Orthostatic hypertension: profile of a Nigerian population

Background: The aim of this study was to determine the prevalence, age, sex distribution and blood pressure (BP) pattern of patients with orthostatic hypertension in a cohort of hypertensives.Method: A total of 179 patients on follow-up treatment in a hypertension clinic were assessed for age, sex and BP in the seated position, and after two minutes in the erect position, on three consecutive visits. Orthostatic hypertension was defined as an increase in systolic blood pressure (SBP) of ≥ 20 mmHg on more than one occasion in the erect position. Orthostatic hypotension was defined as a decrease in BP on more than one occasion, between the seated and erect SBP, of ≥ 20 mmHg. The mean ages of the participants with and without orthostatic hypertension were compared by t-test for any significant difference. The means of the seated SBP of participants with and without orthostatic hypertension were also compared with the t-test. The effect of gender on orthostatic hypertension was tested with a chi-square (χ²). The differences between the mean seated and mean erect SBPs of participants with and without orthostatic hypertension were compared with the paired t-test.Results: Thirty-eight (21.23%) of the participants had orthostatic hypertension. The mean age of those with orthostatic hypertension was not significantly different from that of the participants without orthostatic hypertension (p-value = 0.789). There was no significant effect of gender on orthostatic hypertension (p-value = 0.795). The mean of the seated SBP was significantly lower in the participants with orthostatic hypertension (p-value = 0.008). The mean seated SBP was significantly different from the mean erect SBP for those with orthostatic hypertension, compared to those without orthostatic hypertension (p-value = 0.000 vs. p-value = 0.169). Five (2.79%) of the participants had orthostatic hypotension.Conclusion: Orthostatic hypertension, a form of BP dysregulation, may be more common among treated hypertensives than what is presently known.Keywords: orthostatic hypertension, prevalence, BP, Nigerian

Bilateral Ramsay Hunt syndrome in a diabetic patient

BACKGROUND: Herpes zoster oticus accounts for about 10% cases of facial palsy, which is usually unilateral and complete and full recovery occurs in only about 20% of untreated patients. Bilateral herpes zoster oticus can sometime occur in immunocompromised patients, though incidence is very rare. CASE PRESENTATION: Diabetic male, 57 year old presented to us with bilateral facial palsy due to herpes zoster oticus. Patient was having bilateral mild to moderate sensorineural hearing loss. Patient was treated with appropriate metabolic control, anti-inflammatory drugs and intravenous acyclovir. Due to uncontrolled diabetes, glucocorticoids were not used in this patient. Significant improvement in hearing status and facial nerve functions were seen in this patient. CONCLUSIONS: Herpes zoster causes severe infections in diabetic patients and can be a cause of bilateral facial palsy and bilateral Ramsay Hunt syndrome. Herpes zoster in diabetic patients should be treated with appropriate metabolic control, NSAIDS and intravenous acyclovir, which we feel should be started at the earliest. Glucocorticoids should be avoided in diabetic patients

Blood Pressure Abnormalities in Parkinson's Disease in a Nigerian Population

To compare the effect of posture on blood pressure in levodopa-treated Parkinson's disease (PD) patients with that of age-matched controls. The design is a case control study. Blood pressure was recorded manually in the seated position with Accossons® mercury sphygmomanometer in 30 consecutive patients with PD on levodopa who had no hypertension and it was repeated after two minutes in the erect position to test for orthostatic hypotension (OH). The results were compared with blood pressure in the seated and erect positions in 30 consecutive age-matched controls that had no hypertension. The mean seated and erect systolic and diastolic blood pressures of both groups were compared with t-test for any significant difference(s); the mean seated and erect systolic and diastolic blood pressures of each group were also compared with paired t-test for any significant difference(s) and the proportion of study participants in both groups with orthostatic hypotension were determined. (a) Mean seated and erect systolic and diastolic blood pressures were significantly higher in PD subjects than age matched controls (p=0.000, 0.000) and (p=0.001, 0.000) (b) Mean erect systolic blood pressure was significantly lower than seated blood pressure in PD and significantly higher in controls (p=0.025 and 0.027) (c) OH was found in 6/30(20%) versus 0/30(0%) for cases and controls respectively. Higher seated and erect blood pressures and OH were found in levodopa treated PD compared to age-matched controls and these abnormalities should be assiduously looked out for in the evaluation of PD.Key words: Parkinson's disease, blood pressure, orthostatic hypotension, Nigerians