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Background: Hypertensive retinopathy (HTNR) is a recognized complication of
hypertension. Early diagnosis is crucial for the mitigation of more severe
complications such as retinal detachment and loss of vision by the timely institution
of appropriate management strategies. In addition, HTNR findings are a useful risk
stratification tool for acute coronary events and strokes, two leading causes of
disability adjusted life years (DALYs) worldwide. Paucity of data exists on the
prevalence and associated risk factors for HTNR in Sub Saharan Africa.
Objectives: To determine the prevalence and associated risk factors for HTNR at Moi
Teaching and Referral Hospital (MTRH).
Methods: This was a cross-sectional study conducted among patients with
hypertension attending the medical out-patient clinic at MTRH between January and
April 2018. The study population included 640 patients on follow up for hypertension
in this duration. Systematic random sampling was used to select 240 participants.
Structured interviewer administered questionnaires were utilized to collect sociodemographic,
anthropometric, clinical and laboratory data. Low density lipoproteinscholesterol
(LDL-C) measurement was performed using enzymatic colorimetric
method and fundoscopic examination performed using an ophthalmoscope, with all
measurements taken on the same visit. Grading of HTNR was done using Mitchell-
Wong classification. STATA version 15 was used for analysis and appropriate
statistics used to analyse various variables in line with the study objectives.
Categorical variables were summarized in frequency tables, percentages and bar
graphs. Continuous variables were summarized using means, standard deviations,
frequencies, medians and interquartile ranges (IQR). Medians were compared using
Wilcoxon-rank sum test. Univariate and multivariate logistic regression models were
used to assess associations of the variables with HTNR.
Results: The median age was 59 years (IQR:52,69). The prevalence of HTNR was
23.3% (95%CI: 18.13-29.20) representing 54 participants. Of those with HTNR, 84%
(47) had Grade 1, 13% (7) had Grade 2 and 3% (2) had Grade 3. Chi square p values
for age (p=0.001), blood pressure control (p=0.004) and duration of hypertension
(p=0.017) showed association with the occurrence of HTNR. On multiple logistic
regression, age had an Odds Ratio (OR) of 1.3 (95% CI: 1.026-1.086), Stage 2 HTN
had OR 3.66 (95%CI: 1.40-9.50) and duration of HTN of more than 15 years had OR
3.69 (95%CI: 1.10-12.28). Body mass index and LDL-C measurements did not show
any association with HTNR.
Conclusion: HTNR is a common finding in this population with its mild form (Grade
1) predominating. Longer duration after diagnosis, advanced age and uncontrolled BP
were strongly associated with the occurrence of HTNR.
Recommendation: Routine screening of HTNR should be part of the evaluation of
patients on follow up for HTN, especially those with other additional risk factors.
Prospective studies are required to further evaluate how elevated BP and risk factor
control impacts prognosis of both vision and other vascular complications. |
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