Prevalence of Hypertension Stages and the Main Risk Factors in Khartoum Locality, Sudan, 2014 | Chapter 05 | New Insights into Disease and Pathogen Research Vol. 2

Background Information: Cardiovascular diseases (CVDs) are number one killer in the world among non-communicable diseases (NCDs). The principal underlying risk factor for CVDs is hypertension (HTN).

Objectives: To identify the prevalence of hypertension, the stages of HTN and the related risk factors such as age, sex, smoking and body mass index (BMI) among the population in Khartoum locality, Sudan, 2014

Methods: A community based cross-sectional study was carried out in Khartoum locality during March- April 2014. A total of 948 adult individual were interviewed using structured questionnaire that was filled by medical officers, house officers and semi-final medical students. Blood pressure (BP) was measured twice with 5-6 minutes in-between. Hypertension was considered as ≥ 140 mmHg and ≥ 90 mmHg for systole and diastole BP respectively. The international classification of BMI was used for underweight, normal, overweight and obesity.

Analysis: Prevalence of HTN and the stages was measured by descriptive statistics. Multiple logistic regressions was used to test relationships of age, sex, smoking and BMI with stages of hypertension, pre-HTN, stage one HTN, stage two HTN, isolated systolic hypertension (ISHTN) and isolated diastolic hypertension (IDHTN).

Results: More than half of the population (51.3%) was in the age group 18-36 years. Males and females account to 44.7% and 55.3% respectively. Overweight and obesity was detected in 59.1% of the study population. Most of the study populations were non-smokers (88.8%). Pre-HTN, HTN (stage one and two), ISHTN and IDHTN were 7.7%, 10.7%, 9.4% and 7.9 respectively.

Smoking contributed to occurrence of pre-HTN by 5.7%. It has no contribution to other stages of HTN. Male sex is the contributing factor for occurrence of pre-HTN, stage one HTN and stage two HTN, Odd Ratios: 4.555, 8.355 and 6.588 respectively. Overweight contributes to all stages of  HTN by various degrees. Age is also a contributory factor for stage one HTN, stage two HTN and ISHTN.

Conclusion: Prevalence of different stages of HTN in Khartoum locality was high. Overweight contributes to all stages of HTN. Age and male sex were not contributing to pre-HTN and ISHTN respectively.

Author(s) Details

Dr. Asma Abdelaal Abdalla
Faculty of Medicine, University of Khartoum, Sudan.

Dr. Siham Ahmed Balla
Faculty of Medicine, University of Khartoum, Sudan.

Dr. Mohamed Salah Ahmed Mohamed
Faculty of Medicine, Alneelain University, Sudan.

Dr. Hind Mamoun Behairy
Faculty of Medicine, International University of Africa, Sudan.

Dr. Naiema Abdalla Waqialla Fahal
Khartoum State Ministry of Health, Sudan.

Dr. Dina Ahmed Hassan Ibrahim
Ministry of Higher Education and Scientific Research, Sudan.

Dr. Maha Ismail Mohamed
Faculty of Medicine, Almughtaribeen University, Sudan.

Prof. Ibtisam Ahmed Ali
Faculty of Medicine, International University of Africa, Sudan.

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Can We Predict Preeclampsia? | Chapter 12 | Current Trends in Medicine and Medical Research Vol. 4

Hypertensive  disorders  in  pregnancy  are  a  leading  cause  of  peripartum  morbidity  and  mortality. Preeclampsia is a heterogeneous maternal syndrome. Large  studies  have  pointed  out  the  association  of  impaired  spiral  artery  remodeling  at  the fetomaternal interphase in preeclampsia, but how exactly is the fetomaternal dialogue mediated and what are the biomarkers to detect the subclinical disease in various subsets of high-risk pregnancies is  still  a  challenge.  These  biomarkers  can  finally  be  used  to  diagnose  renal  function  (Kallikrein-creatinine ratio), vascular resistance (uterine artery Doppler), coagulation disorders (platelet volume, fibronectin,  prostacyclin,  thromboxane,  oxidant  stress  (lipid  peroxidase,  8-isoprostane,  antioxidants, anticardiolipin  antibodies,  homocysteine,  serum  uric  acid),  vascular  adaptation  (Placental  growth factor, Vascular endothelial growth factor, s-flt, s-eng) and markers ofplacental function and ischemia (placental  CRH,  CRH  bp,  activin,  inhibin, hCG).Post  partum  preeclampsia  can  be  predicted  by identifying the factors preventing the excretion of sodium, puerperal diuresis  and shift of intravascular fluid into the extra vascular compartment compartment(atrial natriuretic peptide in the first week after delivery,  natriuresis  and  inhibition  of  aldosterone,  angiotensin  II,  vasopressin).  Preeclampsia  is  a heterogeneous  disease.  The  late  onset  preeclampsia  at  or  near  term  has  low fetal  and  maternal morbidity. But the early onset preeclampsia (1%) of all preeclampsia has significant risks. Prediction of  risks  and  identification  of  subclinical  disease  is  mandatory.  The  majority  of  at  risk  groups  in multigravida  are  chronic  hypertension,  pregestational  and  gestational  diabetes,  age  and  multiple fetuses. Whereas, in primi only 14% have these risks. This suggests that there are multiple underlying etiologies  of  different  clinical  presentations.  A  clinical  algorithm  based  on  clinical,  biochemical  and ultrasound markers is outlined. Post partum eclampsia can be predicted and monitored with central venous  pressure  and  pulmonary  capillary  wedge  pressure.  The  maternal  syndrome  (proteinuria, edema  and  hypertension)  also  has  differences  in  time of  onset,  severity  and  organ  system involvement as highlighted in several studies. These clinical subpopulations need to be identified and preeclampsia predicted with rigorous definition of different biomarkers of different clinical phenotypes. The  future endeavors  should  be  to  identify  subclinical  disease  in  various  clinical  phenotypes  with these potential biomarkers in prospective longidunal studies.

Author(s) Details

Dr. Jayavelan Ramkumar

Department of Cardiothoracic Surgery, Sri Ramachandra Medical College and University, Chennai-600116, India.

Dr. Nidhi Sharma

Department of Obstetrics and Gynaecology, Saveetha Medical College, Saveetha University, Chennai-602105, India.

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