QTc prolongation in Black diabetic subjects with cardiac autonomic neuropathy

Background: Prolonged corrected QT (QTc) has been identified as a risk factor for malignant arrhythmias and sudden cardiac death. Caucasian studies have shown a definite relationship between QTc prolongation and Cardiac Autonomic Neuropathy (CAN) in diabetic subjects.Objective: To determine the prevalence of prolonged QTc in Black diabetic individuals with CAN and to ascertain how prolonged QTc correlated with the severity of CAN among these patients.Methods: A total of 176 adult diabetic subjects were studied, 87 males and 89 females. There was a control group of non-diabetic individuals. Cardiac autonomic function was assessed using five cardiovascular autonomic function tests. CAN was diagnosed if 2 or more of these tests were abnormal. Severity of CAN was determined according to the number of abnormal tests. QTc > 0.440 was regarded as prolonged.Results: Fifty-one out of the 176 diabetic subjects (29%) had CAN. The prevalence of prolonged QTc in diabetic subjects with CAN was 12%. QTc was prolonged in 1.6% and 0.6% of diabetic individuals without CAN and controls respectively. Although QTc correlated strongly with cardiac autonomic function neuropathy, there was no definite relationship between QTc prolongation and severity of CAN.Conclusion: This study in a Black population is in agreement with the well-known relationship between QTc prolongation and CAN reported in Caucasian studies. In view of the wide variability of QTc in this study population, it is suggested that relative QTc increase may be a better indicator of CAN than a definite QTc prolongation of greater than 0.440.Keywords: QTc prolongation, Cardiac Autonomic Neuropathy, Black diabetics, sudden cardiac death

High Prevalence and Low Awareness of Hypertension in a Market Population in Enugu, Nigeria

Background. A community-based study put the prevalence of hypertension in Nigeria at 32.8%. Market workers in Nigeria lead sedentary life style and often depend on salt-laden fast food while at work. Method. An unselected population of market workers were screened for hypertension and its risk factors by a pretested, structured questionnaire, clinical examination, and laboratory investigation. Hypertension was defined as BP ≥ 140 and/or ≥ 90 mmHg or being on drug therapy. Results. Forty-two percent of the screened population were hypertensive. Of this number, 70.6% did not know they were hypertensive before the screening. More males than females (P = .022) were hypertensive. Prevalence of hypertension increased with age from 5.4% in the age group <20 years to 80% in the age group ≥70 years. Conclusion. The prevalence of hypertension in market workers in this study was 42%, and the majority of them were unaware of their disease

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Background. A community-based study put the prevalence of hypertension in Nigeria at 32.8%. Market workers in Nigeria lead sedentary life style and often depend on salt-laden fast food while at work. Method. An unselected population of market workers were screened for hypertension and its risk factors by a pretested, structured questionnaire, clinical examination, and laboratory investigation. Hypertension was defined as BP ≥ 140 and/or ≥ 90 mmHg or being on drug therapy. Results. Forty-two percent of the screened population were hypertensive. Of this number, 70.6% did not know they were hypertensive before the screening. More males than females (P = .022) were hypertensive. Prevalence of hypertension increased with age from 5.4% in the age group &lt;20 years to 80% in the age group ≥70 years. Conclusion. The prevalence of hypertension in market workers in this study was 42%, and the majority of them were unaware of their disease

Evaluating the effectiveness of African School of Hypertension for non-physician health workers, a qualitative study : QuASH hypertension study

DATA ACCESSIBILITY STATEMENT : The data that supports the findings of this study are available from the corresponding author upon reasonable request.BACKGROUND : The implementation of task sharing and shifting (TSTS) policy as a way of addressing the shortage of physicians and reducing the burden of hypertension in Africa birthed the idea of the African School of Hypertension (ASH). The ASH is saddled with the responsibility of training non-physician health workers across Africa continent in the management of uncomplicated hypertension. AIM : To get feedback from some faculty members and students who participated in the first ASH programme. METHODS : This was a cross-sectional exploratory qualitative study conducted among eight students and eight faculty members. Feedback from the program was obtained by conducting in-depth interviews centred on description of course content; expectations and knowledge acquired from ASH; level of interaction between students and faculty members; challenges faced during the ASH; level of implementation of acquired training; and suggestions to improve subsequent ASH programs. RESULTS : The course content of the ASH was described as simple, appropriate and adequate while interaction between students and faculty members were highly cordial and engaging. New knowledge about hypertension management was acquired by the students with different levels of implementation post-graduation. Some identified challenges with the ASH program were poor internet connectivity during lectures, non-uniformity of TSTS policies and hypertension management guidelines across Africa, technical problems with hypertension management app and low participation from other African countries apart from Nigeria. Some recommendations to improve ASH program were development of a uniform hypertension management guideline for Africans, wider publicity of the ASH, interpretation of lectures into French and Portuguese languages and improvement of internet connectivity. CONCLUSION : The ASH programme has largely achieved its objectives with the very encouraging feedback received from both faculty members and the students. Steps should be taken to address the identified challenges and implement the suggested recommendations in subsequent ASH program to sustain this success.https://globalheartjournal.com/hj2024Early Childhood EducationSDG-04:Quality Educatio

Assessment of the effects of nisoldipine in patients with mild to moderate hypertension

Objective: The primary objective of the study is to show that once daily nisoldipine is effective in the control of blood pressure in patients with mild to moderate hypertension. The secondary objectives of the trial are to evaluate safety and the change in treatment in patients taking once daily nisoldipine. Subjects and Methods: A non-randomized, dose rising trial with a placebo run-in was done in which 20 consenting subjects (11 males and 9 females) with mild to moderate hypertension participated. Results: Sixteen subjects (80% of total) made up of 9 males and 7 females had a satisfactory response defined as either a mean sitting trough-diastolic blood pressure (DBP) of below 90mmHg or a mean DBP that has decreased by 10mmHg or more from the baseline DBP after placebo run-in. Ten subjects responded at 10mg dose; 3 at 20mg; and 3 responded at 40mg dose. There was no significant mean change in heart rate in the subjects. There was also no significant drug induced adverse events. Conclusion: This study demonstrated the efficacy, tolerability and safety of Syscor CCR 10mg, 20mg and 40mg once daily in Nigerian patients with mild to moderate hypertension: Nisoldipine produced significant reduction in blood pressure within twelve weeks of active treatment. Keywords: hypertension, patients, nisoldipine Orient Journal of Medicine Vol. 17(3&4) 2005: 17-2

Blood pressure, prevalence of hypertension and hypertension related complications in Nigerian Africans : A review

To review studies on hypertension in Nigeria over the past five decades in terms of prevalence, awareness and treatment and complications. Following our search on Pubmed, African Journals Online and the World Health Organization Global cardiovascular infobase, 1060 related references were identified out of which 43 were found to be relevant for this review. The overall prevalence of hypertension in Nigeria ranges from 8%-46.4% depending on the study target population, type of measurement and cut-off value used for defining hypertension. The prevalence is similar in men and women (7.9%-50.2% vs 3.5%-68.8%, respectively) and in the urban (8.1%-42.0%) and rural setting (13.5%-46.4%).The pooled prevalence increased from 8.6% from the only study during the period from 1970-1979 to 22.5% (2000-2011). Awareness, treatment and control of hypertension were generally low with attendant high burden of hypertension related complications. In order to improve outcomes of cardiovascular disease in Africans, public health education to improve awareness of hypertension is required. Further epidemiological studies on hypertension are required to adequately understand and characterize the impact of hypertension in society

Total cardiovascular risk approach to improve efficiency of cardiovascular prevention in resource constrain settings

Objectives: To determine the population distribution of cardiovascular risk in eight low- and middle-income countries and compare the cost of drug treatment based on cardiovascular risk (cardiovascular risk thresholds ≥30%/≥40%) with single risk fact

Development of the roadmap and guidelines for the prevention and management of high blood pressure in Africa: Proceedings of the PASCAR: Hypertension task force meeting: Nairobi, Kenya

Africa has one of the fastest growing economies in the world. The economic changes are associated with a health transition characterised by a rise in cardiovascular risk factors and complications, which tend to affect the African population at their age of maximum productivity. Recent data from Africa have highlighted the increasing importance of high blood pressure in this region of the world. This condition is largely underdiagnosed and poorly treated, and therefore leads to stroke, renal and heart failure, and death. Henceforth, African countries are taking steps to develop relevant policies and programmes to address the issue of blood pressure and other cardiovascular risk factors in response to a call by the World Health Organisation (WHO) to reduce premature deaths from non-communicable diseases (NCDs) by 25% by the year 2025 (25 × 25). The World Heart Federation (WHF) has developed a roadmap for global implementation of the prevention and management of raised blood pressure using a health system approach to help realise the 25 × 25 goal set by the WHO. As the leading continental organisation of cardiovascular professionals, the Pan-African Society of Cardiology (PASCAR) aims to contextualise the roadmap framework of the WHF to the African continent through the PASCAR Taskforce on Hypertension. The Taskforce held a workshop in Kenya on 27 October 2014 to discuss a process by which effective prevention and control of hypertension in Africa may be achieved. It was agreed that a set of clinical guidelines for the management of hypertension are needed in Africa. The ultimate goal of this work is to develop a roadmap for implementation of the prevention and management of hypertension in Africa under the auspices of the WHF