Trends in acute emergency room hypertension related deaths: An autopsy study

No Abstract

Erectile Dysfunction in 101 Consecutive Hypertensive Patients and 86 Normotensive Controls

In a 6 month prospective questionnaire study of 101 consecutive newly referred hypertensive patients and 86 normotensive volunteers, the relationship of erectile dysfunction and hypertension in these patients was studied using a modified international index of erectile function (IIEF). The mean age of the hypertensive subjects was 56.2±45 years and controls were 43.5±11.8 years. The erectile function score of the hypertensive group was significantly different from the normotensive control. (17.51±5.92 vs. 20.56±2.61). P< 0.05. 63 patients (62%) of the hypertensive subjects had varying levels of erectile dysfunction as compared to 38 (44%) of the control group. 39 (38.6%) of subjects had mild erectile dysfunction as compared to 36(41.8%) of the control group. 12 (11%) of the hypertensive subjects had moderate erectile dysfunction as compared to 2(0.2%) of the control group. 12 (11%) of the hypertensive subjects had severe erectile dysfunction as compared to none in the control group. There was a significant difference in the number of subjects in the hypertensive group who had erectile dysfunction compared to the normotensive subjects. Erectile dysfunction appeared to be influenced by subject's age and duration of hypertension. This study clearly suggests that erectile dysfunction is commoner in the hypertensive population than the control group. The cause of this may be multifactorial and a national study is needed to fully define the extent of this problem in Nigeria. Key Words: Erectile dysfunction, hypertensive patients Nigerian Medical Practitioner Vol. 45 No 6, 2004 (98-101

Evaluation of Chest Pain in Ambulatory Patients in Lagos, Using the Rose Questionnaire and Resting Electrocardiogram

Purpose: Using the Rose Questionnaire, we aimed to study the characteristics of chronic chest pain in ambulatory care, to find patterns that are consistent with a diagnosis of angina pectoris. Methods: Patients: Consecutive patients, referred to the Cardiac Out-patient clinic with a major complaint of chest pain of more than one month were included. Exclusion criteria consisted of the presence of congestive heart failure, or recent use of digitalis or beta blockers. The questionnaire for this study was that of the World Health Organisation Cardiovascular Survey/ Rose Questionnaire (RQ) with an additional section designed to obtain data on demography, and descriptive characteristics of chest pain. Angina was according to RQ definition. Health professionals trained in the use of the RQ, administered the instrument. Sub-group analysis was based on the presence and absence of angina. Results: There were 214 patients, a male : female ratio of 0.8: 1; an average age of 44 years (age range of 16-70 years); 48% were obese (body mass index [BMI]>27 kg/m2) and 59% were over 40 years. The median duration of chest pain was six (6) months. Characteristic features of angina were present as follows: retrosternal location - 40%; pressure - like/constricting pain: 43%; and chest pain aggravated by exertion – 35%. Angina was diagnosed in 7%, whose pain stopped within 10 minutes of “stopping and resting”. Underlying diseases were hypertension-14.9%, Diabetes: 1%, and hypercholesterolaemia: 5.6%. Electrocardiographic (ECG ) abnormalities were common: left ventricular hypertrophy: 59%, ST elevation –25%, T wave inversion-6.5%. No ST depression was noted. Bundle branch block, prolonged PR interval axis deviation were found in less than 1%. Age, sex, and BMI were comparable in those with and without angina. Features of chest pain without significant association with angina were location, character, duration of single episodes, and aggravation by emotion. However, aggravation by food and exertion distinguished the angina groups (

Psychosocial Correlates of Subjects with Heart Failure in Lagos, Nigeria

Heart failure (HF) is associated with high morbidity and mortality most especially in developing countries including Nigeria. In the country, most patients present late for treatment and with attendant high treatment default. Thus, the study set out to examine the psychosocial correlates of subjects with HF. It was a cross-sectional study of new patients aged 18 years and above that presented with HF in the cardiology clinic of Lagos University Teaching Hospital (LUTH), Lagos. Each subject had echocardiography done to confirm the diagnosis and grade the severity of HF. Furthermore, the socio-demographic profiles of each subject were obtained and they were also assessed with General Health Questionnaire (GHQ-12) and questionnaire to elicit the attitudes and belief of subjects about HF. In all, 55 subjects were studied over a 6-month period, made up of 25 (45.5%) males and 30 (54.5%) females; with mean age of 51.2+14.0 years. According to New York Heart Association (NYHA) classification, over half (50.9%) of subjects had class II severity of HF followed by classes I and III of 20.0% each. The two commonest causes of HF were dilated cardiomyopathy (47.3%) and Hypertensive Heart Disease,HHD (30.9%). Forty three (78.2%) of the subjects had >2 scores on GHQ-12, indicating the likelihood of co-morbid psychopathology. Close to half (47.3%) of the subjects believed HF was caused by psychosocial /spiritual causes; with further 12.7% believing in admixed medical and spiritual causes. However, 35 (63.6%) of the subjects believed orthodox care to be the effective treatment for HF while the rest 20 (36.4%) believed in combination of orthodox medical care and spiritual intervention of prayer and “deliverance from the enemies”. Up to 81.8% of subjects believed HF has detrimental effect on work/income, sexual ability and social life. Over half (54.6%) admitted to past use of psychoactive substance but stopped on account of the HF. Only 2 (3.6%) were current users (alcohol). It is concluded that there is need to establish intensive health education on HF and cardiovascular diseases in the country.Key Words: Heart Failure; Nigeria; Psychosocial; Factor

Clinical Electrocardiographic and Echocardiographic Features of Atrial Fibrillation in Nigerians: An Analysis of 39 Patients Seen at the Lagos University Teaching Hospital

Purpose: To evaluate the clinical, electrocardiographic (ECG) and echocardiograhic features of adult Nigerians presenting with atrial Fibrillation (AF) at the cardiology unit. Method: All consenting patients presenting to the cardiology unit of LUTH from September 2000 to September 2001 with ECG evidence of AF were recruited into the study. Demographic and anthropometric data were obtained. The subjects had a full clinical examination. 2D and M-mode echocardiogram was performed on the subjects. Result. Of the 39 subjects analysed there were 22 females and 17 males with a mean age of 54.49±14.60. The underlying heart disease distribution was as follows: hypertensive heart disease 46.2%; dilated cardiomyopathy 20.8%; rheumatic heart disease 17.9%; thyrotoxic heart disease 7.7%; hypertrophic cardiomyopathy 5.1%, lone 2.6%. About 23% were asymptomatic for the arrhythmia at diagnosis. Congestive cardiac failure was present in 74% of the subjects with a mean NYHA class of about III. Embolic phenomenon was observed in 15% of the subjects; 12.8% cerebral events and 2.6% limb embolism. Abnormal QRS axis was noted in 33.3%. Ectopic ventricular beats were as follows: uniform ectopics 30.8%; multiform ectopics 10.3% and unsustained ventricular tachycardia 7.7%. Abnormal echocardiographic features are as follows: dilated left atrium 33( 84.62%); abnormal thickness of the interventricular septum and posterior wall 12(30.77%) and 19(48.71%) respectively;Increased left ventricular internal diameter in diastole 20(51.3%) and in systole 25(64.10%); reduced fractional shortening 30(76.9%); spontaneous echoes 7(18.0%) and intramural thrombus 2(5.1%) Conclusion: Commonest underlying heart disease for AF in this study was hypertensive heart disease. Congestive cardiac failure was a frequently documented clinical feature and cerebral embolism remains a very common complication. Nig. Qt. J. Hosp. Med. Vol.12(1-4) 2002: 29-3

QT Dispersion in Healthy Adult Nigerians

Background: Increase in QT dispersion (QTd) is associated with an increased risk of cardiovascular morbidity and mortality.Objectives: This study sought to (i) determine the mean QTd and (ii) characterise QTd in a healthy Nigerian population.Methods: One hundred healthy Nigerian adults were studied. Healthy status of the subjects was determined by history and physical examination. A resting 12- lead ECG was obtained from all subjects for determination of QTc, QTd and ECG left ventricular hypertrophy (LVH) using Sokolow Lyon (SL) and Araoye's codes. Echocardiography was used to determine LV systolic function, LVM and LVMI for 60 subjects.Results: The QTd ranged from 15-70ms with a mean value of 38.5±11.2ms. QTd was independent of age (p= 0.86), sex (p= 0.97), heart rate (p=0.22), blood pressure (p &gt; 0.05), BMI (p=0.81), QTc (p=0.41), LVH (ECG and echo) and LV systolic function (p&gt;0.05).Conclusion: QT dispersion is independent of demographic parameters, LV systolic function and LV hypertrophy in healthy adult Nigerians.Keywords: QT dispersion, Healthy, Adult Nigerian

Self reported adherence to antihypertensive drugs in a Nigerian population using the Morisky medication adherence scale

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May Measurement Month 2017: screening for hypertension in Nigeria-Sub-Saharan Africa.

Hypertension and its complications are now responsible for about a quarter of emergency medical admissions in urban hospitals in Nigeria. It is the commonest risk factor for stroke, heart failure, chronic kidney disease, and dementia. Furthermore, high blood pressure is the commonest cause of sudden unexpected natural death in the country. Regrettably, the rate of awareness, treatment, and control is abysmally low in the country and in many parts of the world. May Measurement Month (MMM) is a global initiative of the International Society of Hypertension aimed at raising awareness of high blood pressure (BP) and to act as a temporary solution to the lack of screening programs worldwide. An opportunistic cross-sectional survey of volunteers aged ≥18 years was carried out in May 2017. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. A total of 19 904 individuals with a mean age of 40.9 years, were screened during MMM17. After multiple imputation, 6709 (36.2%) had hypertension. Of individuals not receiving anti-hypertensive medication, 4140 (25.9%) were found to have hypertension. Of individuals receiving anti-hypertensive medication, 1449 (58.8%) had uncontrolled BP. MMM17 was one of the largest BP screening campaigns undertaken in Nigeria. A significant number of the participants were identified with hypertension (but not on any treatment) and uncontrolled BP despite being treated. These results suggest that opportunistic screening can identify significant numbers with raised BP