Blood Pressure Control and Exaggerated Blood Pressure Response in Nigerians with Essential Hypertension

Background Blood pressure (BP) control in hypertensives is important in preventing cardiovascular (CV) morbidity and mortality. This work was done to assess control of BP among Nigerian hypertensives at rest and during exercise. Materials and Methods A total of 85 male hypertensives were recruited consecutively and had clinical evaluation and treadmill (TM) exercise testing using the Bruce protocol. Independent t -test, chi-square, and Fisher's exact tests were used to compare patients with controlled and uncontrolled BP using SPSS version 16 software. Adjustment for confounders was by logistic regression and general linear model. Results Resting systolic BP (rSBP) (mmHg) and resting diastolic BP (rDBP) (mmHg) were significantly lower in the controlled group (115.0 ± 12.29, 133.1 ± 12.27, P = < 0.001 and 76.00 ± 6.55, 91.4 ± 8.00, P = < 0.001). The proportion of subjects with controlled BP was 37.7%. Adjusted peak SBP (PSBP) during exercise (mmHg) was significantly higher in the uncontrolled than in the controlled group (210.5 ± 27.31, 191.8 ± 20.77, P = 0.001). Adjusted exaggerated blood pressure response (EBPR) was found in 37 subjects (44%) in the uncontrolled group while seven subjects (0.1%) had EBPR in the controlled group ( P = 0.003). Conclusion This study shows that EBPR is significantly higher in subjects with uncontrolled BP compared with those with controlled BP. Therefore, good BP control may be the key factor in preventing EBPR in hypertensives

Pulmonary Hypertension in Heart Failure Patients Presenting at OAUTHC, Ile-Ife, Nigeria

Background Pulmonary hypertension (PH) is common in heart failure patients. Literature on PH in heart failure is sparse in Nigeria. This study was carried out to determine the prevalence of PH in heart failure patients and ascertain the relationship between left ventricular systolic and diastolic function and the degree of PH. Methods A total of 125 heart failure patients had echocardiography done. PH was diagnosed using tricuspid regurgitation jet and pulmonary ejection jet profile. Results PH was present in 70.4% of heart failure patients. Estimated mean pulmonary arterial pressure increased with increasing severity of systolic and diastolic dysfunction and had significantly negative correlation with ejection fraction, fractional shortening, and early mitral annular tissue diastolic velocity ( E′ ), but positive correlation with left ventricular end-systolic volume, right ventricular dimension, transmitral E to A ratio, and E/E′ ratio. Conclusion PH is very common in heart failure and has significant relationship with left ventricular function

Echocardiographic Assessment of Left Ventricular Geometric Patterns in Hypertensive Patients in Nigeria

Left ventricular (LV) hypertrophy is an important predictor of morbidity and mortality in hypertensive patients, and its geometric pattern is a useful determinant of severity and prognosis of heart disease. Studies on LV geometric pattern involving large number of Nigerian hypertensive patients are limited. We examined the LV geometric pattern in hypertensive patients seen in our echocardiographic laboratory. A two-dimensional, pulsed, continuous and color flow Doppler echocardiographic evaluation of 1020 consecutive hypertensive patients aged between 18 and 91 years was conducted over an 8-year period. LV geometric patterns were determined using the relationship between the relative wall thickness and LV mass index. Four patterns of LV geometry were found: 237 (23.2%) patients had concentric hypertrophy, 109 (10.7%) had eccentric hypertrophy, 488 (47.8%) had concentric remodeling, and 186 (18.2%) had normal geometry. Patients with concentric hypertrophy were significantly older in age, and had significantly higher systolic blood pressure (BP), diastolic BP, and pulse pressure than those with normal geometry. Systolic function index in patients with eccentric hypertrophy was significantly lower than in other geometric patterns. Doppler echocardiographic parameters showed some diastolic dysfunction in hypertensive patients with abnormal LV geometry. Concentric remodeling was the most common LV geometric pattern observed in our hypertensive patients, followed by concentric hypertrophy and eccentric hypertrophy. Patients with concentric hypertrophy were older than those with other geometric patterns. LV systolic function was significantly lower in patients with eccentric hypertrophy and some degree of diastolic dysfunction were present in patients with abnormal LV geometry