The incidence and associated factors of hypertensive retinopathy among hypertensive patients attending mulago hospital.

Abstract

BACKGROUND Elevated arterial pressure, otherwise known as hypertension, may well be the most important public health problem in developed countries today. It is widespread, asymptomatic, readily detectable, and usually easily treatable, but it often leads to lethal complications if left untreated. Hypertension confers cardiovascular risk by causing target-organ damage such as retinopathy, heart disease, stroke, renal insufficiency, and peripheral vascular disease. The prevalence of hypertension is particularly high in people of African descent throughout the world, and the consequences of hypertension, including hypertensive heart and renal disease and stroke, are more common in dark races as well. As the two epidemics of infection and malnutrition are increasingly brought under control and as life expectancy and Obesity increase, morbidity and mortality due to hypertension are expected to rise as well. Hypertensive retinopathy is the most frequent marker of target organ damage. The recognition of hypertensive retinopathy is critical in the cardiovascular risk stratification of hypertensive individuals. Significantly, in the USA, the prevalence of retinopathy is two times as high in African Americans as in whites. This may prove noteworthy in the study of hypertensive retinopathy among Ugandans. Uganda, however, has never performed any documented study involving hypertensive retinopathy in its history. Therefore, this study was done to assess the magnitude and associated factors of this problem in Uganda, specifically in Mulago Hospital. PURPOSE This study was conducted to determine the prevalence of hypertensive retinopathy in hypertensive patients and to describe the factors associated with the occurrence of hypertensive retinopathy in these hypertensive patients at Mulago Hospital. METHODS A three month cross-sectional study was conducted between March and May 2005, with 161 consecutive hypertensive adult patients. The subjects were diagnosed to have hypertension while attending Mulago Hospital. Individual's medical history and demographic indices were recorded and direct ophthalmoscopic examinations were done to determine the presence or absence of hypertensive retinopathy. RESULTS The prevalence of hypertensive retinopathy among hypertensive patients at Mulago Hospital was 70.2% (113 out of 161) when measured according to the Keith-Wagener Barker classification of fundoscopic changes, using the direct ophalthalmoscope method. The most common staging observed was Stage 1 hypertensive retinopathy (57, 35.4%). The age of patients, duration of hypertension, and types of hypertension were statistically significant in the occurrence of hypertensive retinopathy. Hypertension was not significantly related to hypertensive retinopathy. CONCLUSIONS The prevalence of hypertensive retinopathy in hypertensive patients at Mulago Hospital was quite high, while most cases were classified to be Stage 1 or Stage 2. Age, types of hypertension, and duration of hypertension were also risk factors in the occurrence of hypertensive retinopathy.