Echocardiographic partition values and prevalence of left ventricular hypertrophy in hypertensive Nigerians

BACKGROUND: Left ventricular hypertrophy (LVH) is a well known independent risk factor for cardiovascular events. It has been shown that combination of left ventricular mass (LVM) and relative wall thickness (RWT) can be used to identify different forms of left ventricular (LV) geometry. Prospective studies have shown that LV geometric patterns have prognostic implications, with the worst prognosis associated with concentric hypertrophy. The methods for the normalization or indexation of LVM have also recently been shown to confer some prognostic value especially in obese population. We sought to determine the prevalence of echocardiographic lLVH using eight different and published cut-off or threshold values in hypertensive subjects seen in a developing country's tertiary centre. METHODS: Echocardiography was performed in four hundred and eighty consecutive hypertensive subjects attending the cardiology clinic of the University college Hospital Ibadan, Nigeria over a two-year period. RESULTS: Complete data was obtained in 457 (95.2%) of the 480 subjects (48.6% women). The prevalence of LVH ranged between 30.9–56.0%. The highest prevalence was when LVM was indexed to the power of 2.7 with a partition value of 49.2 g/ht(2.7 )in men and 46.7 g/ht(2.7 )in women. The lowest prevalence was observed when LVM was indexed to body surface area (BSA) and a partition value of 125 g/m(2 )was used for both sexes. Abnormal LV geometry was present in 61.1%–74.0% of our subjects and commoner in women. CONCLUSION: The prevalence of LVH hypertensive patients is strongly dependent on the cut-off value used to define it. Large-scale prospective study will be needed to determine the prognostic implications of the different LV geometry in native Africans

PREVALENCE AND DETERMINANTS OF ECHOCARDIOGRAPHIC LEFT VENTRICULAR HYPERTROPHY AMONG HYPERTENSIVE PATIENTS IN A TERTIARY CARE HOSPITAL

 Objectives: This cross-sectional study was conducted during the year 2014–15 to determine the prevalence, pattern, and factors associated with left ventricular hypertrophy (LVH) among hypertensive patients attending a tertiary care hospital.Methods: A total of 400 eligible adult patients having essential hypertension were included in this study. After obtaining informed consent, all participants were examined with echocardiography and relevant information was collected using a well-structured questionnaire.Results: The mean age of study population was 52.3 ± 12.8 in years. Mean systolic (SBP) and diastolic blood pressure (DBP) was 149.8 ± 11.2 and 94.7 ± 4.9 mmHg, respectively. Among the study participants, 266 (66.5%) had LVH and concentric hypertrophy was the predominant (64.3%) LV geometric pattern. Multivariate logistic regression revealed that obesity, SBP, and DBP had significant positive association with LVH (p<0.05).Conclusion: Liberal use of echocardiography in hypertensive patients could be useful in early diagnosis of LVH and guiding treatment decision. There should be emphasis on controlling SBP, DBP, and body mass index of hypertensive patients so that further cardiovascular complications can be prevented

Left ventricular hypertrophy, geometric patterns and clinical correlates among treated hypertensive Nigerians

Background: Left ventricular hypertrophy can be due to various reasons including hypertension. It constitutes an increased cardiovascular risk. Various left ventricular geometric patterns occur in hypertension and may affect the cardiovascular risk profile of hypertensive subjects. Methods: One hundred and eighty eight hypertensive subjects were used for this study. Left ventricular hypertrophy was diagnosed by echocardiography. Relative wall thickness was derived by 2 x PWT/LVIDd. Subjects were arbitrarily categorized according to the duration of hypertension. Statistical analysis was done using SPSS 15.0. Results: The mean age of the study population was 55.95±10.71 years. Subjects who had hypertension for >5 years were more likely to be older and had a lower ejection fraction , larger left ventricular diastolic internal dimension than those with duration of hypertensio

Cardiomyopathies in Sub-Saharan Africa: Hypertensive Heart Disease (Cardiomyopathy), Peripartum Cardiomyopathy and HIV-Associated Cardiomyopathy

Cardiomyopathy is an important cause of cardiac-related morbidity and mortality in sub-Saharan Africa. Dilated cardiomyopathy is responsible for 20–30% of adult heart failure (HF) in the region. It is only second to hypertensive heart disease as etiological risk factor for HF in many parts of the continent. The aim of the chapter is to review the current epidemiology, clinical features, management, and prognosis of hypertensive heart disease, peripartum cardiomyopathy, and HIV-associated cardiomyopathy in sub-Saharan Africa

Left ventricular hypertrophy among black hypertensive patients: focusing on the efficacy of angiotensin converting enzyme inhibitors

BACKGROUND: Left ventricular hypertrophy (LVH) is an independent cardiovascular risk factor in patients with essential hypertension. The main objective of this study was to assess the echocardiographic prevalence of left ventricular hypertrophy in patients with hypertension, its risk factors and effect of antihypertensive drugs on its prevalence. METHODS: A hospital based cross sectional study was conducted on 200 hypertensive patients on treatment in southwest Ethiopia. A pretested structured questionnaire was used to collect data from participants and their clinical records. Blood pressure and anthropometric measurements were taken according to recommended standards. Left ventricular mass was measured by transthoracic echocardiography. Associations between categorical variables were assessed using chi-square test and odds ratio with 95% confidence interval. Logistic regression model was done to identify risks factors of LVH. P values of < 0.05 were considered as statistically significant. RESULTS: The mean age, systolic blood pressure, diastolic blood pressure and body mass index were 55.7 ± 11.3 years, 139.2 ± 7.7 mmHg, 89.2 ± 5.7 mmHg and 24.2 ± 3.4 Kg/m(2) respectively. The overall prevalence of LVH among these study subjects was 52%. Age ≥50 years (OR: 3.49, 95% CI 1.33-9.14, P = 0.011), female gender (OR: 7.69, 95% CI 3.23-20.0, P < 0.001), systolic blood pressure ≥140 mmHg (OR: 2.85, 95% CI 1.27-6.41, P = 0.011), and duration of hypertension (OR: 3.59, 95% CI 1.47-8.76, P = 0.005) were independent predictors of left ventricular hypertrophy. Angiotensin converting enzyme (ACE) inhibitors were the only antihypertensive drugs associated with lower risk of left ventricular hypertrophy (OR: 0.08, 95% CI 0.03-0.19, p < 0.001). CONCLUSIONS: Left ventricular hypertrophy was found to be highly prevalent in hypertensive patients in Ethiopia. ACE inhibitors were the only antihypertensive drugs associated with reduced risk of LVH. We thus recommend strategies to early detect and treat hypertension and to timely screen for LVH among patients with hypertension. Multicenter prospective studies in Africa settings would be ideal to identify the best antihypertensive agents in black Africans

Biomarkers of ventricular remodelling in African hypertensives.

Includes abstract.Includes bibliographical references.There is substantial evidence that the burden of hypertension, hypertension with left ventricular hypertrophy and hypertensive heart failure is very enormous in sub-Saharan Africa. There is therefore the need to look for easier and faster means, compared to electrocardiography and echocardiography of diagnosing and differentiating the different effects of long standing hypertension on cardiac remodelling which ultimately lead to systolic and diastolic dysfunctions as this affects the prognosis, management and treatment modalities of hypertension. We studied 210 subjects who were subdivided into three groups after echocardiography: those without left ventricular hypertrophy (HT) (n=83); those with left ventricular hypertrophy (HTLVH) (n=50) and those with hypertensive heart failure (HHF) (n=77)

Clinical and Echocardiographic Findings of Left Ventricular Diastolic Dysfunction Among Hypertensive Patients at Muhimbili National Hospital, Dar es Salaam

Hypertension is the commonest of the cardiovascular risk factors, whose prevalence in Tanzania is high between 20-30%, among rural and urban residents respectively. Uncontrolled hypertension leads to a number of structural changes in the heart which eventually cumulates into interstitial fibrosis, myocardial wall thickness and functional alteration such as diastolic dysfunction. Diastolic dysfunction is thought to be responsible for as many as 74% of cases of HF in hypertensive patients. Despite this likelihood; it is rarely diagnosed in clinical practice except by default. Diastolic heart failure is common in sub-Saharan African hypertensive patients. However less is known about the prevalence of subclinical left ventricular (LV) diastolic dysfunction in asymptomatic and symptomatic hypertensive patients in Tanzania. To describe the clinical and echocardiographic features of Left ventricular diastolic dysfunction among hypertensive patients at Muhimbili National Hospital. LV geometry and diastolic function were assessed by echocardiography in 200 hypertensive patients attending Muhimbili National Hospital in Dar es Salaam, Tanzania. The demographic parameters including age, sex, and body surface area, systolic and diastolic blood pressure were taken. Patients were categorized into groups of in-patients and outpatients. Ethical clearance was sought from the Research and Publications Committee of MUHAS and permission to conduct the study was obtained from the Ethics committee department of MNH. Patients were enrolled after informed verbal and written consent. Data entry and analysis has been done using the SPSS windows version 16 Two hundred participants were recruited into the study during the study period. One hundred and eight (54%) were females.The mean age of the study population was 52±13.5 years, which varied from 23-86 years, with men being older than women, with higher body surface area and heights than women. xii LV diastolic dysfunction was found in 58.5 % of participants, 50% were in grade 1 diastolic dysfunction. The overall prevallence of left ventricular hypertrophy was 86% in this population of patients, concentric LVH dominated in both patient groups constituting 60.4% , eccentric hypertrophy was seen in 17.6% and concentric remodeling in 8%. Fourteen percent had normal left ventricular geometry. Concentric left ventricular geometry was the predominant geometry among the in-patients with diastolic dysfunction In-patient hypertensive group had statistically significant larger LV internal diameters and wall thicknesses, and they had higher LV mass as well as higher prevalence of LVH (all p<0.01. higher E/E’ ratio was independently found to be associated with in-patient status, adjusting for lower age, larger LA size, higher mitral valve A velocity and lower IVRT (multiple R2=0.26, p<0.001). Conclusion: The prevalence of diastolic dysfunction is high among this population of patients with hypertension . Concentric left ventricular hypetrophy is high among hypertensives in this population and is a predominant geometry in patients with diastolic dysfunction. Elevated left ventricular filling pressures were independetly associated with inpatient status. The higher prevalence of cardiac hypertrophy and left ventricular diastolic dysfunction among hypertensives in our study support the need for improved attainment of blood pressure goals in these patients. Aggressive Screening for end organ demage should be warranted in this population