Correlates of target organ damage among black patients with arterial hypertension.
.:: Auteurs : Lepira FB*, Kayembe PK**, M’Buyamba-Kabangu JR***, Nseka MN*
Division of Nephrology* and Hypertension***, Department of Internal Medicine, University of Kinshasa Hospital and
Department of Epidemiology and Biostatistics**, Kinshasa School of Public Health, University of Kinshasa.
Objective: to investigate the prevalence and correlates of target organ damage (TOD) among Black patients with essential hypertension (EHT). Methods: cross sectional analysis for the presence of multiple TOD of data from 100 consecutive uncomplicated hypertensive
patients (53 men and 47 women, mean age 49 ± 10 years, BMI 27 ± 5 kg/m², SBP 155 ± 19 mmHg, DBP 101 ± 11 mmHg) attending the University of Kinshasa hypertension outpatient clinic and enrolled in a case-control study of lipids and lipoproteins. Target organ damage was defined as the presence of either renal dysfunction, left ventricular hypertrophy (LVH) or hypertensive retinopathy. Renal dysfunction was defined as creatinine < 60 mL/min and classified according to NKFK/ DOQI guidelines.
Electro-cardiographic LVH was defined according to Cornell Voltage index as R wave > 13 mm in aVL lead. Hypertenive retinopathy was defined according to Keith and Wegener. Multiple TOD was defined as the concomitant presence in the same patient of the three TOD. Student t test, Mann Whitney U, Chi square tests and logistic regression analysis were used as appropriate.
Results: Overall, 79 patients (79%) had at least the damage of one end-organ. The involvement of 1, 2 or 3 end-organs was observed in 27 (27%), 31 (31%) and 21 patients (21%), respectively. The kidney was most frequently involved in patients with one end-organ damage. Kidney and retina damage was the combination of end-organs most frequently encountered in patients with damage of two end-organs. Obesity has appeared as the only determinant of the risk of having TOD with a paradoxical protective effect [0R 0.19 95% CI 0.052 – 0.738; p = 0.001] in comparison with patients with normal BMI.
Conclusion: TOD is common among the present case series and could expose them to high risk for CVD. The paradoxical protective effect of obesity could translate the phenomenon of reverse epidemiology of traditional risk factors observed in chronic diseases. Identification and management of TOD and associated risk factors should be encouraged in these patients. Key words: Target organ damage, prevalence, correlates, African blacks, hypertension.
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