Hypertension and renal failure in Kumasi, Ghana

Hypertension is common in West Africa and likely to become more common as u rbanisation increases. There are at present few facilities for the detectio n and management of hypertension so the influence it has on overall morbidi ty and mortality in the population is not clear. The objectives of the stud y were to assess: (a) renal disease and blood pressure related admissions a nd deaths among acute medical admissions to Komfo Anokye Teaching Hospital, Kumasi, during an 8-month period; and (b) the burden of renal disease amon g out-patient hypertensives at the same hospital. Ward admission books were examined in the four acute medical wards to ascertain admission diagnosis and cause of death (two 4-month periods in 1995 and 1996). Clinical assessm ent (blood pressure, plasma creatinine, proteinuria) was also made of 448 c onsecutive out-patient hypertensives seen between March 1995 and April 1996 . Five hundred and ninety-three (17.9%) of 3317 acute medical admissions we re ascribable to a cardiovascular cause (hypertension, heart failure, strok e); 171 (28.8%) of these died. One hundred and sixty-six (5.0%) had renal d isease of whom 45 (27.1%) died, usually of end-stage renal disease. Among t he 448 hypertensive out-patients, 30.2% (110 out of 365) had a plasma creat inine >v140 mu mol/l (48 greater than or equal to 400 mu mol/l) and 25.5% ( 96 out of 376) had proteinuria. Eighty-nine of the 448 had a diastolic bloo d pressure greater than or equal to 115 mm Hg; in this group 38 (42.7%) had a plasma creatinine of > 140 mu mol/l(and 18 or 20.2% greater than or equa l to 400 mu mol/l). In conclusion, cardiovascular and renal disease are imp ortant contributors to morbidity and mortality among acute medical admissio ns to a large city hospital in Ghana. Among out-patient hypertensives renal disease is an important complication, especially in those with the more se vere hypertension.