Prevalence of Pulmonary Hypertension and associated factors at St. Paul Hospital Millennium Medical College

Abstract

Abstract Background: Pulmonary Hypertension is a substantial global health issue. It is by no means rare, affects all age groups and associated with increased mortality. It is a pathologic condition that occurs due to many underlying conditions. Many of the known risk factors are endemic in Ethiopia. Despite this, data on prevalence and causes of Pulmonary Hypertension are scarce in Africa and non-existent in Ethiopia. Knowing the burden and etiologies of pulmonary HTN will help establish preventive and therapeutic strategies. Objectives: The main objective of this study is to assess the prevalence & associated factors of pulmonary hypertension at St. Paul Hospital Millennium Medical College. Methods: Institution based, analytic cross sectional study conducted by including adult patients with echocardiographic findings of Pulmonary Hypertension. A PASP value ≥ 35mmHg was considered as pulmonary hypertension. Patients with different or inconsistent echocardiographic finding were excluded. Sample size was determined by single population proportion formula considering 50% prevalence of Pulmonary HTN, with the assumption of 95% confidence interval(CI), 5% margin of error & 10% non-response rate to get a final sample size of 343 and systematic sampling technique was used. Approval from the Institution Review Board was obtained. A structured questionnaire was used to collect data on sociodemographic and associated factors. After data was collected, it was entered and analyzed with SPSS 25. Descriptive statistics of categorical variables was presented by frequencies and percentage and mean with standard deviations was estimated for continuous variables. Bi-variable and multivariable regression analysis were used to test for associations between independent variables and pulmonary hypertension. Results: Data was obtained for a total of 315 patients with 92% response rate. Pulmonary Hypertension was found in 98 (31.1%) of the patients with a mean age of 49.41 ± SD of 18.167. Majority (57.1%) of the patients are between 31-60yrs of age, the peak age is 31-40yrs (27.6%) and 68(69.4%) are female. Majority of patients 76(77.6%) have moderate to severe pulmonary hypertension and 23 (23.5%) patients have right ventricular systolic dysfunction. Of these 56(57.1%) patients are NYHA Class III patients. Cardiac conditions account for the majority of the cases (65.3%), followed by lung conditions (24.5%), chronic thromboembolism(7.1%), Pulmonary Arterial Hypertension(2%) and others(1%). The major causes of pulmonary hypertension are HHD (21.4%), CRVHD(18.4%), DCMP(14.3%), COPD(13.3%) and Thromboembolism(6.1%). The associated factors are female gender (P=0.01), COPD(P=0.001), Thromboembolism(P=0.008), DCMP(P=0.001) and CRVHD(P=0.001), HHD(0.001). However, bronchial asthma, ILD and IHD were not significantly associated with pulmonary hypertension. Conclusion: Generally, pulmonary hypertension is common in patients visiting cardiac and chest clinics of St. Paul Hospital Millennium Medical College and it occurred at an earlier with a peak age of 31-40yrs and female gender is one of the determining factors. Majority of patients are Class III patients and have moderate to severe pulmonary hypertension. The leading causes are cardiac and lung conditions, the major ones being HHD, CRVHD, DCMP, COPD and Thromboembolism. Further study is needed to describe the mortality and outcome of pulmonary hypertension.