Blood Pressure and Obesity Index Assessment in a Typical Urban Slum in Enugu, Nigeria

Background: Rapid transition from rural to urban lifestyle in Africa has been associated with increasing cardiovascular disease burden and thus, the need for continuous reevaluation of cardiovascular risk factors in African slums which have been shown to harbor 40 to 80% of urban residents cannot be over emphasized.Objectives: To evaluate hypertension and obesity in a typical urban slum in South East, Nigeria.Design: Cross-sectional community based study.Setting: A typical urban slum in Enugu State, Eastern Nigeria.Subjects: One hundred and ninety one volunteers from the slum.Results: The mean age of the entire participants in this study was 44.1 ± 16.2 years while their mean BMI was 25.1 ± 5.2 Kg/m2. Their mean systolic BP was 128.8 mmHg ± 22.2 and 79.0mmHg ± 12.9 for mean diastolic BP. Both systolic and diastolic blood pressure (BP) increased as age group increased peaking at the age group 55- 74 years and then dropping after 75 years. Mean BMI peaked at 35- 54 years and then started dropping as age increased. In the entire community, 29.3% of the participants had hypertension (males: 42.1 %, females: 23.9%), 25.1% had isolated systolic HBP (ISH) while 22.0% had isolated diastolic HBP (IDH). In the general population, the general prevalence of HBP and ISH increased as age group increased. IDH increased as age increased peaking at 55- 74 year age group (34.1%) and then dropped thereafter (≥75; ISH=10.0%). Among the females, HBP prevalence increased across board as age increased but among the males, it increased with age and peaked at 55-74 year age group (61.1%) and then dropped (≥75; HBP= 57.1%). The prevalence of obesity in the community was 13.1% (males; 5.3%, females; 16.4%). None of those ≥75 years had obesity. Obesity prevalence was highest in those 35-54 years old (17.6%) and least in those 15- 34 years old (9.1%). Generally and within all age groups, females had higher obesity prevalence than the males. For the males, Obesity was highest in those 55-74 years (11.1%) while for the females, it was highest in those 35-54 years (23.0%). Prevalence of HBP increased with BMI getting to more than double fold in those found to be obese. 26% of the participants (20.8% of males and 31.3% of females) who were found to have hypertension had prior knowledge of it.Conclusion: Hypertension and obesity are on the increase in Nigeria and degree of ignorance about these major cardiovascular risk factors has remained very high

Lipid and Some Other Cardiovascular Risk Factors Assessment in a Rural Community in Eastern Nigeria

Background: Continuous re‑evaluation of modifiable cardiovascular risk factors (cardiovascular diseases [CVDs]) in developing nations is imperative as it lays foundation for early preventive/intervention measures at grass root level to improve/prevent CVD morbidity and mortality in those nations where health indices still score below the standard.Aim: The aim was to assess CVD risk factors as a continuous re‑evaluation of these may underscore the need for early intervention measures at grass root level.Subjects and Methods: A total of 257 apparently healthy inhabitants aged 18–85 years were recruited in a rural community in South Eastern Nigeria by convenient sampling. Blood pressure, waist circumference and blood lipid analysis were done procedurally and data analyzed using SPSS 16.0 statistical software.Results: The males were older (59.41 [5.22]) than the females (53.31 [16.90]). 69.2% (133/192) were low level farmers, retirees and dependents. Total cholesterol (TC), low density lipoprotein (LDL), and risk predictive index were higher in females while triglyceride (TG), high density lipoprotein and very LDL (VLDL) were higher in males. The middle aged and elderly respectively had higher TG and VLDL compared to the young. Aside hypertriglyceridemia, all lipid abnormalities were higher in females than males both singly (high TC: 28.9% [35/121] vs. 16.9% [12/71]; high LDL cholesterol: 52.0% [63/121] vs. 31.0% [22/71]) and in combination hypercholesterolemia with hypertriglyceridemia (42.9% [52/121] vs. 36.6% [26/71]). “Multiple risk factors” also occurred more in females with seeming further increase in older age.Conclusion: The chances of a female having CVD after menopause seemed to outweigh that of the male. CVD preventive measures should be focused at the primary/community level as a means to curtailing the increasing morbidity and eventual mortality from CVDs. Keywords: Blood pressure, Homogenous community, Lipids, Waist circumferenc

COMPARATIVE EFFECTIVENESS STUDY OF COMBINED ANTIHYPERTENSIVES FOR NIGERIAN PATIENTS

Objective: The objective of the study was to compare the clinical and economic effectiveness of four combination antihypertensives recommended for Nigerians. Methods: An open, randomized, controlled, and longitudinal double-blind trial of four groups of antihypertensives combinations: Telmisartan/ chlorthalidone/amlodipine (TCA), TC, CA, and TA was conducted among hypertensive patients. The participants were recruited from three hospitals in Enugu, and randomly assigned to the study groups. The primary outcome for this study was blood pressure (BP) control, based on Joint National Committee-8 and cost per BP control. The secondary outcomes were cost per quality adjusted life years (QALY) and patients’ self-reported health status. Descriptive and inferential statistics were used for statistical analysis. Results: Of the 110 patients enrolled in the study, more than half were women (55.5%). The mean age of patients was 54.93±12.38. The enrollees had hypertension for over 9 years (9.17±8.40). About 77% of the patients completed the study in all the groups except for TA (66.7%). There was no difference in BP in all the groups at baseline and at end-of-study (p>0.050). However, the probability of BP control was highest in TCA group (0.37±0.01), followed by TC group (0.23±0.02). The TA group showed the most favorable cost per QALY, then CA, TC, and TCA in that order. The group with the most favorable cost per BP control was TCA (70.92±0.04), then TA (94.16±0.05). Conclusion: The triple combination therapy of TCA had the best cost per BP control in the management of hypertensive patients. It demonstrated the highest probability of BP control

Intra‑cardiac masses in adults: A review of echocardiogram records at two echocardiographic laboratories in Enugu, South‑East Nigeria

Background: Transthoracic echocardiography (TTE) is an excellent initial diagnostic technique used to evaluate and diagnose cardiac masses, even though transoesophageal echocardiography (TEE) provides superior image resolution and better visualization of cardiac masses, especially in patients with suboptimal transthoracic echocardiographic studies. TTE is the clinical procedure of choice for identification of left ventricular thrombi. TTE has greater than 90% sensitivity and greater than 85% specificity for detection of left ventricular thrombi and is probably superior to the sensitivity and specificity of TEE, especially for apical thrombi.Aims: The study aimed to identify the common types of cardiac masses and their commonest locations in the heart.Materials and Methods: We did a retrospective review of our echocardiogram reports from May 2003 to July 2012 to identify the frequency of intra‑cardiac masses in adults, as well as the gender distribution and commonest location of these masses.Results: There were 2,814 echo examinations in adults over this period, comprising 1,661 males (59.1%) and 1,153 females (40.9%). Intra‑cardiac masses were found in 20 of these patients representing 0.7% of the study population. Thrombi were the commonest masses noted in our study, and there were more masses in the atria than in the ventricles. The left heart chambers also had more masses than the right heart chambers. There was no sex difference in the frequency of cardiac masses.Conclusion: Intra‑cardiac masses are rare, and transthoracic echocardiography is still valuable in the diagnosis and initial characterization of cardiac masses.Keywords: Adults, echocardiography, intra‑cardiac masses, NigeriaNigerian Journal of Clinical Practice • Oct-Dec 2013 • Vol 16 • Issue

Facioscapulohumeral muscular dystrophy (Landouzy-Dejerine type) in a Nigerian female: A case report

No Abstract. Nigerian Journal of Medicine Vol 15 (3) July-September: 329-33

Endomyocardial Fibrosis: Decreasing Prevalence Or Missed Diagnoses?

Objective: The prevalence of endomyocardial fibrosis is reported to on the decline worldwide. This study was carried out to determine the prevalence of endomyocardial fibrosis and the possible contribution of missed diagnoses, at the University of Nigeria Teaching Hospital Enugu. Materials and Methods: The case records of patients admitted into the paediatric and adult medical wards of the University of Nigeria Teaching Hospital, Enugu, between November 1993 and 1999 inclusive were reviewed. Echocardiography records in the same hospital between January 1991 and October 1991, inclusive, were equally analyzed Results: Nine of the total admitted patients and 16 of the echocardiographic records were diagnosed as having endomyocardial fibrosis. This shown a prevalence of 0.09% and 0.8% respectively. Four (44.4%) of the admitted endomyocardial fibrosis, and 31.2%of in the echo- documented case, were within the first three decades of life. The rate of missed diagnosis was quite high (75%) Conclusion: compared with the earlier prevalence rate of 10% for the same environment is the prevalence of endomyocardial fibrosis decreasing, or would missed diagnosis account for the trend obtainable now? More concerted efforts at the provision use of diagnosis facilities are advocated to unravel the true picture. KEY WORDS: Endomyocardial fibrosis, prevalence, missed Diagnosis Nigerian Journal of Clinical Practice Vol.6(2) 2003: 95-9

Efficacy, tolerability and safety of Valsartan in patients with mild to moderate essential hypertension at the University of Nigeria teaching hospital, Enugu

An open label, optional titration trial to evaluate the efficacy, tolerability and safety of Valsartan 80mg o.d/Valsartan 160mg o.d. in patients with mild to moderate hypertension treated for eight weeks. Twenty consenting subjects (11 males and 9 females) aged 29 to 79 years (mean age 48. 2 ± 11. 9yrs) were treated for eight weeks with Valsartan. Ten of the 20 subjects (50%) had diastolic blood pressure (DBP) end point below 90mmhg while 4 had a DBP end point of 90mmHg. There was significant drop in DBP of the entire study population from 101.8± 6. 1mmHg to 89.9 ± 10.0 mmHg (P < 0.05). There was no significant drug induced effect on the body mass index (BMI) and the heart rate of the subjects. Only one patient (5%) complained of slight dizziness, which subsided within two days without any intervention. This study has demonstrated the efficacy, tolerability and safety of Valsartan 80mg and 160mg o.d. given for eight weeks in the study population. Keywords: hypertension; Valsartan; tolerability; efficacy Nigerian Medical Practitioner Vol. 50 (2) 2006: pp 27-3

Clinic Attendance Compliance Pattern of Adult Hypertensive Nigerians Seen at UNTH, Enugu

Objective: A number of factors affect the clinic attendance compliance of the average adult Nigerian. The consequent default from treatment could affect the management outcome of such patients. This study was therefore, undertaken to evaluate the clinic attendance compliance pattern of adult hypertensive patients being seen at the UNTH Enugu, and the factors affecting this. Method: Records of consecutive adult hypertensive patients attending the Cardiac Clinics of the University of Nigeria Teaching Hospital, Enugu, in a total study period from 1989 to 1999 were retrospectively studied. Data were collected from patients' case records using a proforma that had been specifically designed for the study. Results: Four hundred and ten patients were reviewed. Forty percent of the patients had already defaulted by the 3rd visit. The default rate was significantly affected by the number of antihypertensive drugs the patients were taking ( P < 0.0001). The 41 – 60 year age groups accounted for the greatest default rates. Conclusion: This study shows a high default rate at clinic attendance. Age, severity of hypertension at first visit and the number of antihypertensive drugs appear to affect the clinic compliance pattern. Efforts should be geared at addressing these factors in the bid to ensure a better management outcome for hypertensive patients. Key Words: Clinic Compliance, Adult Hypertensive Nigerians Orient Journal of Medicine Vol.15(3&4) 2003: 1-

Cardiac Arrhythmias in Recently Diagnosed Hypertensive Patients at First Presentation an Electrocardiographic-Based Study

Various forms of cardiac arrhythmias have been documented in hypertensive subjects, and hypertension is an important risk factor for the development of atrial and ventricular arrhythmias and sudden death. Electrocardiography at rest easily documents significant arrhythmias in patients, and this study was carried out to determine the types and frequency of arrhythmias in hypertensive subjects at first presentation in the Hypertension Clinics of the University of Nigeria Teaching Hospital (UNTH) Enugu, Nigeria. The study was hospitalbased and retrospective in nature. The resting 12lead ECG reports of 346 consecutive hypertensive subjects seen at the Hypertension clinics of the UNTH Enugu over a 14 month period were retrieved from the case files and studied. Other information obtained from the case files included the age and gender of the subjects. The mean age of the subjects was 57.3years. Ninety-five of the subjects had arrhythmias representing 27% of the study population, out of which fifty-five were males (57.9%) and forty were females (42.1%). However 26.9% of all the male subjects had arrhythmias while 28.2% of all the females had arrhythmias. Multiple ventricular ectopics, sinus tachycardia, sinus bradycardia and atrial fibrillation were the most prevalent arrhythmias. This study showed that a significant proportion of hypertensive subjects present initially with significant rhythm disturbances.Keywords: Arrhythmia, Hypertension, 1st Presentation, EC

Electocardiographic findings in adult Nigerians with sickle cell anaemia

Background: Cardiovascular system abnormalities are common causes of morbidity and mortality in sickle cell anaemia. Objectives: The study aims at determining the pattern of electrocardiographic changes in adult Nigerian sickle cell anaemia patients. Methods: A descriptive cross sectional study was done on sixty sickle cell anaemia patients seen at the adult sickle cell clinic of University of Nigeria Teaching Hospital (UNTH) Enugu, and sixty age and sex matched normal controls. All the subjects had clinical evaluation as well as electrocardiographic examination. Results: The mean heart rate, P-wave duration, P-wave dispersion, PR interval, QRS duration, QRS dispersion, QTc interval and QTc dispersion were significantly higher in the patients than in the control group. Electrocardiographic abnormalities identified by this study were: left ventricular hypertrophy (75%; 1.7%), left atrial enlargement (40%; 0%), biventricular hypertrophy (11%; 0), ST segment elevation (10%; 0%) and increased P-wave and QTc dispersions. ST segment elevation was found more in patients with moderate and severe anaemia (P= 0.02, Spearman correlation r= 0.342; P= 0.007). Conclusion: Sickle cell anaemia is associated with significant electrocardiographic abnormalities. Further prospective studies are recommended to evaluate the prognostic significance of the electrocardiographic intervals dispersion on the long term disease outcome in sickle cell anaemia