Determinants of hypertension complications among adult hypertensive inpatients in Kenyatta National Hospital, Nairobi.

Abstract

Introduction: Hypertension is a silent killer disease owing to the late recognition of symptoms, uncontrolled hypertension is the primary risk factor for stroke, heart failure and kidney failure in sub Saharan Africa therefore control of hypertension is associated with reduction in morbidity and mortality. Efforts to address the complications associated with hypertension are still a global concern. In sub Saharan Africa the epidemiological transition of non communicable diseases poses a great threat to most of the population. Broad objective: The study assessed the determinants of hypertension complications among adult hypertensive patients admitted in medical wards in Kenyatta National Hospital (KNH). Ethical approval: Approval to conduct the study was sought form the UON/KNH ERC and study participants signed a written informed consent before participation in the study. Research methods: A cross sectional descriptive study conducted among adult hypertensive patients in medical wards who were clinically stable and consented to take part in the study. Sample size of 80 participants was obtained using Fishers et.al method. Study participants were recruited by simple random sampling to fill in the structured questionnaires and purposive sampling for Focused group discussion and key informants interviews. Data was collected within a period of six weeks. SPSS version 20 was used to analyze the quantitative data and manual analysis of qualitative data was done. Significant findings were identified using both descriptive and inferential statistics. The association between variables was determined at a P-Value of 0.05. Results: Eighty hypertensive patients admitted in medical wards were enrolled into the study. The mean age was 49.7 years (SD 15.1) with most participants being in the 40-59 age group . Sixty percent of participants were females and the male to female ratio was 2:3 .There was a significant relationship between patients level of education and hypertension complications (p=0.001). The risk of hypertensive complications was 94% lower in clients with primary compared to no education (OR 0.06; 95% CI 0.01-0.6) The risk of hypertension complication increased 2.84 times (OR = 2.84; 95% CI 1.07-7.53) in clients with high systolic blood pressure compared to those with normal systolic blood pressure. Measurements of BMI indicated that 23 (28.8%) patients were overweight and 32 (40%) were obese. xvi There was a negative correlation between BMI and both systolic (Pearson’s rho -0.05) and diastolic (Pearson’s rho-0.01) blood pressure. Financial constraints and lack of adequate knowledge among hypertensive patients were main factors cited to be contributing to development of hypertension complications in the key informants’ interviews and focused group discussions. Conclusion and recommendation Hypertension and hypertension related complications are high in Kenyatta National Hospital with at least 34: 80 hypertensive patient having hypertension associated complications. No education/low education level was associated with hypertension complications so there is need to have individualized health education for hypertensive patients so that each patient is educated according to their unique needs. Financial constraints play a key role in development of hypertension complications so patients should be encouraged to take up insurance covers so that they are able to pay for medical services when need arises. The risk of hypertension complication increased 2.84 times in clients with high systolic blood pressure compared to those with normal systolic blood pressure it is therefore recommended that the follow up system be strengthened so that the hypertensive patients can be traced and treated,this will prevent/reduce the number of patients coming to hospital already suffering complications. There is a need for more studies in this area to identify how this determinants that contribute to development of complications can be addressed in KNH as developing countries continue experiencing the epidemiologic transition of non-communicable diseases especially in Kenya where data is scarce