Editorial

Coronary artery disease and insulin resistance in the South African India

Acute Renal Failure from Callilepsis laureola

This article describes the clinical course and management of a patient who developed hyperkalaemic acute renal failure due to a herbal medicine, Callilepsis laureola

The abridged South African hypertension guideline 2011

Extensive data from randomised controlled trials have shown the benefit of treating hypertension. The target blood pressure (BP) for antihypertensive management is < 140/90 mmHg, and < 130/80 mmHg in patients with end-organ damage, coexisting risk factors, and co-morbidity. Benefits of management include reduced risk of death, stroke, cardiac failure, chronic kidney disease, and coronary heart disease. The correct BP measurement procedure is described, and evaluation of cardiovascular risk factors and recommendations for antihypertensive therapy, are stipulated. Lifestyle modification and patient education are cornerstones in the management of every patient. Major indications, precautions, and contraindications to each recommended antihypertensive drug are listed. Combination therapy should be considered ab initio if the BP is ≥ 20/10 mmHg above goal. First-line drug therapy for uncomplicated essential hypertension includes low-dose thiazide-like diuretics, calcium-channel blockers, angiotensin-converting enzyme inhibitors, or angiotensin-receptor blockers. The guideline was developed by the Southern African Hypertension Society

Risk factors for coronary heart disease in the white community of Durban

Coronary heart disease (CHD) is the leading cause of death among the white and Indian populations of Durban. This was a community-based study of the white population of Durban, which is predominantly English-speaking. There were 396 subjects (194 men, 202 women) aged 15 - 69 years. A history of CHD was present in 9,3% of the subjects. The important risk factors were hypercholesterolaemia, hypertension and smoking. The minor risk factors were obesity, hypertriglyceridaemia, hypeuricaemia, a sedentary occupation and a history of CHD in the immediate family. Electrocardiograph abnormalities denoting CHD were present in 17% of subjects. A study of the major risk factors showed that 35,1% (age and sex adjusted) had at least one major risk factor at the higher level (level A) and 33,8% (age and sex adjusted) at the lower risk levels (level B). When the combination of risk factors was taken into account, 15,2% and 28% had two major risk factors, one each at levels A and B respectively. On average the percentage of men and women with one risk factor or more increased with age. A protective high-density lipoprotein/total cholesterol ratio≥20% was present in 53,5% of the respondents. Because of the severe nature of CHD, an intensive programme for the primary prevention of CHD risk factors should be instituted

South African Hypertension Guideline 2011

Outcomes. Extensive data from randomised controlled trials have shown the benefit of treating hypertension. The target blood pressure (BP) for antihypertensive management is systoli

Risk factors for coronary heart disease in the Indians of Durban

Coronary heart disease (CHD) is a major problem in migrant Indians throughout the world. In South Africa it has reached 'epidemic' proportions. A field survey was conducted among Indians in the metropolitan area of Durban to determine the prevalence and known risk factors for CHD. In a study of 778 subjects aged 15 - 69 years (408 men), 15,3% (sex and age adjusted 13,4%) had a history of CHD. The important risk factors in men were hypercholesterolaemia, hypertriglyceridaemia, diabetes, and smoking, and in women diabetes, hypercholesterolaemia, and hypertriglyceridaemia. The minor risk factors were hyperuricaemia, sedentary occupation, obesity in women and a positive family history of CHD. A study of the major risk factors leading to CHD showed that 52% (sex and age adjusted 45,5%) had at least one major risk factor at the higher (level A) and 68% (sex and age adjusted 61,9%) at the lower (level B) risk levels. Diabetes mellitus was strongly associated with a positive history of CHD. In 47,6% (sex and age adjusted 48,2%) of the total group resting ECG abnormalities were found that could be coded. Because of the severe nature of CHD in the migrant Indian, an immediate and intensive programme of primary prevention of CHD risk factors should be instituted

South African Hypertension Guideline 2006

Outcomes. Extensive data from many randomised controlled trials have shown the benefit of treating hypertension. The target blood pressure (BP) for antihypertensive management should be systolic BP < 140 mmHg, diastolic BP < 90 mmHg, with minimal or no drug side-effects. However, a lesser reduction will elicit benefit although this is not optimal. The reduction of BP in the elderly should generally be achieved gradually over 6 months. Stricter BP control is required for patients with end-organ damage, co-existing risk factors and co-morbidity, e.g. diabetes mellitus. Co-existent risk factors should also be controlled. Benefits. Reduction in risk of stroke, cardiac failure, renal insufficiency and coronary artery disease. The major precautions and contraindications to each antihypertensive drug recommended are listed. Recommendations. Correct BP measurement procedure is described. Evaluation of cardiovascular risk factors and recommendations for antihypertensive therapy are stipulated. The total cardiovascular disease risk profile should be determined for all patients and this should inform management strategies. Lifestyle modification and patient education are cornerstones in the management of every patient. Drug therapy for the patient with uncomplicated hypertension should be as follows: first line – low-dose thiazide or thiazide-like diuretics; second line – add either an angiotensin-converting enzyme inhibitor (ACE-I) or a calcium channel blocker (CCB); third line – add another second-line drug not already used. In resistant hypertension where a fourth drug is needed, use either a centrally acting drug, vasodilator, alpha-blocker, or beta-blocker. The order of drug choice may change in those with compelling indications for a particular drug class. The guideline includes management of specific situations including hypertensive emergency and urgency, severe hypertension with target-organ damage and hypertension in diabetes mellitus, etc. Validity. The guideline was developed by a joint Southern African Hypertension Society and National Department of Health Directorate: Chronic Diseases, Disabilities and Geriatrics working group. Input was also obtained from representatives of the various related professional societies