Blood pressure control and left ventricular hypertrophy in hypertensive Nigerians

Background : Hypertension is a disease characterized by end-organ complications, leading to high morbidity and mortality in many cases. People with untreated or uncontrolled hypertension often run the risk of developing complications directly associated with the disease. Left ventricular hypertrophy (LVH) has been shown to be a significant risk factor for adverse outcomes both in patients with hypertension and in the general population. We investigated the prevalence and pattern of LVH in a treated hypertensive population at the University College Hospital, Ibadan, Nigeria, using non-hypertensive subjects as control. Design and Setting : A prospective observational study performed at the University College Hospital, Ibadan, Nigeria. Methods : Patients had 6 visits, when at least one blood pressure measurement was recorded for each hypertensive subject and average calculated for systolic blood pressure (SBP) and diastolic blood pressure (DBP) separately. The values obtained were used for stratification of the subjects into controlled and uncontrolled hypertension. Subjects also had echocardiograms to determine their left ventricular mass. Results : LVH was found in 14 (18.2%) of the normotensive group, 40 (20.8%) of the uncontrolled hypertensive group and 14 (24.1%) of the controlled hypertensive group when left ventricular mass (LVM) was indexed to body surface area (BSA). When LVM was indexed to height, left ventricular hypertrophy was found in none of the subjects of the normotensive group, while it was found present in 43 (22.4%) and 14 (24.1%) subjects of the uncontrolled and controlled hypertensive groups, respectively. Significant difference in the prevalence of LVH was detected only when LVM was indexed to height alone. Conclusion : Clinic blood pressure is an ineffective way of assessing BP control. Thus in apparently controlled hypertensive subjects, based on office blood pressure, cardiac structural changes do remain despite antihypertensive therapy. This population is still at risk of cardiovascular events.arri\ue8re-plan: l\u2019hypertension est une maladie caract\ue9ris\ue9e par l\u2019orgue de fi n complications menant \ue0 \ue9lev\ue9 de morbidit\ue9 et mortalit\ue9 dans de nombreux cas. Personnes avec l\u2019hypertension non trait\ue9e ou non contr\uf4l\ue9e souvent risquent de d\ue9velopper complications directement associ\ue9es \ue0 la maladie. Laiss\ue9 ventriculaire hypertrophie (LVH) a \ue9t\ue9 d\ue9montr\ue9 un facteur de risque signifi catif pour les effets n\ue9gatifs r\ue9sultats tant chez les patients atteints de l\u2019hypertension et de la population g\ue9n\ue9rale. Nous avons a enqu\ueat\ue9 sur la pr\ue9valence et le mod\ue8le de LVH dans un trait\ue9 hypertendues population au University College Hospital, \ue0 l\u2019aide Ibadan, Nigeria non-hypertendues des sujets comme contr\uf4le. conception et la confi guration: A \ue9ventuel \ue9tude d\u2019observation effectu\ue9e \ue0 la University College Hospital, Ibadan, Nigeria. m\ue9thodes: Patients avaient six visites o\uf9 au moins un sang mesure de pression a \ue9t\ue9 enregistr\ue9e pour chaque sujet hypertendues et moyenne calcul\ue9s s\ue9par\ue9ment pour SBP et DBP. Les valeurs obtenues ont \ue9t\ue9 utilis\ue9es pour stratifi cation des sujets dans l\u2019hypertension contr\uf4l\ue9e et incontr\uf4l\ue9e. Sujets ont \ue9galement echocardiograms pour d\ue9terminer leur masse ventriculaire gauche. r\ue9sultats: LVH a \ue9t\ue9 trouv\ue9 en 14(18.2%) de la groupe normotensive, 40(20.8%) de groupe de hypertendues non contr\uf4l\ue9es et 14(24.1%) de hypertendues contr\uf4l\ue9e groupe lorsque quitt\ue9 masse ventriculaire (LVM) a \ue9t\ue9 index\ue9e \ue0 corps surface (BSA). Lorsque LVM a \ue9t\ue9 index\ue9 \ue0 hauteur, laiss\ue9 ventriculaire hypertrophie a \ue9t\ue9 trouv\ue9 dans aucun du groupe normotensive, bien qu\u2019il a \ue9t\ue9 constat\ue9 pr\ue9sents dans les 43(22.4%) et 14(24.1%) de hypertendues non ma\ueetris\ue9e et contr\uf4l\ue9e groupes respectivement. \uc9tait de diff\ue9rence signifi cative dans la pr\ue9valence de la LVH d\ue9tect\ue9s uniquement lorsque LVM a \ue9t\ue9 index\ue9 \ue0 hauteur alone. conclusion: clinique art\ue9rielle est un moyen ineffi cace de mesurer le contr\uf4le de BP. Ainsi en sujet hypertendues apparemment contr\uf4l\ue9e bas\ue9e sur la pression art\ue9rielle de bureau, des changements structurels cardiaques restent malgr\ue9 th\ue9rapie antihypertensive. Cette population est toujours \ue0 risque de maladies cardiovasculaires \ue9v\ue9nements

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

Quality of anti-malarial drugs provided by public and private healthcare providers in south-east Nigeria

BACKGROUND: There is little existing knowledge about actual quality of drugs provided by different providers in Nigeria and in many sub-Saharan African countries. Such information is important for improving malaria treatment that will help in the development and implementation of actions designed to improve the quality of treatment. The objective of the study was to determine the quality of drugs used for the treatment of malaria in a broad spectrum of public and private healthcare providers. METHODS: The study was undertaken in six towns (three urban and three rural) in Anambra state, south-east Nigeria. Anti-malarials (225 samples), which included artesunate, dihydroartemisinin, sulphadoxine-pyrimethamine (SP), quinine, and chloroquine, were either purchased or collected from randomly selected providers. The quality of these drugs was assessed by laboratory analysis of the dissolution profile using published pharmacopoeial monograms and measuring the amount of active ingredient using high performance liquid chromatography (HPLC). FINDINGS: It was found that 60 (37%) of the anti-malarials tested did not meet the United States Pharmacopoeia (USP) specifications for the amount of active ingredients, with the suspect drugs either lacking the active ingredients or containing suboptimal quantities of the active ingredients. Quinine (46%) and SP formulations (39%) were among drugs that did not satisfy the tolerance limits published in USP monograms. A total of 78% of the suspect drugs were from private facilities, mostly low-level providers, such as patent medicine dealers (vendors). CONCLUSION: This study found that there was a high prevalence of poor quality drugs. The findings provide areas for public intervention to improve the quality of malaria treatment services. There should be enforced checks and regulation of drug supply management as well as stiffer penalties for people stocking substandard and counterfeit drugs

Characterisation of heart failure with normal ejection fraction in a tertiary hospital in Nigeria

<p>Abstract</p> <p>Background</p> <p>The study aimed to determine the frequency and characteristics of heart failure with normal EF in a native African population with heart failure.</p> <p>Methods</p> <p>It was a hospital cohort study. Subjects were 177 consecutive individuals with heart failure and ninety apparently normal control subjects. All the subjects underwent transthoracic echocardiography. The group with heart failure was further subdivided into heart failure with normal EF (EF ≥ 50) (HFNEF) and heart failure with low EF(EF <50)(HFLEF).</p> <p>Results</p> <p>The subjects with heart failure have a mean age of 52.3 ± 16.64 years vs 52.1 ± 11.84 years in the control subjects; p = 0.914. Other baseline characteristics except blood pressure parameters and height were comparable between the group with heart failure and the control subjects. The frequency of HFNEF was 39.5%. Compared with the HFLEF group, the HFNEF group have a smaller left ventricular diameter (in diastole and systole): (5.2 ± 1.22 cm vs 6.2 ± 1.39 cm; p < 0.0001 and 3.6 ± 1.24 cm vs 5.4 ± 1.35 cm;p < 0.0001) respectively, a higher relative wall thickness and deceleration time of the early mitral inflow velocity: (0.4 ± 0.12 vs 0.3 ± 0.14 p < 0.0001 and 149.6 ± 72.35 vs 110.9 ± 63.40 p = 0.001) respectively.</p> <p>The two groups with heart failure differed significantly from the control subjects in virtually all echocardiographic measurements except aortic root diameter, LV posterior wall thickness(HFLEF), and late mitral inflow velocity(HFNEF). HFNEF accounted for 70(39.5%) of cases of heart failure in this study.</p> <p>Hypertension is the underlying cardiovascular disease in 134(75.7%) of the combined heart failure population, 58 (82.9%) of the subjects with HFNEF group and 76(71%) of the HFLEF group. Females accounted for 44 (62.9%) of the subjects with HFNEF against 42(39.3%) in the HFLEF group (p = 0.002).</p> <p>Conclusion</p> <p>The frequency of heart failure with normal EF in this native African cohort with heart failure is comparable with the frequency in other populations. These groups of patients are more likely female, hypertensive with concentric pattern of left ventricular hypertrophy.</p

The utility of robotic assisted pancreas transplants \u2013 a single center retrospective study

The prevalence of obesity within the diabetic population is on the rise. This development poses unique challenges for pancreas transplantation candidates as obese individuals are often denied access to transplant. The introduction of robotic approach to transplant has been shown to improve outcomes in obese patients. A single center retrospective review of pancreas transplant cases over a 4-year period ending December 2018 was performed. Patients undergoing robotic surgery were compared to their counterparts undergoing open transplant. 49 patients (10 robot, 39 open) received pancreas transplants over the study period. Mean age was 43.1\ua0\ub1\ua07.5 vs. 42.8\ua0\ub1\ua09.7\ua0years. There were no significant differences in demographics except body mass index (33.7\ua0\ub1\ua05.2 vs. 27.1\ua0\ub1\ua06.6, P\ua0=\ua00.005). Operative duration (7.6\ua0\ub1\ua01.6 vs. 5.3\ua0\ub1\ua01.4, P\ua0<\ua00.001), and warm ischemia times [45.5 (IQR: 13.7) vs. 33 (7), P\ua0<\ua00.001] were longer in the robotic arm. There were no wound complications in the robotic approach patients. Graft (100% vs. 88%, P\ua0=\ua00.37) and patient survival (100% vs. 100%, P\ua0=\ua00.72) after 1\ua0year were similar. Our findings suggest that robotic pancreas is both safe and effective in obese diabetic patients, without added risk of wound complications. Wide adoption of the technique is encouraged while long term follow-up of our recipients is awaited