Comparative Study of Intrarenal Vascular Impedance Among Hypertensive Diabetics and Normotensive Type 2 Diabetics In South Western Nigeria

Diabetes is a serious health problem with staggering morbidity and mortality rates documented to be rising at an alarming rate worldwide, more so in low income countries. The uncontrolled effect of high blood glucose and disease complications have protean multisytemic consequences. Concomitant Diabetes Mellitus (DM) and hypertension accelerates the progression of micro and macro vascular complications including nephropathy. In this prospective comparative study amongst Diabetic hypertensives, normotensive Diabetics and healthy non-diabetic normotensive controls, we evaluated the effect of co-existing hypertension with diabetes and normotensive DM on renal vascular impedance. Demographic, clinico-laboratory data and Duplex ultrasound impedance of the renal interlobar arteries were documented and data analyzed using Statistical Package for Social Sciences (SPSS) version 23 computer software. The Intra-renal Resistive index (RI) among Diabetic hypertensives (Mean = 0.72 ± 0.15), normotensive DM patients (Mean = 0.69±0.08) and control (Mean = 0.63 ± 0.08) were statistically significant, F (2, 89) = 10.94, p <0.001. The intra renal Doppler RI showed significant correlations with age (r = 0.236, p=0.019) and duration of diabetes (r = 0.333, p=0.003). The Pulsatility index showed statistical significant associations with age (r = 0.370, p<0.001), duration of diabetes (r = 0.338, p = 0.002) and serum creatinine (r = 0.208, p = 0.039). A unit increase in mean arterial blood pressure increases the risk of concomitant hypertension in DM patients by about 3% (AOR= 1.03, 95% CI 1.10; 1.33, p <0.001). Also, an increase by 1mg/dl in cholesterol level increases the risk of concomitant hypertension in DM patients by about 1% (AOR= 1.01, 95% CI 1.00; 1.02, p = 0.044). Altogether concomitant hypertension with DM causes slightly high renal vascular impedance, particularly the RI as well as mild renal dysfunction than in normotensive persons with diabetes. Particularly among cases with clinico-laboratory evidence of good glycaemic control as well as blood pressure management. The arterial blood pressure and cholesterol levels are predictors of concomitant Hypertensive Diabetic status in this study