Biomarkers of ventricular remodelling in African hypertensives.

Includes abstract.Includes bibliographical references.There is substantial evidence that the burden of hypertension, hypertension with left ventricular hypertrophy and hypertensive heart failure is very enormous in sub-Saharan Africa. There is therefore the need to look for easier and faster means, compared to electrocardiography and echocardiography of diagnosing and differentiating the different effects of long standing hypertension on cardiac remodelling which ultimately lead to systolic and diastolic dysfunctions as this affects the prognosis, management and treatment modalities of hypertension. We studied 210 subjects who were subdivided into three groups after echocardiography: those without left ventricular hypertrophy (HT) (n=83); those with left ventricular hypertrophy (HTLVH) (n=50) and those with hypertensive heart failure (HHF) (n=77)

Risk assessment of adherence in hypertensives and diabetics in a subSaharan African outpatient clinic

Medication nonadherence is a significant burden to health care utilization[1], in addition to poor disease control. But there is a paucity of structured adherence counselling as a thematic area of care. We have used a modified adherence tool for patients living with HIV and AIDs which incorporates social background, treatment preparation, adherence habits, disclosure of illness, the use of treatment partners, and assessment of potential barriers to adherence. This form was designed only to explore known characteristics that are important for adherence, but patients were asked to make judgement on their own level of adherence. Of the one hundred and eighty one eighty six (47.5%) were males while 95(52.5%) were females. The mean age was 50.83 years (SD 12.54). Majority of the patients were married (81.8%) and had at least primary education. Most of the patients whom we interviewed were hypertensives (65%). One hundred and twelve (61.88%) were taking medications during a daily routine, such as eating. Most of the patients, 116(64.10%) had some knowledge about their illness and the medications they were taking by names. Majority of patients (72.4%) had disclosed their illness to their spouses. Many patients selfreport that their adherence is good

Building capacity of community nurses to strengthen the management of uncomplicated hypertension in persons living with HIV in low- and middle-income countries

OBJECTIVES: Poor training of non-physician healthcare workers (especially community nurses) could hinder the successful integration of cardiovascular disease (CVD) management into HIV chronic care in primary healthcare facilities in low- and middle-income countries. To address this limitation, we included a holistic training programme with a robust module for both practice facilitators and community nurses as part of the formative stages of the managing hypertension among people living with HIV: an integrated model (MAP-IT), which is a study that is evaluating the effectiveness of practice facilitation on the integration of a task-strengthening strategy for hypertension control (TASSH) into primary healthcare centres in Akwa Ibom State of Nigeria. METHODS: Between June and November 2021, 3 didactic training workshops were conducted using a training module which is based on the simplified Nigerian Hypertension Protocol for primary care and the World Health Organization (WHO) heart package. Knowledge acquired by the participants was assessed using anonymized pre- and post-training assessments in the first two workshops. Participants\u27 view of the training was assessed using a comprehensive course evaluation questionnaire. RESULTS: A total of 92 community nurses and six practice facilitators were trained in the workshops on managing hypertension in persons living with HIV. Mean pre- and post-test scores improved from 11.9(3.4) to 15.9(2.9); p \u3c 0.001 in the first workshop, and from 15.4(0.9) to 16.4 (1.4); p \u3c 0.001 in the second workshop. The methodology used in the training, understanding of the MAP-IT study programme, and the level of engagement was highly rated by the participants with LIKERT scores of 3.2/4.0, 3.2/4.0, and 3.1/4.0 respectively. CONCLUSION: Our training methodology, which involved the train-the-trainer model to deliver simplified HIV and HTN care guidelines, showed improvement in the knowledge of managing hypertension in persons living with HIV and was highly rated by participants

Characteristics, treatment, and control of hypertension in public primary healthcare centers in Nigeria: Baseline results from the Hypertension Treatment in Nigeria Program

BACKGROUND: There are limited data on large-scale, multilevel implementation research studies to improve hypertension diagnosis, treatment, and control rates at the primary healthcare (PHC) level in Africa. We describe the characteristics, treatment, and control rates of patients with hypertension in public PHC centers in the Hypertension Treatment in Nigeria Program. METHODS: Data were collected from adults at least 18 years at 60 public PHC centers between January 2020 and November 2020. Hypertension treatment rates were calculated at registration and upon completion of the initial visit. Hypertension control rates were calculated based on SBP and DBPs less than 140/90 mmHg. Regression models were created to evaluate factors associated with hypertension treatment and control status. RESULTS: Four thousand, nine hundred and twenty-seven individuals [66.7% women, mean (SD) age = 48.2 (12.9) years] were included. Mean (SD) SBP was higher in men compared with women [152.9 (20.0) mmHg versus 150.8 (21) mmHg, P = 0.001]. Most (58.3%) patients were on treatment at the time of registration, and by the end of the baseline visit, 89.2% of patients were on treatment. The baseline hypertension control rate was 13.1%, and control was more common among patients who were older [adjusted OR (95% CI) 1.01 [1.01 -1.02)], women [adjusted OR (95% CI) 1.30 (1.05- 1.62)], who used fixed dose combination therapy [adjusted OR (95% CI) 1.83 (1.49 -2.26)], and had higher education levels. CONCLUSION: This baseline report of the largest facility-based hypertension study in Africa demonstrates high hypertension treatment rates but low control rates

Soluble ST2 correlates with some indicators of right ventricular function in hypertensive heart failure

Purpose: ST2 receptor, which is a member of the Toll-like/interleukin-1 (IL-1) receptor family, has been found to be increased in the serum of patients 1 day after myocardial infarction. Several other studies have shown that soluble ST2 levels correlate with severity of heart failure (HF), left ventricular ejection fraction, creatinine clearance, B-type natriuretic peptide and C-reactive protein, and are predictors of mortality in HF. Most of these studies were not only limited to ischemic heart disease but also concentrated on left-sided HF. We therefore decided to study the relationship between soluble ST2 and some markers of right ventricular (RV) function in a cohort of hypertensive HF subjects. Patients and methods: This is a prospective cohort study of hypertensive HF patients presenting to the University of Abuja Teaching Hospital, Abuja, over a 12-month period. ST2 was measured in plasma sample by the enzyme-linked immunosorbent assay (ELISA) method. Right ventricular diameters in diastole (RVDD) and right atrial area (RAA) were obtained on echocardiography, while right ventricular systolic pressure (RVSP) was estimated from echocardiography by the addition of the pressure gradient between the right ventricle and right atrium (RA) to the pressure in the RA. Results: There was a significant correlation between RVSP and soluble ST2 (t=0.75, p < 0.0001), RVDD (t=0.28, p=0.004) and RAA (t=0.46, p=0.002). Conclusion: In a cohort of hypertensive HF subjects, soluble ST2 correlates significantly with RVSP, RVDD and RAA

Elevated blood pressure among adolescents in sub-Saharan Africa : A systematic review and meta-analysis

Background More people from sub-Saharan Africa aged between 20 years and 60 years are affected by end-organ damage due to underlying hypertension than people in high-income countries. However, there is a paucity of data on the pattern of elevated blood pressure among adolescents aged 10–19 years in sub-Saharan Africa. We aimed to provide pooled estimates of high blood pressure prevalence and mean levels in adolescents aged 10–19 years across sub-Saharan Africa. Methods In this systematic review and meta-analysis, we searched PubMed, Google Scholar, African Index Medicus, and Embase to identify studies published from Jan 1, 2010, to Dec 31, 2021. To be included, primary studies had to be observational studies of adolescents aged 10–19 years residing in sub-Saharan African countries reporting the pooled prevalence of elevated blood pressure or with enough data to compute these estimates. We excluded studies on non-systemic hypertension, in African people not living in sub-Saharan Africa, with participant selection based on the presence of hypertension, and with adult cohorts in which we could not disaggregate data for adolescents. We independently extracted relevant data from individual studies using a standard data extraction form. We used a random-effects model to estimate the pooled prevalence of elevated blood pressure and mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels overall and on a sex-specific basis. This study is registered with PROSPERO (CRD42022297948). Findings We identified 2559 studies, and assessed 81 full-text studies for eligibility, of which 36 studies comprising 37 926 participants aged 10–19 years from ten (20%) of 49 sub-Saharan African countries were eligible. A pooled sample of 29 696 adolescents informed meta-analyses of elevated blood pressure and 27 155 adolescents informed meta-analyses of mean blood pressure. Sex data were available from 26 818 adolescents (14 369 [53·6%] were female and 12 449 [46·4%] were male) for the prevalence of elevated blood pressure and 23 777 adolescents (12 864 [54·1%] were female and 10 913 [45·9%] were male) for mean blood pressure. Study quality was high, with no low-quality studies. The reported prevalence of elevated blood pressure ranged from 4 (0·2%) of 1727 to 1755 (25·1%) of 6980 (pooled prevalence 9·9%, 95% CI 7·3–12·5; I2=99·2%, pheterogeneity<0·0001). Mean SBP was 111 mm Hg (95% CI 108–114) and mean DBP was 68 mm Hg (66–70). 13·4% (95% CI 12·9–13·9; pheterogeneity<0·0001) of male participants had elevated blood pressure compared with 11·9% (11·3–12·4; pheterogeneity<0·0001) of female participants (odds ratio 1·04, 95% CI 0·81–1·34; pheterogeneity<0·0001). Interpretation To our knowledge, this systematic review and meta-analysis is the first systematic synthesis of blood pressure data specifically derived from adolescents in sub-Saharan Africa. Although many low-income countries were not represented in our study, our findings suggest that approximately one in ten adolescents have elevated blood pressure across sub-Saharan Africa. Accordingly, there is an urgent need to improve preventive heart-health programmes in the region. Funding None

Addressing failures in achieving hypertension control in low- and middle- income settings through simplified treatment algorithms

Hypertension is the most important risk factor for cardiovascular diseases (CVDs), which are the leading global cause of death. Hypertension is under-diagnosed and under-treated in most low- and middle-income countries (LMICs). Current algorithms for hypertension treatment are complex for the healthcare worker, limit decentralization, complicate procurement and often translate to a large pill burden for the person with hypertension. We summarize evidence supporting implementation of simple, algorithmic, accessible, non-toxic and effective (SAANE) algorithms to provide a feasible way to access and maintain quality care for hypertension. Implementation of these algorithms will enable task shifting to less specialised health care workers and lay cadres, provision of fixed dose combinations, consolidation of the market while retaining generic competition, simplification of laboratory requirements, and lowering costs for health systems and people who incur out of pocket expenses.https://globalheartjournal.comSchool of Health Systems and Public Health (SHSPH

Use of single pill anti-hypertensive combination medications in Cardiology Clinic of a Tertiary Health Institution in Nigeria

Background: Majority of patients with hypertension require 2 or more medications to provide adequate blood pressure (BP) control. In addition, contemporary guidelines on the management of hypertension favor the use of single-pill combinations (SPCs) as they simplify the treatment regimen and decrease the daily pill burden for patients, both of which are associated with improved adherence. In spite of this, there is a lack of data in sub-Saharan Africa on the frequency of use of SPC anti-hypertensive medications. Method: We prospectively collected detailed clinical data from 373 patients with primary diagnosis of hypertension attending the cardiology clinic of University of Abuja Teaching Hospital between 2016 and 2017. Results: Three hundred and seventy three patients with mean age of 50.6 ± 12.3 years and mean body mass index of 31.2 ± 6.5kg/m2 on anti-hypertensive treatment were evaluated. Baseline mean systolic and diastolic BPs were 161.1 ± 3.1mmHg and 95.4 ± 15.6mmHg respectively, while the mean pulse pressure was 56.6 ± 18.1mmHg. 212 (56.8%) where on SPCs, with 32.5% on angiotensin receptor blockers (ARBs) plus hydrochlorothiazide (HCTZ), 18.9% on angiotensin converting enzyme inhibitors (ACEIs) plus HCTZ, 9.9% on amlodipine (AML) plus ARB, 3.3% on AML plus ACEI, 3.8% on thiazide-like diuretic plus atenolol, 29.2% on HCTZ plus amiloride, and 2.4% on triple combination of AML+ARB+HCTZ. Conclusion: Our study has shown that over 50% of our patients were on SPC anti-hypertensive medications, with the most prescribed single pill combination being angiotensin receptor blocker plus thiazide diuretic

Stakeholder perspectives on the demand and supply factors driving substandard and falsified blood pressure lowering medications in Nigeria: A qualitative study

OBJECTIVES: Although substandard and falsified (SF) blood pressure (BP) lowering medications are a global problem, qualitative research exploring factors driving this in Nigeria has not been reported. This study provides information on factors driving demand for and supply of low-quality BP lowering medications in Nigeria and potential strategies to address these factors. METHODS: This was a cross-sectional qualitative study. Between August 2020 and September 2020, we conducted 11 in-depth interviews and 7 focus group discussions with administrators of health facilities, major manufacturers and distributors of BP lowering medications, pharmacists, drug regulators, patients and primary care physicians purposively sampled from the Federal Capital Territory, Nigeria. Data were analysed using directed content analysis, with the aid of Dedoose. RESULTS: We found that demand for SF BP lowering medications in Nigeria was driven by high out-of-pocket expenditure and stockouts of quality-assured BP lowering medications. Supply of low-quality BP lowering medications was driven by limited in-country manufacturing capacity, non-adherence to good manufacturing and distribution practices, under-resourced drug regulatory systems, ineffective healthcare facility operations, poor distribution practices, limited number of trained pharmacists and the COVID-19 pandemic which led to stockouts. Central medicine store procurement procedures, active pharmaceutical ingredient quality check and availability of trained pharmacists were existing strategies perceived to lower the risk of supply and demand of SF BP lowering medications. CONCLUSION: Our findings suggest that demand for and supply of SF BP lowering medications in Nigeria are driven by multi-level, interrelated factors. Multi-pronged strategies need to target stakeholders and systems involved in drug production, distribution, prescription, consumption, regulation and pricing