L’observance médicamenteuse et ses facteurs dans un groupe d’hypertendus congolais

L'objectif de ce travail était d'évaluer le niveau d'observance des patients hypertendus et identifier les facteurs prédictifs de mauvaise observance. Il s'est agi d'une étude transversale à recueil de données prospectif sur une période de six mois. Elle s'est déroulée dans les services de consultations externes de cardiologie dans trois hôpitaux : le CHU de Brazzaville, l'hôpital central des armées de Brazzaville, et l'hôpital général de Loandjili (Pointe-Noire). Cette étude a concerné 212 patients dont 122 femmes (57.5%) et 90 hommes (42.5%), âgés de plus de 18ans, hypertendus traités depuis au moins six mois. Le questionnaire à six questions conçu par Girerd a été utilisé pour évaluer l'observance médicamenteuse. Une régression logistique a été utilisée pour rechercher les facteurs de mauvaise observance. L'observance était considérée comme bonne chez 45 patients soit 21.2%, et mauvaise chez 69 patients soit 32.5%. Dans 98 cas soit 46.2% il y avait un minime problème d'observance. Une HTA ancienne de plus de 5 ans, la présence des complications évolutives de l'HTA ainsi que les niveaux élevés de la PAS et de la PAD étaient liés à la mauvaise observance. Par contre aucune relation statistique n'a été retrouvée entre la mauvaise observance et l'existence d'une co-morbidité, la fréquence des prises médicamenteuses, le nombre de comprimés par jour et une pression artérielle non contrôlée. Les patients non observant étaient en moyenne plus âgés que les autres. Une mauvaise connaissance du traitement et des complications de l'HTA, le fait de ne pas acheter soi-même ses médicaments, l'ignorance de la gravité de l'HTA, et le coût élevé du traitement étaient prédictifs d'une mauvaise observance. La possession d'un tensiomètre électronique d'auto mesure tensionnelle ainsi que le rappel des prises médicamenteuses par les parents étaient liés à une bonne observance. Après ajustement par une régression logistique, seule la bonne connaissance du traitement et la perception de la gravité de l'HTA étaient liées à une bonne observance. L'observance  médicamenteuse dans notre population d'étude s'est révélée faible. Il faut insister sur l'éducation thérapeutique des patients. Key words: Observance médicamenteuse, hypertension artérielle, Cong

Endomyocardial Fibrosis: Still a Mystery after 60 Years

The pathologist Jack N. P. Davies identified endomyocardial fibrosis in Uganda in 1947. Since that time, reports of this restrictive cardiomyopathy have come from other parts of tropical Africa, South Asia, and South America. In Kampala, the disease accounts for 20% of heart disease patients referred for echocardiography. We conducted a systematic review of research on the epidemiology and etiology of endomyocardial fibrosis. We relied primarily on articles in the MEDLINE database with either “endomyocardial fibrosis” or “endomyocardial sclerosis” in the title. The volume of publications on endomyocardial fibrosis has declined since the 1980s. Despite several hypotheses regarding cause, no account of the etiology of this disease has yet fully explained its unique geographical distribution

May Measurement Month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension

Aims Raised blood pressure (BP) is the biggest contributor to mortality and disease burden worldwide and fewer than half of those with hypertension are aware of it. May Measurement Month (MMM) is a global campaign set up in 2017, to raise awareness of high BP and as a pragmatic solution to a lack of formal screening worldwide. The 2018 campaign was expanded, aiming to include more participants and countries. Methods and results Eighty-nine countries participated in MMM 2018. Volunteers (≥18 years) were recruited through opportunistic sampling at a variety of screening sites. Each participant had three BP measurements and completed a questionnaire on demographic, lifestyle, and environmental factors. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or taking antihypertensive medication. In total, 74.9% of screenees provided three BP readings. Multiple imputation using chained equations was used to impute missing readings. 1 504 963 individuals (mean age 45.3 years; 52.4% female) were screened. After multiple imputation, 502 079 (33.4%) individuals had hypertension, of whom 59.5% were aware of their diagnosis and 55.3% were taking antihypertensive medication. Of those on medication, 60.0% were controlled and of all hypertensives, 33.2% were controlled. We detected 224 285 individuals with untreated hypertension and 111 214 individuals with inadequately treated (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) hypertension. Conclusion May Measurement Month expanded significantly compared with 2017, including more participants in more countries. The campaign identified over 335 000 adults with untreated or inadequately treated hypertension. In the absence of systematic screening programmes, MMM was effective at raising awareness at least among these individuals at risk

Aging, female sex, migration, elevated HDL-C, and inflammation are associated with prevalence of metabolic syndrome among African bank employees

Thierry Gombet,1 Benjamin Longo-Mbenza,2 Bertrand Ellenga-Mbolla,1 Meo Stephane Ikama,3 Etienne Mokondjimobe,4 Gisele Kimbally-Kaky,3 Jean-Louis Nkoua,31Emergency Department, University Hospital Center of Brazzaville, Brazzaville, Congo; 2Faculty of Health Sciences, Walter Sisulu University, Mthatha, Eastern Cape, South Africa; 3Department of Cardiology and Internal Medicine, University Hospital Center of Brazzaville, Brazzaville, Congo; 4Laboratory of Biochemistry and Pharmacology, Faculty of Health Sciences, Brazzaville, CongoBackground: The objective of this study was to compare four different criteria for diagnosing metabolic syndrome (MS) and to correlate sociodemographic data, liver enzymes, lipids, inflammation, and insulin resistance with MS definitions.Methods: This cross-sectional study included a random number of 126 African bank employees from Brazzaville, Congo.Results: The prevalence of MS varied according to the different definitions used: 4.8% under World Health Organization (WHO) criteria, 8.7% under the National Cholesterol Education Program Adult Treatment Panel III (NECP-ATPIII) criteria, 14.3% under the International Diabetes Federation (IDF) for Europe, and 15.9% by the IDF for Central Africa. According to the IDF, specific cutoff points for the erythrocyte sedimentation rate, ≥13 mm at first hour and ≥30 mm at second hour, defined MS for Central Africa. The best agreement was observed between the IDF for Europe and the IDF for Central Africa (Kappa = 0.938; P < 0.0001) criteria. The worst agreements were between the WHO and IDF for Central Africa (Kappa = 0.419; P < 0.0001) criteria and between the WHO and IDF for Europe (Kappa = 0.462; P < 0.0001) criteria. The NECP-ATPIII criteria did not agree with either the IDF for Europe or the IDF for Central Africa criteria. There was a significant relationship between female sex, aging, elevated liver enzymes, elevated phospholipids, high homeostasis model assessment of insulin resistance, and MS defined by the IDF for Central Africa.Conclusion: The IDF definition of the MS modified for Central Africa provides higher prevalence estimates of MS than the estimates based on the NECP-ATPIII and IDF for Europe criteria. Liver enzymes, phospholipids, and homeostasis model assessment of insulin resistance should be included in clinical practice to stratify cardiovascular disease risk among Africans.Keywords: metabolic syndrome, insulin resistance, inflammation, liver enzymes, atherosclerosis, sub-Saharan Africa&nbsp

Pratique de la mesure ambulatoire de la pression artérielle à Brazzaville (Congo): données préliminaires

Introduction: évaluer l'apport de la MAPA dans la prise en charge de l'hypertension artérielle à Brazzaville.Méthodes: cette étude transversale descriptive a été menée à Brazzaville entre janvier 2011 et décembre 2013 (soit 36 mois). Elle a inclus une série consécutive de 1040 patients ayant bénéficié d'une Mesure Ambulatoire de la Pression Artérielle. Nous avons utilisé le TONOPORT V et le logiciel Cardiosoft 6.51 de GE Health Care, respectivement pour l'enregistrement et l'analyse des données. Les seuils fixés sur les moyennes de 24H étaient une PA < 130/80 mmHg pour les patients contrôlés, et une PA > 130/80 mmHg pour la confirmation de l'HTA.Résultats: il s'agissait de 573 hommes (55%) et de 467 femmes (45%), âgés en moyenne de 51,7 ± 10,6 ans (extrêmes: 22 et 89 ans). L'indication de la MAPA était à visée thérapeutique dans 627 cas (60,3%), à visée diagnostique dans 410 cas (39,4%), et dans trois cas une suspicion d'effet « blouse blanche ». Dans l'indication à visée diagnostique, l'HTA était confirmée dans 303 cas (74%). La moyenne nycthémérale était de 139 ± 12 mmHg pour la PAS et 89,7 ± 9,6 mmHg pour la PAD; 141,2 ± 13,9 mmHg de PAS et 92,4 ± 10,0 mmHg de PAD en période diurne ; 131,1 ± 13,5 mmHg de PAS et 80,7 ± 9,9 mmHg de PAD en période nocturne. Dans l'indication à visée thérapeutique, l'HTA était contrôlée chez 220 patients (35%). La moyenne nycthémérale était de 139 ± 14 mmHg pour la PAS et 88,1 ± 10 mmHg pour la PAD. Les moyennes diurnes et nocturnes étaient respectivement de 140,7 ± 14,0 mmHg et 133,1 ± 16,2 mmHg pour la PAS, 90,3 ± 10,5 et 81,1 ± 10,9 mmHg pour la PAD. Le protocole antihypertenseur utilisé était une monothérapie dans 126 cas (22%), une bithérapie dans 270 cas (47%), une trithérapie dans 149 cas (26%), une quadrithérapie et plus dans 29 cas (5%). Conclusion: cette étude préliminaire a montré l'importance de la MAPA comme outil de diagnostic et d'évaluation thérapeutique. Son utilisation rationnelle dans notre contexte permettrait d'améliorer la prise en charge des patients hypertendus

Rates of untreated, treated, and controlled hypertension and relationships between blood pressure with other cardiovascular risk factors in Brazzaville (Republic of the Congo): May Measurement Month 2017-Sub-Saharan Africa.

Hypertension (HT) is a growing burden worldwide, leading to over 10 million deaths each year. In Brazzaville, the prevalence of HT was 32.5% in 2004. The mortality for stroke in 2008 and heart failure in 2013 were, respectively, 24% and 20.2%. May Measurement Month (MMM) is a global initiative initiated by the International Society of Hypertension aimed at raising awareness of HT and to act as a temporary solution to the lack of screening programmes worldwide. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May 2017. Blood pressure (BP) measurement, the definition of HT and statistical analysis followed the standard MMM protocol. The screening was carried out in Brazzaville, and the screening sites were distributed in different districts of the city in public places and health facilities. A total of 3842 individuals were screened during MMM17. After multiple imputations, 1576 (41.0%) had HT. About 956 (29.7%) individuals not receiving anti-hypertensive medication, were hypertensive. Four hundred and nine (66.0%) individuals receiving anti-hypertensive medication, had uncontrolled BP. Systolic and diastolic BPs after adjustment for age and sex differed significantly in association with use of anti-hypertensive medication (P < 0.0001), previous stroke (P = 0.001 for systolic), and waist circumference (P < 0.0001). MMM17 was the largest BP screening campaign undertaken in Congo. Almost one-third of screenees had untreated HT, and two-thirds of treated hypertensives were not well controlled. These results suggest that opportunistic screening can identify significant numbers with raised BP

May measurement month 2018: an analysis of blood pressure screening results from Republic of the Congo.

To determine the proportion with hypertension among opportunistic screenees in the Republic of the Congo. This cross-sectional study was conducted in Republic of the Congo in May 2018. This screening was done in urban and rural areas that included Brazzaville, Pointe-Noire, District of Ngoyo, and District of Nkayi. The study protocol was provided by the International Society of Hypertension, and local ethical clearance was obtained. The data were processed by the May Measurement Month global project team. In total, 6169 people were screened, 2418 of which were female (39.2%). Most of the people screened were from 18 to 29 years old (n = 4184, 67.8%). The proportion of hypertension found was 22.2% (n = 1371). Among the hypertensive patients, 40.2% were aware of their hypertension, but only 493 (36.0%) were on antihypertensive treatment, and only 16.0% were controlled. The frequency of diabetes was 2.2% (n = 135), 2.3% (n = 139) had a previous stroke, and overweight and obesity were present in 15.4% (n = 952) and 7.3% (n = 449), respectively. Hypertension is frequent in the Republic of the Congo, and levels of awareness, treatment and control are low. Actions are needed to increase access of all to a correct diagnosis and treatment of hypertension to achieve universal health coverage