Research Square · Oct 26, 2026
Factors associated with hypertension among diabetic patients at two tertiary Hospitals in Rwanda: a case-control study
By Nsengiyumva P, Iracyahari E, sebera E et al.
Background Globally, 60–80% of diabetic patients develop hypertension, leading to increased cardiovascular mortality. In sub-Saharan Africa, including Rwanda, both conditions are on the rise due to urbanization and lifestyle changes. Despite high prevalence, specific risk factors for hypertension in Rwandan diabetic populations remain poorly understood, limiting targeted interventions. This case-control study aimed to identify risk factors for hypertension among diabetic patients at two tertiary hospitals in Rwanda (2020–2024). Methods This retrospective matched case-control study was conducted at two tertiary hospitals in Rwanda from January 2020 to December 2024. The cases consisted of diabetic patients with hypertension (n = 200), and the controls were diabetic patients without hypertension (n = 200), matched for gender. Medical records were reviewed using structured data extraction forms, and we conducted interviews with participants to collect data on lifestyle characteristics. Data analysis employed chi-square tests and multivariate logistic regression using SPSS version 28.0. A p-value of less than 0.05 was considered statistically significant at 95% confidence. Results Among eligible 400 participants in outpatient clinic (200 cases, 200 controls), hypertensive diabetic patients were older (60.3 vs 48.6 years), had longer duration of diabetes (12 vs 10 years), poorer glycemic control (HbA1C 9% vs 8%), and worse lifestyle factors including higher smoking rates (21.2% vs 5.2%) and lower physical activity (17.6% vs 43.8%). In multivariate logistic regression analysis, hypertension among diabetic patients was significantly associated with family history of hypertension (AOR = 3.12, 95% CI: 2.43–22.68), elevated creatinine levels ≥ 88 µmol/L (aOR = 4.23, 95% CI: 1.02–17.48), smoking (aOR = 2.46, 95% CI: 1.15–14.60), and poor glycemic control (HbA1c > 7%) (aOR = 3.46, 95% CI: 1.96–15.81). Engagement in physical exercise was inversely associated with hypertension (aOR = 0.17, 95% CI: 0.05–0.56). Hypertensive diabetic patients also exhibited higher frequencies of chronic kidney disease and cardiovascular complications compared with controls. Conclusion It was revealed that hypertension among diabetic patients is associated with a family history of hypertension, poor glycemic control, elevated kidney function, and smoking, while regular physical exercise has demonstrated a protective effect. These findings support routine risk assessment and integrated diabetes care in service delivery by targeting these associated factors while promoting physical activity.