Level of blood pressure control among hypertensive patients receiving treatment at federal medical centre Nguru Yobe state North Eastern Nigeria

Hypertension remains the most readily identifiable and reversible risk factor for cardiovascular diseases (CVD) and is the leading cause of death worldwide. Despite the avalanche of medications for the management of elevated blood pressure, adequate control of systemic hypertension has largely remained enigmatic. Previous studies from African countries including Nigeria have shown that blood pressure (BP) control still remained poor. The objective of this study therefore was to determine the level of blood pressure control among hypertensive patients on treatment and identify associated factors Methodology: The study was an observational, cross-sectional study of consecutive hypertensive patients attending the general outpatient, cardiac, endocrine and renal clinics at the Federal Medical Centre Nguru, in northeastern Nigeria; conducted over a period of six months from June 2016 to December 2016. Result: A total of two hundred and ninety-one (291) consecutive subjects, comprising 134(46.1%) males and 157(53.9%) females were recruited. The mean age of the study population was 56.15±12.72. There was no difference in the mean age of subjects with controlled and uncontrolled hypertension 57.13±12.97 and 55.48±12.54 respectively with P = 0.275. One hundred and nineteen (40.9%) subjects had controlled hypertension while the remaining 172(59.1%) had uncontrolled hypertension. There was a significant difference in the mean systolic and diastolic blood pressure of subjects with controlled and uncontrolled hypertension (116.22± 12.14 and 153.14±18.17) P = 0.001 and (73.78±8.02 and 89.53±11.12) P = 0.001 respectively. The predominant pattern of uncontrolled hypertension among the study population was combined systolic and diastolic hypertension. Conclusion: Our study revealed that blood pressure control among hypertensive on medication was not optimal, decreased glomerular filtration rate, low anti-hypertensive medication adherence and use of NSAID were found to be responsible for the inadequate blood pressure control observed in this study. Poverty and ignorance were major contributing factors for low medication adherence

Obesity, overweight, and underweight among urban Nigerians

Background: Disease burden from communicable and noncommunicable diseases is a significant health challenge facing many developing nations. Among the noncommunicable diseases, is obesity, which has become a global epidemic associated with urbanization.Objective: The aim was to evaluate the prevalence of weight abnormalities, their pattern of distribution and regional differences among apparently healthy urban dwelling Nigerians.Methods: A cross‑sectional community‑based descriptive survey was carried out in five urban cities, each from one geo‑political zone of Nigeria. Multistage sampling procedures were used to select participants using the World Health Organization STEPS instrument. Ethical approval and consents were duly and respectively obtained from the Ethics Committee in the tertiary centers and participants in each of these cities. Analysis was performed using SPSS version 20 (IBM Corp., Amonk, NY; released 2011) with P value set at < 0.05.Results: A total of 5392 participants were recruited; of which, 54.5% and 45.5% were males and females respectively. Mean (standard deviation) age and body mass index (BMI) were 40.6 (14.3) years and 25.3 (5.1) kg/m2. Obesity, overweight, and underweight were found in 17%, 31%, and 5% of participants respectively. Significantly, while underweight declined with increasing age, overweight, and obesity increased to peak in the middle age brackets. Age of ≥ 40 years was found to confer about twice the risk of becoming overweight. The prevalence of obesity and mean BMI were significantly higher both among the females and the participants from southern zones.Conclusion: Obesity and overweight are common in our urban dwellers with accompanying regional differences. Attainment of middle age increases the likelihood of urban dwelling Nigerians to become overweight/obese. There is therefore the need to institute measures that will check development of overweight/obesity early enough, while improving the nutritional status of the few who may still be undernourished.Key words: Nigerians, obesity, urban, weight distributio

Prevalence of metabolic syndrome among apparently healthy adults in a rural community, in north-western Nigeria

Background: Metabolic syndrome (MetS) is a cluster of multiple metabolic abnormalities that increases the risk of cardiovascular morbidity and mortality, and a resultant severe economic implication.This study assessed the burden of MetS in a Nigerian rural community setting.Method: This was a cross-sectional, community based study on apparently healthy subjects.A multi stage cluster sampling technique was employed to recruit the study subjects.A standardized pre-tested questionnaire was used to obtain data, and blood samples from subjects were analysed using standard laboratory techniques. MetS was defined using the NCEP-ATP3 criteria. Data were analysed using STATA version 11, and a p value of <0.05 was considered statistically significant.Results: A total of 450 subjects completed the study, with 38% being males, and a mean age of 40.27±16.41 years. MetS was found in 116 (25.78%) of the subjects.Of these, systemic hypertension was found in 91(78.45%), while all (116) had elevated cholesterol and triglycerides.Abdominal adiposity was found in 45 (38.79%) subjects and 44 (37.93%) had Type 2 diabetes mellitus.Conclusion: The prevalence of MetS and its components in our studied population was high; hence the need for further large population based studies to determine its predictors in our environment

Serum C-Reactive Protein in Nigerians With Type 2 Diabetes Mellitus

Background: C-reactive protein is an acute-phase proteins, produce in the liver, its release is stimulated by cytokines (interleukin 6 and tumour necrosis factor alpha). Elevated level of it is a risk factor for coronary heart disease. Baseline levels of C-reactive protein in apparently healthy men and women predict long-term risk of a first myocardial infarction. Diabetics are at increased risk for coronary heart disease, data from the Framingham Study showed a two-to three-fold elevation in the risk of clinically evident atherosclerotic disease in patients with type II diabetes compared to those without diabetes. However, but data regarding CRP in Nigerian diabetic is lacking.Method: A cross-sectional study conducted among patients attending out patient clinic of the Obafemi Awolowo University Teaching Hospitals complex (OAUTHC) Ile Ife, Osun State south western Nigeria. Measurement of C-reactive protein was based on the principle of solid phase enzyme-linked immunosorbent assay (ELISA).Results: A total of 125 consecutive subjects were recruited comprising 75 patients with type II diabetes mellitus with or without hypertension and 50 apparently healthy age-and-sex comparable controls. There was a significant difference between the mean systolic and diastolic blood pressures of the patients and controls. The fasting blood glucose and C-reactive protein were significantly higher in diabetics compared to controls. There was a positive and significant correlation between FBG and CRP in both patients and controls. Conclusion: This study showed that diabetics have significantly higher serum C-reactive protein compared to the apparently controls. Also there was a positive and significant correlation between C-reactive protein and fasting blood glucose among both patients and controls

Prevalence of Overweight and Obesity in Maiduguri, North-Eastern Nigeria

BACKGROUND: The prevalence of obesity is on the increase worldwide including in many developing countries. There is no report on the magnitude of obesity among adults in Maiduguri, a major city in northeastern Nigeria.MATERIALS and METHODS: We selected a sample of 1650 men and women aged 15 years and above resident in Gwange ward in Maiduguri metropolitan council using a multistage sampling technique. Height, weight, waist (WC) and hip circumferences were measured. Body mass index (BMI) and waist-to-hip ratio (WHR) were calculated. Data were analyzed using SPSS version13. The ethics committee of the Universityof Maiduguri Teaching Hospital approved the study and consent was sought individually from the participants before being enlisted.RESULTS: The mean (SD) age of the respondents was 36.2 (14.4) years, with a range of 15 to 70 years. The mean (SD) ages of the males and  females were 34.9 (14.3) and 38.9 (14.0) years, respectively, (p<0.001). The overall crude prevalence rates of overweight and obesity were 27.1% and 17.1%, respectively. In men, 40.6% were either overweight or obese, while in women 51.9% were either overweight or obese. We observed thehighest prevalence rates of overweight and obesity in the middle age group. There were more obese females than males (14.05 vs. 4.3%) among both young and elderly (12.1% vs. 10.5%) subjects.CONCLUSION: The prevalence of overweight and obesity is high in Maiduguri metropolis particularly among women. Concerted efforts should be made to curb the menace of increasing rate of obesity in the metropolis through public enlightenment on the risks associated with obesity and the benefits of adopting a healthy lifestyle.KEY WORDS: Overweight, Obesity, Prevalence, Maiduguri

Prevalence of microalbuminuria in untreated Nigerian hypertensive patients

The burden of cardiovascular disease imposed by hypertension is a result of target organ damage. Microalbuminuria (MA) is the first clinical expression of nephropathy and has become acardiovascular and/or renal disease prognostic indicator for hypertensive subjects. Objectives: To establish the prevalence of MA among newly diagnosed hypertensive patients using thesimple spot urine Albumin-Creatinine Ratio (ACR). Method: : One hundred and eighty six newly diagnosed hypertensive patients were enrolled for assessment of MA using spot urine ACR. Those with overt proteinuria, diabetes mellitus, overt kidney disease and other potential causes of albuminuria were excluded. Spot urine was obtained for measurement of albuminand creatinine. Anthropometric variables were measured and body mass index calculated. All patients had echocardiographic assessment. Statistical analysis was performed using SPSS version 11.0 software. Multiple regression analysis was used in determining predictors of MA. A p-value of ≤ 0.05 was considered significant. Results: Results of 136 patients comprising of 66(48.53%) males and 70(51.47%) females was considered. The overall prevalence of microalbuminuria was 42.65%. Males had a prevalence of 51.52% compared to 34.27% for the females (p=0.29). Weight, BMI, LVM, LVMI, UAE, and ACR were significantly higher in patients with MA, whereas those without MA had a significantly higher urinary creatinine. Multiple regression analysis identified DBP, MAP, LVM and LVMI as significant predictors of increased urinary albumin excretion Microalbuminuria showed significant positive correlation with LVM and LVMI. Conclusion: The prevalence of microalbuminuria is high among untreated Nigerian hypertensive patients. The spot urine ACR provides a simple, accurate and cost effective way of identifying this high risk group of hypertensive patients, allowing for more aggressive treatment to reduce cardiovascular outcomes

Anthropometric correlates of insulin resistance: a study of healthy Nigerian adults in Maiduguri

Indices of obesity, especially abdominal adiposity have been shown to correlate positively with the components of the metabolic syndrome in several studies. Objectives: The aim of this study was to determine the correlation between anthropometric indices and insulin resistance in healthy subjects. Methods: A representative sample of 100 subjects aged 15 to 70 years was recruited for the study. Weight, height, waist circumference (WC) and hip circumference were measured, while body mass index (BMI) and waist-to-hip ratio (WHR) were calculated for each participant. Fasting blood samples were drawn for plasma glucose and plasma insulin concentrations, respectively. The values obtained were used to calculate insulin resistance using the Homeostasis Model Assessment Method for Insulin Resistance (HOMA-IR). Results: Insulin resistance (IR) was found in 25(25%) of the study subjects. There were significant andpositive correlations between waist circumference and HOMA-IR (r=+0.20, p<0.05), as well as between BMI and HOMA-IR(r=+0.19, p<0.05).Both anthropometric indices however, only predicted 4.1% and 3.9% of the variation in HOMA-IR, respectively. The correlation between WHR and HOMA-IR was positive but non-significant (r=+0.12, p>0.05). Conclusion: Waist circumference exhibited the strongest correlation with HOMA-IR, closely followed by BMI and WHR. We recommend that measurement of waist circumference should continue to be used as a screening tool for identifying individuals with insulin resistance in our setting

Deriving an optimal threshold of waist circumference for detecting cardiometabolic risk in sub-Saharan Africa.

BACKGROUND: Waist circumference (WC) thresholds derived from western populations continue to be used in sub-Saharan Africa (SSA) despite increasing evidence of ethnic variation in the association between adiposity and cardiometabolic disease and availability of data from African populations. We aimed to derive a SSA-specific optimal WC cut-point for identifying individuals at increased cardiometabolic risk. METHODS: We used individual level cross-sectional data on 24 181 participants aged ⩾15 years from 17 studies conducted between 1990 and 2014 in eight countries in SSA. Receiver operating characteristic curves were used to derive optimal WC cut-points for detecting the presence of at least two components of metabolic syndrome (MS), excluding WC. RESULTS: The optimal WC cut-point was 81.2 cm (95% CI 78.5-83.8 cm) and 81.0 cm (95% CI 79.2-82.8 cm) for men and women, respectively, with comparable accuracy in men and women. Sensitivity was higher in women (64%, 95% CI 63-65) than in men (53%, 95% CI 51-55), and increased with the prevalence of obesity. Having WC above the derived cut-point was associated with a twofold probability of having at least two components of MS (age-adjusted odds ratio 2.6, 95% CI 2.4-2.9, for men and 2.2, 95% CI 2.0-2.3, for women). CONCLUSION: The optimal WC cut-point for identifying men at increased cardiometabolic risk is lower (⩾81.2 cm) than current guidelines (⩾94.0 cm) recommend, and similar to that in women in SSA. Prospective studies are needed to confirm these cut-points based on cardiometabolic outcomes.International Journal of Obesity advance online publication, 31 October 2017; doi:10.1038/ijo.2017.240

Deriving an optimal threshold of waist circumference for detecting cardiometabolic risk in sub-Saharan Africa

BACKGROUND: Waist circumference (WC) thresholds derived from western populations continue to be used in sub-Saharan Africa (SSA) despite increasing evidence of ethnic variation in the association between adiposity and cardiometabolic disease and availability of data from African populations. We aimed to derive a SSA-specific optimal WC cut-point for identifying individuals at increased cardiometabolic risk. METHODS: We used individual level cross-sectional data on 24 181 participants aged ⩾15 years from 17 studies conducted between 1990 and 2014 in eight countries in SSA. Receiver operating characteristic curves were used to derive optimal WC cutpoints for detecting the presence of at least two components of metabolic syndrome (MS), excluding WC. RESULTS: The optimal WC cut-point was 81.2 cm (95% CI 78.5–83.8 cm) and 81.0 cm (95% CI 79.2–82.8 cm) for men and women, respectively, with comparable accuracy in men and women. Sensitivity was higher in women (64%, 95% CI 63–65) than in men (53%, 95% CI 51–55), and increased with the prevalence of obesity. Having WC above the derived cut-point was associated with a twofold probability of having at least two components of MS (age-adjusted odds ratio 2.6, 95% CI 2.4–2.9, for men and 2.2, 95% CI 2.0–2.3, for women). CONCLUSION: The optimal WC cut-point for identifying men at increased cardiometabolic risk is lower (⩾81.2 cm) than current guidelines (⩾94.0 cm) recommend, and similar to that in women in SSA. Prospective studies are needed to confirm these cut-points based on cardiometabolic outcomes

An observational study of the prevalence of anaemia in clinical AIDS, immunological AIDS And HIV infection in Maiduguri, north eastern Nigeria

Aim: To deterime the prevalence of anaemia in patients with clinical AIDS. Methodology: A retrospective small observational study of the prevalence of anaemia in 114 patients with confirmed HIV/AIDS seen at the department of medicine of the university of Maiduguri Teaching Hospital between January, 2002 and June, 2004 are reported. Results: One hundred and three (90.4%) patients had anaemia and only 11 (9.6%) did not have anaemia. Forty one (36%) patients had immunological AIDS and anaemia was seen in 39 (95.1%) of them with median haematocrit of 31 %± 4.7SD. Thirty-four (29.8%) had clinical AIDS and anaemia was seen in 31 (91.2%) of them with median haematocrit of 32.5% ± 6.1SD. Thirty-nine (34.2%) had HIV infection and anaemia seen in 33(84.6%) of them with median haematocrit of 35% ± 7.4SD. Regression of anaemia and opportunistic infection showed a positive correlation (p-value = 0.003). Conclusion: The study shows that anaemia is a common finding in patients with HIV/AIDS with opportunistic infection being the most likely contributing factor in our environment. A large collaborative observational cohort study design and a prospective follow up design is necessary to address questions regarding causal relationship of anaemia and survival and whether HAART may have a positive impact on reducing the prevalence of anaemia in HIV/AIDS patients. Keywords: prevalence, anaemia, HIV/AIDS Sahel Medical Journal Vol. 8(1) 2005: 12-1