authors.initials: P
authors.lastname: Yogeswaran
authors.affiliation: Department of family medicine, Walter Sisulu University, Mthatha, South Africa.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Longo-Mbenza
authors.affiliation: University of Fort Hare, East London, South Africa.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ter Goon
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D015992:Body Mass Index; D008076:Cholesterol, HDL / Q000097:blood; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D016014:Linear Models; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D012424:Rural Population / Q000706:statistics & numerical data*; D013019:South Africa / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents; D008076:Cholesterol, HDL; D008055:Lipids