HYPERTENSIVE RENAL-FAILURE IN BLACK-AFRIC ANS

Objectives: The increased risk of renal disease due to high blood pres sure observed in Black Americans would suggest ethnic factors are invo lved. We examined the clinical features of renal disease in patients h ospitalized in Ouagadougou, Burkina Faso for high blood pressure to de termine the risk factors in this black population. Methods: From Novem ber 1988 to October 1990, 317 patients (mean age 49+/-14 years, 62.5% males) under treatment for high blood pressure or with a diastolic pre ssure > 90 mmHg without antihypertensive therapy were examined at thei r initial hospitalization. The patients were divided into socio-econom ic groups according to their professional occupation and level of educ ation. Criteria of renal disease, including raised serum creatinine, p roteinuria and blood urea nitrogen, together with factors related to h ypertension, including obesity, diabetes mellitus, hypertensive retino pathy, heart failure, coronary artery disease, cerebral vascular event s and hypertensive encephalopathy were analyzed. Results: Severe hyper tension, diastolic pressure > 130 mm Hg was observed in 43% of the pat ients. There was a significant inverse correlation between age and dia stolic pressure (r = 0.23, p < 0.0001). Response to initial anti-hyper tensive treatment was good in 88% and proportional to severity. Hospit al mortality was 18.6% (59 patients) including 39 cases during the fir st two days. Mortality was not correlated with blood pressure, age, se x or socio-economic conditions. Renal disease was observed in 121 pati ents and chronic renal failure in 117 (44%). Effect of hypertension on at least one target organ was observed in 73.2% of the patients and o n at least three target organs in 38.2%. Subjects with renal disease w ere younger (p < 0.02) and responded less well to treatment than those without renal disease. Conclusions: These clinical observations confi rm the high prevalence of renal failure and the gravity of high blood pressure in Black Africans. In Burkina Faso, hospitalization for high blood pressure often leads to the discovery of terminal renal failure.