Determinants of Blood Pressure Control in Hypertensive Diabetic Patients in Rajshahi District of Bangladesh

Abstract

Hypertension (HTN), also known as high blood pressure (HBP), is one of the most common chronic health conditions prevalent in most of the developed countries. Approximately 1 in 3 or 73 million adults in the United States has HBP. Many people suffer from HTN in the developing countries as well. Blood pressure is essential to move blood from the heart through veins and arteries to all other parts of the body. However, when the pressure is too high, it becomes dangerous, making the heart work harder and increasing the risk for heart problems, such as heart attacks and strokes. Many diabetic patients develop HTN, which increases the potential risk for various problems including kidney disease, diabetes mellitus, renal disease, blindness, and many other deadly diseases. No specific cause for HTN is found in 95 % of the cases but it is an extremely common co-morbid condition in diabetes, affecting 20–60 % of patients with diabetes, depending on obesity, ethnicity, and age (ADA 2004). Although diabetes mellitus and HTN are not among the top leading causes of deaths, such as cancer and stroke, public attention is increasing as their occurrence increases. Diabetes has been ranked the sixth leading cause of death and is also known as costly disease (ADA 2004). Coronary heart disease (CHD) is projected to be the most common cause of death globally by 2020 (Yusuf et al. 2001). HTN is one of the most important modifiable risk factors for CHD in Western and Asian populations (He and Whelton 1999). Studies from India and Bangladesh have shown an increasing trend in the prevalence of HTN (HTN Study Group 2001). The prevalence of diabetes mellitus and HTN increases with age (Moon et al. 2002). It is estimated that more than 220 million people worldwide have diabetes and the number is likely to more than double by 2030 without any intervention, with 80 % residing in low and middle income countries. Almost 80 % of diabetes deaths occur in low and middle-income countries (Wild et al. 2004). Diabetes increases the risk of coronary events twofold in men and fourfold in women. Hypertensive diabetes patients have approximately twice the risk of cardiovascular disease compared with hypertensive non-diabetic patients. Hypertensive diabetic patients are also at increased risk for diabetes-specific complications including retinopathy and nephropathy along with kidney diseases, diabetic leg ulcers, sexual dysfunction, and sterility.