Blood pressure gradients and cardiovascular risk factors in urban and rural populations in Abia State South Eastern Nigeria using the WHO STEPwise approach

Background: Developing countries of sub-Saharan Africa (SSA) face a double burden of non-communicable diseases (NCDs) and communicable diseases. As high blood pressure (BP) is a common global cardiovascular (CV) disorder associated with high morbidity and mortality, the relationship between gradients of BP and other CV risk factors was assessed in Abia State, Nigeria. Methods: Using the WHO STEPwise approach to surveillance of chronic disease risk factors, we conducted a populationbased cross-sectional survey in Abia state, Nigeria from August 2011 to March 2012. Data collected at various steps included: demographic and behavioral risk factors (Step 1); BP and anthropometric measurements (Step 2), and fasting blood cholesterol and glucose (Step 3). Results: Of the 2983 subjects with complete data for analysis, 52.1% were females and 53.2% were rural dwellers. Overall, the distribution of selected CV disease risk factors was diabetes (3.6%), hypertension (31.4%), cigarette smoking (13.3%), use of smokeless tobacco (4.8%), physical inactivity (64.2%) and being overweight or obese (33.7%). Presence of hypertension, excessive intake of alcohol, smoking (cigarette and smokeless tobacco) and physical inactivity occurred more frequently in males than in females (p,0.05); while low income, lack of any formal education and use of smokeless tobacco were seen more frequently in rural dwellers than in those living in urban areas (p,0.05). The frequency of selected CV risk factors increased as BP was graded from optimal, normal to hypertension; and high BP correlated with age, gender, smokeless tobacco, overweight or obesity, annual income and level of education. Conclusion: Given the high prevalence of hypertension in this part of Nigeria, there is an urgent need to focus on the reduction of preventable CV risk factors we have observed to be associated with hypertension, in order to effectively reduce the burden of NCDs in Africa.http://dx.doi.org/10.1371/journal.pone.0073403IS

Comparing the Efficacy and Safety of Induction Therapies for the Treatment of Patients with Proliferative Lupus Nephritis in South Africa

Background. Lupus nephritis (LN) can be complicated with requirement for kidney replacement therapy and death. Efficacy of induction therapies using mycophenolate mofetil (MMF) or intravenous cyclophosphamide (IVCYC) has been reported from studies, but there is limited data in Africans comparing both treatments in patients with proliferative LN. Methods. This was a retrospective study of patients with biopsy-proven proliferative LN diagnosed and treated with either MMF or IVCYC in a single centre in Cape Town, South Africa, over a 5-year period. The primary outcome was attaining complete remission after completion of induction therapy. Results. Of the 84 patients included, mean age was 29.6 ± 10.4 years and there was a female preponderance (88.1%). At baseline, there were significant differences in estimated glomerular filtration rate (eGFR) and presence of glomerular crescents between both groups (p≤0.05). After completion of induction therapy, there was no significant difference in remission status (76.0% versus 87.5%; p=0.33) or relapse status (8.1% versus 10.3%; p=0.22) for the IVCYC and MMF groups, respectively. Mortality rate for the IVCYC group was 5.5 per 10,000 person-days of follow-up compared to 1.5 per 10,000 person-days of follow-up for the MMF group (p=0.11), and there was no significant difference in infection-related adverse events between both groups. Estimated GFR at baseline was the only predictor of death (OR: 1.0 [0.9–1.0]; p=0.001). Conclusion. This study shows similar outcomes following induction treatment with MMF or IVCYC in patients with biopsy-proven proliferative LN in South Africa. However, a prospective and randomized study is needed to adequately assess these outcomes

Relationship between selected non-communicable diseases and mean systolic and diastolic blood pressures.

<p>Relationship between selected non-communicable diseases and mean systolic and diastolic blood pressures.</p

Regression analysis for hypertension and NCD risk factors in Abia state Nigeria.

<p>B – Unstandardized coefficients; S.E. – standard error.</p

Distribution of selected NCDs and their risk factors in participants enrolled in the Abia State NCD STEPS survey.

§<p>Represents subjects with self reported diabetes, those with fasting blood glucose ≥7.0 mmol/L or a random blood sugar ≥11.1 mmol/L.</p>*<p>P<0.05 for males vs females.</p>#<p>P<0.05 for urban vs rural dwellers.</p><p>Data is presented as number of subjects (percentage).</p

Demographic features of participants enrolled in the Abia State NCD STEPS survey.

<p>Data is presented as mean ± standard error of mean (SEM) or as number of subjects (percentage).</p

Geographical location of Abia State in Nigeria showing the distribution of local government areas within the state.

<p>Geographical location of Abia State in Nigeria showing the distribution of local government areas within the state.</p

Scale of selected NCD risk factors in Abia state and their distribution with classes of hypertension.

<p>Data is presented as number of subjects (percentage).</p

Blood pressure and blood pressure classification of participants dwelling in urban and rural parts of Abia state.

#<p>P<0.05 for urban males vs females.</p>*<p>P<0.05 for rural males vs females.</p><p>Data is presented as mean ± standard error of mean (SEM) or as number of subjects (percentage).</p