Registry for Acute Coronary Events in Nigeria (RACE-Nigeria): Clinical Characterization, Management, and Outcome

Background

Coronary artery disease was hitherto a rarity in Africa. Acute coronary syndrome (ACS) accounts for coronary artery disease–related morbidity and mortality. Reports on ACS in Africa are few.

Methods and Results

We enrolled 1072 indigenous Nigerian people 59.2±12.4 years old (men, 66.8%) with ACS in an observational multicentered national registry (2013–2018). Outcome measures included incidence, intervention times, reperfusion rates, and 1‐year mortality. The incidence of ACS was 59.1 people per 100 000 hospitalized adults per year, and comprised ST‐segment–elevation myocardial infarction (48.7%), non–ST‐segment–elevation myocardial infarction (24.5%), and unstable angina (26.8%). ACS frequency peaked 10 years earlier in men than women. Patients were predominantly from urban settings (87.3%). Median time from onset of symptoms to first medical contact (patients with ST‐segment–elevation myocardial infarction) was 6 hours (interquartile range, 20.1 hours), and only 11.9% presented within a 12‐hour time window. Traditional risk factors of coronary artery disease were observed. The coronary angiography rate was 42.4%. Reperfusion therapies included thrombolysis (17.1%), percutaneous coronary intervention (28.6%), and coronary artery bypass graft (11.2%). Guideline‐based pharmacotherapy was adequate. Major adverse cardiac events were 30.8%, and in‐hospital mortality was 8.1%. Mortality rates at 30 days, 3 months, 6 months, and 1 year were 8.7%, 9.9%, 10.9%, and 13.3%, respectively. Predictors of mortality included resuscitated cardiac arrest (odds ratio [OR], 50.0; 95% CI, 0.010–0.081), nonreperfusion (OR, 34.5; 95% CI, 0.004–0.221), pulmonary edema (OR, 11.1; 95% CI, 0.020–0.363), left ventricular diastolic dysfunction (OR, 4.1; 95% CI, 0.091–0.570), and left ventricular systolic dysfunction (OR, 2.1; 95% CI, 1.302–3.367).

Conclusions

ACS burden is rising in Nigeria, and patients are relatively young and from an urban setting. The system of care is evolving and is characterized by lack of capacity and low patient eligibility for reperfusion. We recommend preventive strategies and health care infrastructure‐appropriate management guidelines.

Masquerading Bundle Branch Block in a Patient with Heart Failure in Nigeria

Background

Masquerading bundle branch block (MBBB) is a rare and important electrocardiographic pattern. It consists of right bundle branch block (RBBB) in precordial leads and left bundle branch block (LBBB) in limb leads. It indicates advanced conduction system abnormality usually associated with severe underlying heart disease. MBBB is associated with poor prognosis. MBBB patients are at increased risk of complete atrioventricular (AV) block. To our knowledge, there is no previous published report of MBBB in heart failure in Nigeria.

Aim

To present a case of an African patient with heart failure and masquerading bundle branch block, a rare and important finding on 12-lead electrocardiogram.

Objective

To highlight the electrocardiographic feature of masquerading bundle branch block in a heart failure patient in our environment and the need for early recognition and close monitoring.

Patient and Methods

A 65-year-old man, known hypertensive and asthmatic, who presented with cough productive of whitish frothy sputum, bilateral leg swelling, and difficulty in breathing of 3 weeks duration. There was associated paroxysmal nocturnal dyspnea, orthopnea, and early satiety. No central chest pain on exertion or at rest.

Results

The 12-lead electrocardiography (ECG) showed precordial type MBBB with right bundle branch block in V1 and LBBB without deep and wide S waves in leads V5 and V6. Echocardiography confirmed heart failure with reduced ejection fraction of 19%, grade 3 diastolic dysfunction with E/A velocity ratio of 2.31, E/e’ of 29.7. Chest X-ray revealed unfolded aorta and cardiomegaly with cardio-thoracic ratio (CTR) of 65%. Patient was stabilized on anti-failure drugs and is being followed up.

Conclusion

We have reported electrocardiographic feature of MBBB in an African patient with heart failure. Early recognition of this rare electrocardiographic pattern, close monitoring and follow-up of these patients is important because of its association with poor prognosis.

Mixed connective tissue disease complicated by heart failure in Ile-Ife, Nigeria: management challenges in a resource-limited economy

Background

Mixed connective tissue disease (MCTD; also known as Sharp’s syndrome) is a rare autoimmune inflammatory disorder characterized by high titer of U1 ribonucleoprotein (U1RNP) antibody and clinical and serological overlap of systemic lupus erythematosus, systemic sclerosis, and polymyositis. The diagnosis is based on clinical and serological factors in criteria such as Alarcon-Segovia, Khan, Kusakawa, and Sharps. Cardiac disease can be a complication of connective tissue disease (CTD). There are few reports in Africa.

Aims

To present MCTD as underlying cause of heart failure with reduced ejection fraction and highlight challenges of investigations and treatment.

Objectives

To highlight the first case in our center and discuss the cardiac, respiratory, and rheumatologic management.

Patient and methods

We present a 52-year-old woman with 3 weeks history of productive cough with whitish sputum, severe dyspnea, orthopnea, paroxysmal nocturnal dyspnea, right sided abdominal pain, leg swellings, a one year history of recurrent fever, Raynaud’s phenomenon, small joint swellings and deformities with pain in both hands.

Results

On examination there was microstomia, tethered forehead and lower eyelid skin, tender swelling of the interphalangeal joints and arthritis mutilans. Laboratory findings showed estimated glomerular filtration rate <60 mL/kg/min/1.73 m², U1RNP antibody levels were eight times upper limit of normal, elevated rheumatoid factor, speckled antinuclear antibody pattern, negative anticentromere antibody, anti Scl-70 and anticyclic citrullinated peptide. Chest X-ray/CT revealed pulmonary fibrosis. Echocardiography findings showed reduced ejection fraction of 40%, elevated pulmonary arterial pressure at rest of 60.16 mmHg. The patient showed improvement on antifailure drugs, but prednisolone was stopped for sudden reversal of previously controlled stage 2 hypertension (HTN), and the patient was discharged in a stable condition. Difficulties ensued in obtaining prompt definite results due to the unavailability of serologic tests in the hospital, and the tests were done outside the state and country.

Conclusion

Identifying MCTD is critical, especially in patients requiring steroids that may worsen systemic HTN and heart failure. There is a need to have definitive investigative facilities for such patients in hospitals.

Joint predictability of physical activity and body weight status on health-related quality of life of patients with hypertension

This study investigated the predictability of physical activity (PA) and body weight status (BWS) on health-related quality of life (HRQoL) of patients with hypertension. A cross-sectional study involved 250 patients with hypertension (≥140/90≤179/109 mmHg) selected from government hospitals in Osun State, Nigeria. Purposive sampling technique was used to select participants. Socio-demographic characteristics and cardiovascular parameters were recorded. PA and HRQoL were assessed using the International Physical Activity Questionnaire and Short Form health survey questionnaire respectively. Sufficient PA equals ≥150 min/wk while BWS was defined using body mass index classification. Data were analyzed using descriptive and inferential statistics. Alpha level was set at P<0.05. Of all participants, 63.6% reported sufficient PA and 78.4% was either overweight or obese. The HRQoL of participants become poorer in all domains with higher body weight. The HRQoL including role limitation due to physical health (RLdPhp) and emotional problems (RLdEmp) had worst scores. Participants in the categories of normal and overweight/obese with sufficient PA demonstrated higher (better) HRQoL in all domains than those with insufficient PA (P<0.05). When adjusted for body weight, significant differences were found in all domains of HRQoL except in RLdPhp, RldEmp, and bodily pain (P>0.05). There were significant correlations between PA and all domains of HRQoL except in RldEmp, emotional well-being and bodily pain (P>0.05). Regression models established PA as a significant predictor of HRQoL. Sufficient PA is a better predictor of HRQoL among patients with hypertension irrespective of BWS. Regular PA is recommended for improving HRQoL among patients with hypertension.

Right ventricular systolic function in hypertensive heart failure

BACKGROUND

Heart failure (HF) is a major cause of cardiovascular admissions and hypertensive heart failure (HHF) is the most common cause of HF admissions in sub-Saharan Africa, Nigeria inclusive. Right ventricular (RV) dysfunction is being increasingly recognized in HF and found to be an independent predictor of adverse outcomes in HF. This study aimed to determine the prevalence of RV systolic dysfunction in HHF by several echocardiographic parameters.

METHODOLOGY

One hundred subjects with HHF were recruited consecutively into the study along with 50 age and sex-matched controls. All study participants gave written informed consent, and had a full physical examination, blood investigations, 12-lead electrocardiogram, and transthoracic echocardiography. RV systolic function was assessed in all subjects using different methods based on the American Society of Echocardiography guidelines for echocardiographic assessment of the right heart in adults. This included tricuspid annular plane systolic excursion (TAPSE), RV myocardial performance index (MPI), and RV systolic excursion velocity by tissue Doppler (S').

RESULTS

RV systolic dysfunction was found in 53% of subjects with HHF by TAPSE, 56% by RV MPI, and 48% by tissue Doppler systolic excursion S'. RV systolic dysfunction increased with reducing left ventricular ejection fraction (LVEF) in subjects with HHF.

CONCLUSION

A high proportion of subjects with HHF were found to have RV systolic functional abnormalities using TAPSE, RV MPI, and RV S'. Prevalence of RV systolic dysfunction increased with reducing LVEF.

Pulmonary hypertension in Nigerian adults with sickle cell anemia

Background

Sickle cell anemia (SCA) is the commonest hemoglobinopathy and is associated with high morbidity and mortality. Pulmonary hypertension (PH) is reported to play a significant role in this regard. There is very limited literature on PH in SCA in Nigeria.

Objectives

The objectives of this study were to determine the prevalence of Doppler-derived PH in SCA, assess its influence on exercise capacity, and determine the correlates and predictors of measures of estimated pulmonary pressure.

Methods

A total of 92 SCA subjects had echocardiography and 6-minute self-paced walking exercise. PH was diagnosed by Doppler echocardiography on finding a tricuspid regurgitant velocity (TRV) of ≥2.5 m/s. The pulmonary flow profile was also assessed to estimate mean pulmonary arterial pressure (MPAP).

Results

Doppler-derived PH was detected in 23.9% of adults with SCA. The 6-minute walking distance (6MWD) was significantly lower in SCA adults with PH than in those without PH (380.33 ± 63.17 m vs 474.28 ± 76.74 m; p = 0.014). TRV and estimated MPAP had a significant inverse correlation with the 6MWD (r = −0.442; p < 0.001 and r = −0.571; p < 0.001, respectively).

Conclusion

PH as derived by Doppler is common in Nigerian adults with SCA and has a significantly negative influence on exercise capacity. Screening for PH should be encouraged to optimize management and thus improve their quality of life and life expectancy.

Prognostic indices among hypertensive heart failure patients in Nigeria: the roles of 24-hour Holter electrocardiography and 6-minute walk test

Background

Hypertensive heart failure (HHF) is associated with a poor prognosis. There is paucity of data in Nigeria on prognosis among HHF patients elucidating the role of 24-hour Holter electrocardiogram (ECG) in concert with other risk factors.

Objective

The aim of this study was to determine the prognostic utility of 24-hour Holter ECG, the 6-minute walk test (6-MWT), echocardiography, clinical and laboratory parameters among HHF patients.

Methods

A total of 113 HHF patients were recruited and followed up for 6 months. Thirteen of these patients were lost to follow-up, and as a result only 100 HHF patients were analyzed. All the patients underwent baseline laboratory tests, echocardiography, 24-hour Holter ECG and the 6-MWT. HHF patients were analyzed as “mortality vs alive” and as “events vs no-events” based on the outcome at the end of 6 months. Events was defined as HHF patients who were rehospitalized for heart failure (HF), had prolonged hospital stay or died. No-events group was defined as HHF patients who did not meet the criteria for the events group.

Results

HHF patients in the mortality group (n = 7) had significantly higher serum urea (5.71 ± 2.07 mmol/L vs 3.93 ± 1.45 mmol/L, p = 0.003) than that in those alive. After logistic regression, high serum urea conferred increased mortality risk (p = 0.035). Significant premature ventricular complexes (PVCs) on 24-hour Holter ECG following logistic regression were also significantly higher (p = 0.015) in the mortality group than in the “alive” group (n = 93) at the end of the 6-month follow-up period. The 6-minute walk distance (6-MWD) was least among the HHF patients who died (167.26 m ± 85.24 m). However, following logistic regression, the 6-MWT was not significant (p = 0.777) for predicting adverse outcomes among HHF patients. Patients in the events group (n = 41) had significantly higher New York Heart Association (NYHA) class (p = 0.001), Holter-detected ventricular tachycardia (VT; p = 0.009), Holter-detected atrial fibrillation (AF; p = 0.028) and PVCs (p = 0.017) following logistic regression than those in the no-events group (n = 59).

Conclusion

High NYHA class, elevated serum urea, Holter ECG-detected AF and ventricular arrhythmias are predictive of a poor outcome among HHF patients. The 6-MWT was not a useful prognostic index in this study.

Assessment of functional capacity and sleep quality of patients with chronic heart failure

Background:

Adequate sleep improves physical and mental alertness. However, there is a dearth of empirical data on functional capacity (FC) and sleep quality (SpQ) in patients with chronic heart failure (CHF).

Objective:

This study investigated the relationship between FC and SpQ of patients with CHF and apparently healthy controls (HCs).

Methods:

This case-control study recruited 50 patients with CHF whose left ventricular ejection fraction (LVEF) was <40%, attending cardiac clinics of selected government hospitals in Osun State. Furthermore, 50 age- and sex-matched healthy individuals were recruited as controls. Socio-demographic characteristics and cardiovascular parameters were assessed. The FC (VO₂ max) and SpQ were assessed using the 6-minute walk test (6-MWT) and Pittsburgh Sleep Quality Index (PSQI), respectively. Data were analysed using descriptive and inferential statistics. Alpha level was set at p < 0.05.

Results:

Patients had a significantly lower FC and poorer SpQ than HCs, 4.6 ± 0.5 versus 11.3 ± 1.6 mL/kg/min (t = −3.452; p = 0.001) and 8.74 ± 1.6 versus 3.8 ± 1.3 (t = −5.371; p = 0.001), respectively. HCs were about five times more likely to walk longer distance [odds ratio (OR), 4.8; confidence interval (CI), 2.0–11.1] and had a better heart rate (OR, 2.8; CI, 1.4–5.3) than patients. SpQ had a significant negative correlation with FC of patients (r = −0.362; p = 0.001) but a significant positive correlation with HCs (r = 0.481; p = 0.041). Furthermore, there were significant correlations between FC and body mass index in both groups (CHF: r = 0.247, p = 0.022; HCs: r = 0.321, p = 0.040).

Conclusion:

Patients with heart failure demonstrated lower functional capacity and poorer sleep quality.

Echocardiographic Assessment of Cardiac Changes During Normal Pregnancy Among Nigerians

BACKGROUND

Pregnancy is a physiological process associated with an increased hemodynamic load and cardiac structural remodeling. Limited echocardiographic information exists on cardiac chambers, left ventricular (LV) systolic and diastolic functions, and LV mass during trimesters of normal pregnancy among African women.

MATERIALS AND METHODS

Echocardiography was done at the beginning of the second trimester, beginning of the third trimester, and middle of the third trimester for 100 normal pregnant women and at one visit for age-matched 100 nonpregnant women. The data were analyzed using the Statistical Package for Social Sciences (SPSS) version 17 software. Analysis of variance was used to compare within trimesters, and a P value of <0.05 was considered significant.

RESULTS

The mean (SD) ages of the patients and controls were 28.20 (±5.91) and 28.35 (±6.06) years, respectively (age range = 19–44 years, P = 0.86). Cardiac chambers, LV systolic function, and LV mass and its index increased significantly during pregnancy. A significant increase in A-wave velocity but slight increase in E-wave velocity and a reduction in tissue e′ velocity at the septal margin but a progressive increase in a′ velocity were also observed (P < 0.05).

CONCLUSION

Cardiac chamber dimensions, LV wall thickness, and mass, most indices of LV systolic and diastolic function, though within normal range, were significantly higher in pregnant than in nonpregnant Nigerian women.

Volume Measurements in Aortic Root Assessment Using Two-Dimensional Echocardiography

BACKGROUND

Aortic dilatation is associated with the presence of aortic diseases. Current guidelines for assessing the aortic root (AoR) depend on linear measurements acquired by two-dimensional (2D) echocardiography. We considered that real-time three-dimensional echocardiography, which correlates better with AoR volume obtained by computed tomography, is widely unavailable, and therefore, there is a need to determine the AoR volume using 2D echocardiography.

METHODS

Fifty-one consecutive apparently healthy volunteers were recruited and subsequently divided into three age groups. Specified planes of acquisition and previously defined landmarks were identified, and phases of the cardiac cycle that allowed for measurement standardization were used. Volume was determined by the modified Simpson’s method.

RESULTS

Although the average diastolic and systolic volume measurements of the AoR dimensions were not significantly different across the three age groups in the study population, a highly significant difference was observed in the volume measurements between male and female normotensive persons, P < 0.01 in each case. AoR volume measurements were five times in the diseased compared with the normotensive individuals; however, linear measurements were only 1.5 times in size of the normal individuals. Both point and interval estimates of the volume measurements of AoR in adult normotensives in three age groups were presented as baseline information.

CONCLUSIONS

We hereby present a novel way to determine the AoR volume using 2D echocardiography and the normal reference range with respect to age and gender. We also established the relevance of our measurement by comparing the normal population with two isolated diseased aortas.

Pulmonary Hypertension in Heart Failure Patients Presenting at OAUTHC, Ile-Ife, Nigeria

Background

Pulmonary hypertension (PH) is common in heart failure patients. Literature on PH in heart failure is sparse in Nigeria. This study was carried out to determine the prevalence of PH in heart failure patients and ascertain the relationship between left ventricular systolic and diastolic function and the degree of PH.

Methods

A total of 125 heart failure patients had echocardiography done. PH was diagnosed using tricuspid regurgitation jet and pulmonary ejection jet profile.

Results

PH was present in 70.4% of heart failure patients. Estimated mean pulmonary arterial pressure increased with increasing severity of systolic and diastolic dysfunction and had significantly negative correlation with ejection fraction, fractional shortening, and early mitral annular tissue diastolic velocity ( E′), but positive correlation with left ventricular end-systolic volume, right ventricular dimension, transmitral E to A ratio, and E/E′ ratio.

Conclusion

PH is very common in heart failure and has significant relationship with left ventricular function.

Comparison between treadmill and bicycle ergometer exercise tests in mild-to-moderate hypertensive Nigerians

BACKGROUND

Comparative cardiovascular responses to treadmill and bicycle ergometer (bike) exercise tests in hypertensive Nigerians are not known. This study compared cardiovascular responses to the two modes of exercise testing in hypertensives using maximal exercise protocols.

METHODS

One hundred and ten male subjects with mild-to-moderate hypertension underwent maximal treadmill and bike test one after the other at a single visit in a simple random manner. Paired-sampled t-test was used to compare responses to both exercise tests while chi-squared test was used to compare categorical variables.

RESULTS

The maximal heart rate (P<0.001), peak systolic blood pressure (P=0.02), rate pressure product (P<0.001), peak oxygen uptake (P<0.001), and exercise capacity (P<0.001) in metabolic equivalents were signifcantly higher on the treadmill than on the bike.

CONCLUSION

Higher cardiovascular responses on treadmill in Nigerian male hypertensives in this study, similar to findings in non-hypertensives and non-Nigerians in earlier studies, suggest that treadmill may be of better diagnostic utility in our population.

Pattern of arrhythmias among Nigerians with congestive heart failure

Background

In patients with heart failure, death is often sudden due to life-threatening arrhythmias. This work was carried out to evaluate the pattern of arrhythmias in Nigerians with heart failure.

Materials and methods

Thirty subjects with congestive heart failure (CHF), 30 subjects with hypertensive heart disease, and 15 normal subjects with no obvious features of heart disease were evaluated with resting and 24-hour electrocardiographic monitoring and transthoracic echocardiography. Data were analyzed with one-way analysis of variance with post hoc Duncan’s analysis, Fisher’s exact test, and linear regression analysis using SPSS version 16.

Results

CHF subjects had more instances of supraventricular tachycardia (P=0.005), ventricular extrasystoles (P<0.001), bigeminy (P<0.001), trigeminy (P<0.001), couplets (P<0.001), triplets (P<0.001), and nonsustained ventricular tachycardia (VT) (P=0.003) than the other two control groups. They also showed a significantly longer VT duration (4.6±5.6 seconds) compared with the other groups (P<0.001). Linear regression analysis showed a significant direct relationship between VT and the maximum number of ventricular extrasystoles per hour (P=0.001).

Conclusion

Cardiac arrhythmias are common in subjects with CHF and are more frequent when compared with patients with hypertensive heart disease and normal subjects.

Sexual practices and knowledge of sexually transmitted infections among hairdressers in Ibadan, Southwest Nigeria

The environment in salons provides hairdressers the opportunity to discuss sexual exploits which may promote unhealthy sexual behaviour and increase the risk of sexually transmitted infections (STIs). The aim of the study was to determine sexual practices and knowledge and experience of STIs among hairdressers. The study was carried out in Ibadan, Southwest Nigeria. A total of 1700 hairdressers were selected by cluster sampling technique. Predictors of risky sexual behaviour, knowledge and experience of STIs were identified. Their mean age was 27.0 ± 8.1 years, 860 (50.6%) were single. Majority of them, 1453(85.5%) had ever had sex. The mean age at sexual debut was 15.9 years. Mean knowledge score of STIs was 14.0 out of 25. Only 158(9.3%) experienced symptoms of STIs in the last 12 months. Among singles, senior secondary education was a predictor of ever had sex (odds ratio [OR]: 2.20, 95% confidence interval [CI]: 1.53-3.13), good knowledge of STIs (OR: 2.04, 95% CI: 1.45-2.83) and experience of STIs in the last 12 months (OR: 2.20, 95% CI: 1.53-3.13). Hairdressers, especially singles, are a vulnerable group at risk of reproductive health morbidities. There is a need to focus reproductive health interventions on this occupational group.

Blood pressure control and exaggerated blood pressure response in nigerians with essential hypertension

BACKGROUND

Blood pressure (BP) control in hypertensives is important in preventing cardiovascular (CV) morbidity and mortality. This work was done to assess control of BP among Nigerian hypertensives at rest and during exercise.

MATERIALS AND METHODS

A total of 85 male hypertensives were recruited consecutively and had clinical evaluation and treadmill (TM) exercise testing using the Bruce protocol. Independent t-test, chi-square, and Fisher’s exact tests were used to compare patients with controlled and uncontrolled BP using SPSS version 16 software. Adjustment for confounders was by logistic regression and general linear model.

RESULTS

Resting systolic BP (rSBP) (mmHg) and resting diastolic BP (rDBP) (mmHg) were significantly lower in the controlled group (115.0 ± 12.29, 133.1 ± 12.27, P = <0.001 and 76.00 ± 6.55, 91.4 ± 8.00, P = <0.001). The proportion of subjects with controlled BP was 37.7%. Adjusted peak SBP (PSBP) during exercise (mmHg) was significantly higher in the uncontrolled than in the controlled group (210.5 ± 27.31, 191.8 ± 20.77, P = 0.001). Adjusted exaggerated blood pressure response (EBPR) was found in 37 subjects (44%) in the uncontrolled group while seven subjects (0.1%) had EBPR in the controlled group (P = 0.003).

CONCLUSION

This study shows that EBPR is significantly higher in subjects with uncontrolled BP compared with those with controlled BP. Therefore, good BP control may be the key factor in preventing EBPR in hypertensives.

Prevalence and pattern of overweight and obesity in three rural communities in southwest Nigeria

BACKGROUND

Limited data exist on the prevalence of overweight and obesity in the Nigerian adult rural population. This study therefore assessed the prevalence and pattern of overweight and obesity in adults in three rural communities of the Ife North Local Government Area, Nigeria.

MATERIALS AND METHODS

A total of 777 adults between 20 and 90 years of age were recruited into this cross-sectional study, which was performed over a 6-month period using a multistage proportional stratified random sampling technique. Sociodemographic data and anthropometric variables were obtained.

RESULTS

A total of 385 (49.5%) men and 395 (50.5%) women participated in the study. The mean age and body mass index of the participants were 36.3±14.3 years and 23.53±4.6 kg/m(2), respectively. The overall crude prevalence of overweight and obesity in the total population were 20.8% and 8.4%, respectively. Obesity increased across the age gradient, peaking in the 51- to 60-year age-group in men and women. Among the overweight and obese subjects (n=227), 70.9% of them were overweight and the remaining 29.1% were obese, with class I obesity accounting for 20.7% of these overweight and obese subjects.

CONCLUSION

The prevalence of overweight and obesity in these communities was 20.8% and 8.4% respectively, indicating a trend towards increased prevalence. Class I obesity is the most common obesity pattern, and obesity increased across the age gradient, peaking in the 51- to 60-year age-group. There is a need for regular community education on healthy lifestyles, and regular health screening to control the rising prevalence of overweight and obesity, as well as to prevent or reduce the risk of obesity comorbidities in these communities.

Evaluation of the indications and arrhythmic patterns of 24 hour Holter electrocardiography among hypertensive and diabetic patients seen at OAUTHC, Ile-Ife Nigeria

BACKGROUND

There are very limited published studies in Nigeria on the use of 24 hour Holter electrocardiogram (Holter ECG) in the arrhythmic evaluation of hypertensive and diabetic patients.

OBJECTIVE

To evaluate indications, arrhythmic pattern of Holter ECG, and heart rate variability (HRV) among patients with hypertensive heart disease (HHD) with or without heart failure and type 2 diabetes mellitus (T2DM) seen in our cardiac care unit.

METHODS

Seventy-nine patients (32 males and 47 females) were studied consecutively over a year using Schiller type (MT-101) Holter ECG machine.

RESULTS

Out of the 79 patients, 17 (21.5%) had HHD without heart failure, 33 (41.8%) had HHD with hypertensive heart failure (HHF), while 29 (36.7%) were T2DM patients. The mean (standard deviation) ages of HHD without heart failure, HHF and T2DM patients were 59.65 (±14.38), 65.15 (±14.30), and 54.66 (±8.88) respectively. The commonest indication for Holter ECG was palpitation (38%), followed by syncope (20.3%). Premature ventricular contraction was the commonest arrhythmic pattern among the 79 patients, especially among HHF patients. The HRV using standard deviation of all normal-normal intervals was significantly reduced in T2DM patients (81.03±26.33, confidence interval [CI] =71.02-91.05) compared to the HHD without heart failure (119.65±29.86, CI =104.30-135.00) and HHF (107.03±62.50, CI =84.00-129.19). There was a negative correlation between the duration of T2DM and HRV (r=-0.613).

CONCLUSION

Palpitation was the commonest Holter ECG indication and premature ventricular contractions were the commonest arrhythmic pattern among our patients. HRV was reduced in T2DM patients compared with hypertensive patients.

Prevalence of hypertension in three rural communities of Ife North Local Government Area of Osun State, South West Nigeria

BACKGROUND

The prevalence of hypertension is increasing rapidly in sub-Saharan Africa, but data are limited on hypertension prevalence. In addition, few population-based studies have been conducted recently in Nigeria on the prevalence and correlates of hypertension in both urban and rural communities. Therefore, we determined the prevalence of hypertension in adults in the three rural communities of Ipetumodu, Edunabon, and Moro, in South West Nigeria.

MATERIALS AND METHODS

One thousand adults between 15 and 90 years of age were recruited into this cross-sectional study, over a 6-month period, using a multistage proportional stratified random sampling technique. Sociodemographic data and anthropometric variables were obtained, and resting blood pressure (BP) was measured using an electronic sphygmomanometer. Diagnosis of hypertension was based on the JNC VII guidelines, the WHO/ISH 1999 guidelines, and the BP threshold of 160/95 mmHg.

RESULTS

Four hundred and eighty-six men (48.6%) men and 514 women (51.4%) participated in the study. Their mean age, weight, height, and body mass index were 32.3±14.7 years, 62±13 kg, 1.5±0.1 m, and 23.02 kg/m(2), respectively. The prevalence of hypertension, based on the 140/90 mmHg definition, was 26.4% (Male: 27.3%; Female: 25.4%). The prevalence of hypertension, based on the 160/95 mmHg definition, was 11.8% (Male: 13.5%; Female: 10.1%). There were significant positive correlations between BP and some anthropometric indicators of obesity.

CONCLUSION

The prevalence of hypertension in the three rural communities was 26.4%, indicating a trend towards increasing prevalence of hypertension. There was also a significant positive correlation between anthropometric indicators of obesity and BP in this population.

Echocardiographic assessment of left ventricular geometric patterns in hypertensive patients in Nigeria

Left ventricular (LV) hypertrophy is an important predictor of morbidity and mortality in hypertensive patients, and its geometric pattern is a useful determinant of severity and prognosis of heart disease. Studies on LV geometric pattern involving large number of Nigerian hypertensive patients are limited. We examined the LV geometric pattern in hypertensive patients seen in our echocardiographic laboratory. A two-dimensional, pulsed, continuous and color flow Doppler echocardiographic evaluation of 1020 consecutive hypertensive patients aged between 18 and 91 years was conducted over an 8-year period. LV geometric patterns were determined using the relationship between the relative wall thickness and LV mass index. Four patterns of LV geometry were found: 237 (23.2%) patients had concentric hypertrophy, 109 (10.7%) had eccentric hypertrophy, 488 (47.8%) had concentric remodeling, and 186 (18.2%) had normal geometry. Patients with concentric hypertrophy were significantly older in age, and had significantly higher systolic blood pressure (BP), diastolic BP, and pulse pressure than those with normal geometry. Systolic function index in patients with eccentric hypertrophy was significantly lower than in other geometric patterns. Doppler echocardiographic parameters showed some diastolic dysfunction in hypertensive patients with abnormal LV geometry. Concentric remodeling was the most common LV geometric pattern observed in our hypertensive patients, followed by concentric hypertrophy and eccentric hypertrophy. Patients with concentric hypertrophy were older than those with other geometric patterns. LV systolic function was significantly lower in patients with eccentric hypertrophy and some degree of diastolic dysfunction were present in patients with abnormal LV geometry.

C-reactive protein in healthy adult Nigerians

BACKGROUND

C-reactive protein (CRP) is an acute phase reactant produced in the liver in response to tissue injury or systemic inflammation, its release is stimulated by cytokines (interleukin-6 and tumour necrosis factor-alpha). Elevated CRP levels have been linked to an increased risk of later development of diabetes mellitus and systemic hypertension. Baseline level of C-reactive protein in apparently healthy men and women predict long-term risk of a first myocardial infarction.

METHOD

The study design was cross-sectional conducted among apparently healthy adult relative of patients and hospital staff of the Obafemi Awolowo University Teaching Hospitals complex (OAUTHC) Ile Ife, Osun State south western Nigeria. Serum lipids and fasting blood glucose were measured, while C-reactive protein measurement was based on the principle of solid phase enzyme-linked immunosorbent assay (ELISA).

RESULTS

Atotal of 50 apparently healthy consecutive adult subjects were recruited into the study comprising 19 male and 31 female. There was no significant difference in mean Fasting blood glucose and serum lipids between the male and female study subjects. However, C-reactive protein was found to be higher in female compared to male, but the difference was not statistically significant.

CONCLUSION

This study showed that apparently healthy adult female Nigerians have higher level of C-reactive protein compared to male, but with no significant difference.

Left ventricular geometry in Nigerians with type II diabetes mellitus

BACKGROUND

Left ventricular hypertrophy is independently associated with increased incidence of cardiovascular disease, cardiovascular and all cause mortality. In a relatively healthy hypertensive adult population, type II diabetes is associated with higher left ventricular mass, concentric left ventricular geometry and lower myocardial function independent of age, sex, body size, and arterial blood pressure.

OBJECTIVE

The study is to investigate left ventricular geometry in Nigerians with Type II Diabetes mellitus.

METHODS

The study design was cross-sectional and it comprised 75 consecutive patients with type II diabetes mellitus with or without hypertension. Using a structured pre-evaluated questionnaire, the demographic and clinical data were obtained. All subjects had two dimensional (2D) and 2D derived M-mode echocardiography using Sonoline G60s Ultrasound imaging system with 4.2 MHZ transducer equipped with simultaneous ECG tracing.

RESULTS

A total of 75 consecutive type II diabetic patients with or without hypertension were recruited into the study. There were 18 (24.0%) hypertensive-diabetic and 12 (16.0%) normotensive-diabetic males and Thirty-four (45.3%) hypertensive-diabetic and 11 (14.0%) normotensive-diabetic were females. Hypertensive-diabetic males had significantly higher left ventricular mass compared to normotensive-diabetic counterpart 207.05 +/- 41.5g and 156.00 +/- 27.1g P = 0.001. Similarly, left ventricular mass index was found to be higher in hypertensive-diabetic males than their normotensive-diabetic counterpart 114.50 +/- 29.2g/m2 and 92.28 +/- 20.5g/m2 P = 0.014. Hypertensive-diabetic female significantly had higher LVM compared to the normotensive-diabetics 196.06 +/- 41.5g and 161.54 +/- 31.6g P = 0.016. Left ventricular mass index was also found to be higher in hypertensive-diabetic female than their normotensive counterpart 118.52 +/- 27.8g/m2 and 95.75 +/- 23.0g/m2 P = 0.019. Hypertensive-diabetics had predominantly concentric left ventricular hypertrophy compared to the normotensive-diabetics 36 (69.2. %) and 5 (21.7%) P = 0.001.

CONCLUSION

The study reported that hypertensive-diabetics have predominantly concentric left ventricular hypertrophy, higher left ventricular mass and left ventricular mass index compared to normotensive-diabetic. Female hypertensive-diabetic had predominantly concentric left ventricular hypertrophy, while male hypertensive-diabetic and normotensive-diabetic had predominantly concentric left ventricular remodelling.

Ambulatory blood pressure profile and left ventricular geometry in Nigerian hypertensives

Background:

Left ventricular hypertrophy (LVH) is an independent cardiac risk factor in hypertensives and the structural classification of left ventricular (LV) geometry provides additional prognostic information. Ambulatory blood pressure (ABP) monitoring has been shown to be superior to office blood pressure (BP) in relation to hypertension LVH. We investigated ambulatory BP variables in relation to LV geometric patterns in Nigerian hypertensives.

Materials and Methods:

A total of 130 patients (males = 96, females = 34) with hypertension had their 24-hours ambulatory BP and trans-thoracic 2D/M- mode echocardiography. Data were analyzed with SPSS 13.0. P < 0.05 was considered statistically significant.

Results:

The mean age of the patients was 54.08±11.88 years. The prevalence rate of abnormal LV geometry was 48.4%. Mean ambulatory Systolic BP (day time, night time and 24-hour-average) was significantly higher in patients with LVH compared with those without LVH. Day-night systolic and diastolic BP decay (i.e. percentage nocturnal decline in BP) was also significantly lower in LVH group than in the group without LVH. Patients with eccentric LVH had abnormal day time mean ambulatory systolic BP, night time mean ambulatory systolic BP, elevated day time and night time systolic BP loads, as well as non-dipping diastolic BP pattern. Significant correlates of LV mass index in this study population were mean ambulatory systolic BP (day time: r = 0.355, P = 0.004; night time: r = 0.343, P = 0.005; 24- hour average: r = 0.358, P = 0.004) and day-night decay (systolic: r = -0.388, P = 0.007; diastolic: r = -0.290, P = 0.022) as well as 24-hour systolic BP variability.

Conclusion:

The presence of LVH in hypertension was associated with higher mean ambulatory systolic BP and lower percentage nocturnal decline in systolic and diastolic BP than its absence which appeared to be worse in patients with eccentric LV geometry when compared with other geometric patterns.

The significance of mild renal dysfunction in chronic heart failure

BACKGROUND

Heart failure is a major public health concern. Prediction models in heart failure have employed echo-cardiography and other advanced laboratory parameters in predicting the risk of mortality. However, most of the patients in the resource poor economies still do not have easy access to these advanced technology.

OBJECTIVE

To determine the clinical and echocardiographic correlates of patients with chronic heart failure (CHF) in the presence or mild renal disease (MRD).

METHODS

One hundred CHF patients were categorized based on their estimated glomerular filtration rates into either normal renal function or MRD. The clinical and echocardiographic variables of both groups were compared.

RESULTS

There were 38 females and 62 males with an overall mean age of 54 years. A significantly greater proportion of patients with mild renal disease presented in New York Heart Association classes 3 and 4 (82.9% vs 27.1%). Patients with MRD had echocardiographic findings of a significantly larger left atrial dimension, lower ejection fraction and fractional shortening and shorter deceleration time. A significantly greater proportion of patients with mild renal disease also had moderate-severe mitral and tricuspid regurgitation and grades 2-3 diastolic dysfunction compared to patients without mild renal disease. Patients with MRD also exhibited a significantly greater degree of deterioration in the fractional shortening and ejection fraction compared to non-MRD patients. Multivariate regression analysis indicated that a low ejection fraction and a low fractional shortening were significantly associated with MRD.

CONCLUSION

Identification of MRD in chronic heart failure patients using the estimated glomerular filtration rate is valuable in resource poor countries. The presence of MRD in CHF is associated with poor left ventricular function and increased deterioration of ventricular function.

Cardiovascular and electrocardiographic changes in Nigerians with a normal pregnancy

INTRODUCTION

Pregnancy is associated with major haemodynamic and cardiac changes, which can mimic or precipitate cardiac diseases. There is a paucity of this kind of data among pregnant Nigerian women. This study was aimed at describing the cardiovascular and electrocardiographic changes found among healthy pregnant Nigerian women.

METHODS

This was an age-matched control study of 69 consecutive normal pregnant and 70 healthy non-pregnant controls. The study protocol included history, physical examination and 12-lead electrocardiography.

RESULTS

Diastolic blood pressure < 60 mmHg was significantly commoner among pregnant subjects than controls (64.7 vs 24.3%, respectively, p < 0.005). Mean heart rate was higher among pregnant women (88.34 ± 11.46 bpm) than the controls (75.16 ± 12.22 bpm, p = 0.020). Pregnant subjects also had a higher proportion of left ventricular hypertrophy (LVH) (10.2 vs 0%, p < 0.05) than non-pregnant controls. Abnormal cardiac findings included a loud second heart sound (P(2)), missed beats and systolic murmurs (41.2% in pregnant subjects vs 12.9% in non-pregnant controls, p < 0.05). Negroid-pattern ST-segment elevation was commoner among controls (24.3%) than pregnant subjects (2.9%, p < 0.005). Arrhythmias were rare among the study participants.

CONCLUSION

Significant findings on examination were low diastolic blood pressure and a systolic ejection murmur. However, ECG changes showed a normal frontal-plane QRS axis, normal PR interval, significantly rare normal Negroidpattern ST elevation, significant LVH based on Araoye RI > 12 mm and a rarity of all forms of arrhythmias. These data may help resolve some cardiac diagnostic difficulties during pregnancy.

Prediction of functional capacity during six-minute walk among patients with chronic heart failure

BACKGROUND

Formulae for predicting functional capacity during 6-minute walk are lacking and the accuracy of the existing formulae has been challenged in deferent populations.

AIMS

The purpose of this study was to develop an equation that would be useful in predicting functional capacity in form of maximum oxygen consumption) (V0 2 ) in Chronic Heart Failure Patients (CHF) during exercise.

METHODS

Sixty-five subjects were recruited for the study. The procedure required the subjects to walk on a self paced speed on a 20 meter marked level ground for 6 minutes. The distance covered in 6 minutes was measured and the speed calculated.

RESULTS

The result showed that the distance covered was highly correlated with the VO2 (0.65, p< 0.01). The regression analysis revealed that a linear equation model developed was a good predictor of V0 2 for the group.

CONCLUSION

The study concluded that in situation where sophisticated equipments are lacking, this equation might be useful during exercise supervision for patients with CHF. [VO2 (mlkg-1 min-1) = 0.0105 x distance (m) + 0.0238 age (yr) - 0.03085 weight (kg) + 5.598].

Valvular regurgitation impact on left ventricular 2-dimensional and Doppler echocardiographic indices in patients with essential hypertension

BACKGROUND

Blacks have both a higher hypertension prevalence and accelerated cardiac end organ damage. Because blacks also have a higher prevalence of valvular heart disease, which occurs at a younger age than for whites, we further examined the contribution of valvular regurgitation to the severity of hypertensive heart disease in Nigerians.

METHODS

We evaluated and compared echocardiographic indexes in 75 essential hypertensive Nigerians with (n=48) and without (n=27) valvular regurgitations. Demographic and echocardiographic indices, as well as the types and severity of valvular lesions were compared between the groups using bivariate logistic regression and analysis of variance.

RESULTS

The 2 groups were of similar demographics, but those with regurgitations had larger cardiac size (p < .05), greater mass (147 +/- 31 vs. 122 +/- 32 g/m2, p = .01) higher volume (p < .01), and left atrial size (35.6 +/- 4.6 vs. 33.3 +/- 4.6 mm, p < .05). Atrial size, cardiac volume, and dimension were independent correlates/predictors of regurgitation occurrence. Relative wall thickness of at least 0.6 was more common in regurgitation patients. Cardiac mass was correlated to increasing age (r = 0.23, p = .043). The valvular lesions frequencies were aortic regurgitation, 8; mitral regurgitation, 22; and mixed, 18. The aortic orifice dimension was significantly different among the regurgitant cases, highest in aortic regurgitation (p = .001). Aortic orifice dimension increased with hypertension duration (p = .028).

CONCLUSIONS

Regurgitant lesions are common and occur early in hypertensive Africans. Apparently mild valvular regurgitation may accentuate preclinical concentric hypertrophy in hypertensive blacks.

Reported occupational hazards and illnesses among hairdressers in Ibadan, Southwest Nigeria

BACKGROUND

Hairdressers work in small scale enterprises with little or no health supervision in the workplace.

OBJECTIVE

To identify workplace hazards and health problems of workers in this trade.

METHODS

A cross sectional study was conducted in hairdressing salons in Ibadan, Southwest Nigeria. Questionnaires were administered to a total of 355 hairdressers by trained interviewers. Information on work conditions, workplace hazards, accidents and current illnesses was obtained.

RESULTS

All respondents were females comprising 295 qualified hairdressers and 60 apprentices. They were aged 15-49 years, mean 29 +/- 6.9 years. With respect to work conditions, hairdressers complained of long working hours, poor earnings and prolonged standing. Occupational hazards identified included needles used for fixing hair attachments, 157 (44%), hair relaxing creams, 114 (32%), blades, 38 (11%), handling hot water, 16 (4%) and electrical equipment, 8 (2%). Types of accidents reported were needle pricks, cuts, accidents involving hot water and electric shock. Joint pains (21%) and low back pain (19%) were the most frequently reported illnesses among hairdressers. Hand dermatitis was reported by 5% of hairdressers.

CONCLUSION

The hairdressers' work environment has predominantly mechanical and chemical hazards. Long working hours and poor earnings in a physically demanding job, as highlighted in this study are characteristic of small scale enterprises. The regulation of work conditions in this sector continues to pose a challenge to occupational health authorities in developing countries.

Assessment of exercise capacity in African patients with chronic heart failure using six minutes walk test

BACKGROUND

The purpose of this study was to assess the functional capacity during a 6-minute corridor walk and a 6-minute bicycle ergometry exercise in patients with chronic heart failure (CHF).

METHOD

Thirty five patients with stable CHF were recruited for the study. Each subject performed six minutes corridor walk and 6-minute bicycle ergometry testing. The 6-minute walk required the subjects to walk at a self selected speed on a 20 meter marked level ground for 6-minute. All the subjects also performed a 6-minute exercise on a stationary bicycle ergometer with initial resistance of 20 watts and increased by 10 watts after 3-minutes. The perceived rate of exertion was assessed using a modified Borg Scale after each exercise mode. The maximum oxygen consumption was derived using American College of Sport Medicine equations.

RESULTS

Result showed high positive correlation between distance walked in the 6-minute and the maximum volume of oxygen (VO(2) max) (r = 0.65, P < 0.01). The average distance walked was 327 m +/- 12.03 m. The VO(2) max estimated during bicycle ergometry was higher (13.7 +/- 1.9 L) than during the six minutes walk (8.9 +/- 1.2 L).

CONCLUSION

Six minutes walk could be useful to evaluate exercise tolerance in patients with chronic heart failure, while the bicycle ergometer could be more appropriate in the assessment of maximum functional capacity in these patients.

Blood pressure response to an exercise treadmill test, and echocardiographic left ventricular geometry in Nigerian normotensive diabetics

OBJECTIVES

This study evaluated normotensive diabetic patients' blood pressure response to graded exercise and their echocardiographic pattern of left ventricular geometry.

METHODS

A descriptive, cross-sectional, hospital-based study was carried out on 30 normotensive type 2 diabetic patients and 34 controls, aged 30 to 60 years. The outcome measures were to determine the exercise-related variable, blood pressure response, and left ventricular geometry by means of echocardiography.

RESULTS

Nineteen (29.7%) and 11 (17.2%) normotensive diabetic subjects had normal left ventricular geometry and concentric left ventricular remodelling, respectively. None of the subjects had concentric or eccentric left ventricular hypertrophy. On this basis, the normotensive diabetic subjects were divided to two groups: G1 (normal) and G2 (concentric left ventricular remodelling). The groups had comparable mean age, body mass index (BMI), fasting blood glucose (FBG) and two-hour post-prandial blood glucose values, and heart rate, systolic (SBP) and diastolic blood pressure (DBP) at rest. G2 patients had higher mean duration of diabetes than G1 subjects (69.0 +/- 9.48 vs 18.7 +/- 8.7 months; p = 0.007). Peak systolic blood pressure was significantly higher in G2 than G1 subjects (213.6 +/- 20.1 vs 200.0 +/- 15.3 mmHg; p = 0.04). Although there was no statistically significant difference in the left ventricular (LV) mass index between the groups, G2 patients had significantly higher relative wall thicknesses than G1 patients (0.53 +/- 0.03 vs 0.41 +/- 0.04; p < 0.001).

CONCLUSION

Normotensive diabetic subjects with concentric left ventricular remodelling have increased blood pressure reactivity to exercise. It is probable, as suggested in earlier studies, that increased blood pressure reactivity to exercise is an indicator of target-organ damage, particularly in normotensive diabetics.

Prevalence and pattern of hypertension in a semiurban community in Nigeria

BACKGROUND

Hypertension has been reported to be a major problem of the blacks. There is a paucity of studies, however, on community-based surveys on the prevalence and pattern of hypertension in Nigeria in the recent time. This study sought to investigate the prevalence and pattern of hypertension in the adult population living in the ancient semiurban community of Ile-Ife, southwest Nigeria.

DESIGN AND METHODS

Two thousand and ninety-seven adults of above 20 years of age were recruited into the door-to-door survey through a multistage cluster sampling technique. Diagnosis of hypertension was based on blood pressure (BP) threshold of 160/95 mmHg and the World Health Organization /International Society of Hypertension guidelines (Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines) definitions. Resting blood pressure was taken using electronic sphygmomanometer.

RESULTS

The mean age and BP of the participants were aged 44.2 +/- 11.6 years and 127/77 mmHg, respectively. The participants (36.6%) had a BP of greater than or equal to 140/90 mmHg whereas 13.3% had BP of greater than or equal to 160/95 mmHg. 22.1% had isolated systolic hypertension whereas 14.5% had isolated diastolic hypertension using the BP of greater than or equal to 140/90 mmHg cut off-point. Using the BP of greater than or equal to 160/95 mmHg, isolated systolic hypertension and isolated diastolic hypertension were 6.63%, respectively. A male-to-female ratio of 1.7 : 1 and 1 : 5 was observed for BP greater than or equal to 140/90 mmHg and BP greater than or equal to 160/95 mmHg, respectively. Hypertension prevalence increased across age gradient from young to old adults.

CONCLUSION

The prevalence estimates of hypertension obtained in this study was higher than those found in most earlier studies from Nigeria, other West Africa nations and for African-Americans.

Obesity prevalence in adult residents of Ile-Ife, Nigeria

BACKGROUND

Few data on obesity exist on Sub-Sahara population in Africa. This study investigated the prevalence of obesity and Body Mass Index (BMI) percentile and quartiles in accordance with sex and age in adult residents of the historic ancient semi-urban community of Ile-Ife, South-West, Nigeria.

METHODS

2097 adults aged 21 years and above were recruited into the door-to-door survey through a multistage cluster sampling technique. The World Health Organization (WHO) criteria based on BMI was used in the definition of overweight and obesity. Height and weight were measured using standardized procedures.

RESULTS

The mean age and BMI of the participants were 44.2 years and 24.2 Kg/m2 respectively. Although age-matched; the females had higher BMI values compared to males (23.8 vs. 24.5 Kg/m2). The overall crude prevalence of overweight (25.0-29.9 Kg/m2) and obesity (>30 Kg/m2) were 20.3% and 12.5% respectively. The rates of overweight (17.9 vs. 22.1 Kg/m2) and obesity (9.7 vs. 14.5 Kg/m2) were both higher in women than men. Obesity increased across age gradient from young to old adults; peaking in the 60-69-year age group. The first to fourth BMI quartiles were = 20.4 Kg/m2, 20.5-24.1 Kg/m2, 24.2-25.2 Kg/m2, = 25.3 Kg/mr respectively in the study population. At all ages; more females (32.4%) than males (24.7%) were placed within fourth BMI quartile. The 95th percentile BMI in the study population was 33.4 Kg/m2.

CONCLUSION

Overweight and obesity are common in Nigerians, particular among females and elderly. The prevalence estimates of overweight and obesity in Nigerians is comparable with prevalence among Blacks in other populations.

Obesity prevalence in adult residents of Ile-Ife, Nigeria

BACKGROUND AND PURPOSE

Few data on obesity exist on Sub-Sahara population in Africa. This study investigated the prevalence of obesity and Body Mass Index (BMI) percentile and quartiles in accordance with sex and age in adult residents of the historic ancient semi-urban community of Ile-Ife, South-West, Nigeria.

MATERIALS AND METHODS

2097 adults aged 21 years and above were recruited into the door-to-door survey through a multi-stage cluster sampling technique. The World Health Organization (WHO) criteria based on BMI was used in the definition of overweight and obesity. Height and weight were measured using standardized procedures.

RESULTS

The mean age and BMI of the participants were 44.2 years and 24.2 Kg/m2 respectively. Although age-matched; the females had higher BMI values compared to males (23.8 vs. 24.5 Kg/m2). The overall crude prevalence of overweight (25.0-29.9 Kg/m2) and obesity (>30 Kg/m2) were 20.3% and 12.5% respectively. The rates of overweight (17.9 vs. 22.1 Kg/m2) and obesity (9.7 vs. 14.5 Kg/m2) were both higher in women than men. Obesity increased across age gradient from young to old adults; peaking in the 60-69-year age group. The first to fourth BMI quartiles were = 20.4 Kg/m2, 20.5-24.1 Kg/m2, 24.2-25.2 Kg/m2, = 25.3 Kg/ m2 respectively in the study population. At all ages; more females (32.4%) than males (24.7%) were placed within fourth BMI quartile. The 95th percentile BMI in the study population was 33.4 Kg/m2.

CONCLUSION

Overweight and obesity are common in Nigerians, particular among females and elderly. The prevalence estimates of overweight and obesity in Nigerians is comparable with prevalence among Blacks in other populations.

Prognostic significance of QT interval prolongation in adult Nigerians with chronic heart failure

BACKGROUND AND OBJECTIVES

Prognostic survival studies for heart-rate corrected QT interval in patients with chronic heart failure are few; although these patients are known to have a high risk of sudden cardiac death. This study was aimed at determining the mortality risk associated with prolonged QTc in Nigerians with heart failure.

MATERIALS AND METHOD

Ninety-six consecutive patients with heart failure were recruited with 90 age and sex-matched controls. All the subjects had a 12-lead electrocardiogram at a paper speed of 25 mm/sec and a rhythm strip (lead II) at 50 mm/sec. The latter was used to calculate the QTc using the Bazett's formula. Left ventricular systolic and diastolic functions were assessed using 2D guided M-mode and Doppler echocardiogram respectively. They were followed-up for six months.

RESULTS

Ninety-one patients and 90 controls completed the study. Five patients were lost to follow-up. The mean age (51.9 +/- 16 years) of the patients was similar to that of the controls (50.3 +/- 15) (P = 0.475). Twenty-eight (30.8%) patients died after 6 months of follow-up against none of the controls. The mean QTc was significantly longer in the non-survivors (0.494 +/- 0.027) than in the survivors (0.462 +/- 0.035) (P = 0.0001). The percentage mortality in patients with prolonged QTc against those with normal QTc was 41% and 14% respectively (P = 0.001). In the stepwise regression analysis, QTc was an independent predictor of mortality (R = 0.412, R2 = 0.17, P= 0.001).

CONCLUSION

QTc prolongation is a predictor of mortality in CHF and may be an important adjunct in risk stratification of patients with heart failure.

Relationship of anthropometric indicators with blood pressure levels and the risk of hypertension in Nigerian adults

BACKGROUND AND PURPOSE

Studies on cardiovascular risks in relation to anthropometric factors are limited in Sub-Sahara Africa. The aims of this study were to examine the relationship between anthropometric parameters and blood pressure; and to evaluate body mass index (BMI) across the range of underweight and obesity as a primary risk factor of hypertension in adult Nigerians.

MATERIAL AND METHODS

2097 adults aged between 20 and 100 years consented and participated in this door-to-door survey. All participants underwent blood pressure and anthropometric measurements using standard procedures. The population study was separated in normotensive and hypertensive males and females and the possible risk for hypertension were categorized into different classes of value based on BMI definition.

RESULTS

The relative risks (odds ratio [OR] and 95% confidence interval [CI]) of developing hypertension among the obese compared with the underweight, normal weight, and overweight persons were (OR 5.75; CI 5.67-5.83), (OR 1.73; CI 1.65-1.81), and (OR 1.54; CI 1.46-1.62) for all the participants, respectively. Among obese (BMI >/= 30.0 Kg/m(2)) males, the OR for hypertension was three times (OR 2.78; CI 2.76-2.80) that of normal weight (BMI >/= 18.5-24.9 Kg/m(2)) males. Females with obesity had a risk of hypertension three times (OR 3.34; CI 3.33-3.35) that of normal weight females.

CONCLUSION

Our results indicated that the there was a significant positive correlation of obesity indicator with blood pressure. In Nigeria, we found a strong gradient between higher BMI and increased risk of hypertension among all ages. Approaches to reduce the risk of hypertension may include prevention of overweight and obesity.

Prevalence of QTc prolongation in adult Nigerians with chronic heart failure

BACKGROUND

The heart rate corrected QT interval (QTc) on the electrocardiogram (ECG) has been proposed as a risk factor for ventricular arrhythmias and death in apparently healthy populations, patients with myocardial infarction and diabetes mellitus. However, data on the significance of QTc prolongation in heart failure are scarce.

OBJECTIVE

Our objective was to examine the prevalence of QTc prolongation in adult Nigerians with heart failure and its association with arrhythmias.

METHODS

Ninety consecutive patients with heart failure were recruited along with 90 age-and sex-matched controls. All the subjects had a 12-lead ECG and a rhythm strip (lead II). The latter was used to calculate the QTc using the Bazett's formula. Left ventricular systolic and diastolic functions were assessed using a 2D guided m-mode and Doppler echocardiogram respectively.

RESULTS

The mean age of the patients was 51.9 (16) years compared with 50.3 (15.2) years for the control group, p = 0.47. Mean left ventricular ejection fraction was significantly lower in the patients than in the controls (38.9 (11)% versus 72.2 (8)%), p = 0.001. The mean QTc was significantly prolonged in the patients than in the controls (0.472 (0.036) versus 0.390(0.032) respectively), p = 0.001. The prevalence of QTc prolongation was 63% in the patients against 4.4% in the controls. There was a significant association between ventricular arrhythmias and QTc prolongation.

CONCLUSION

The results of this study shows that there is a high prevalence of QTc prolongation in adult Nigerians with heart failure and this may be harbinger for ventricular arrhythmias and sudden death.

Prevalence and correlates of major depressive disorder in Nigerian outpatients with heart failure

This study aims to estimate the prevalence and correlates of major depressive disorder (MDD) in Nigerian outpatients with heart failure. Authors assessed patients with heart failure (N = 102) for DSM-IV diagnosis of MDD and obtained sociodemographic and clinical data. MDD was found in 28 (27.5%) of the patients. The significant correlates predicting MDD included unemployment and disability due to the illness, more severe illness (NYHA class), age younger than 60 years, and not being married. These factors should be considered in planning further studies and in screening and intervention programs for patients with heart failure.

Work conditions and health problems of female traders in Ibadan, Nigeria

This descriptive cross-sectional survey was conducted among all the female traders in Sango market, Ibadan in, April 2003. The aim of the study was to identify the common health problems of women traders in Sango and their work conditions. The most commonly reported health problems were muscular and joint pains by 105 (37.4%), 95 (33.8%) had symptoms suggestive of malaria and 66 (23.5%) had chronic low back pain. The prevalence of muscular and joint pain was highest among respondents aged > 60yrs (p=0.023), and among those who spent eight to ten hours per day in the market (p=0.200). On examination 56 (19.9%) were hypertensive, 88 (31.3%) and 97 (16.7%) were overweight and obese respectively. The prevalence of hypertension was associated with increasing age and obesity (p=0.000). The common health problems among these female traders were muscular and joint pain, symptoms suggestive of malaria, chronic low back pain and hypertension. It is recommended that appropriate health interventions be instituted to address these problems.

An assessment of cardiovascular risk among the people of a Nigerian university community

BACKGROUND

The purpose of this study was to assess the level of cardiovascular disorder risk among the staff and students of Obafemi Awolowo University, Ile-Ife, Nigeria.

METHODS

Six hundred apparently healthy subjects voluntarily participated in this study. They consisted of 200 students, 200 junior workers and 200 senior staff. Subjects' weight, height and blood pressures were taken. Subsequently, the questionnaire used for the Framingham Heart Study was given for completion. The questionnaire sought information on cardiovascular risk factors including smoking habits, sedentary lifestyle, diet, personality trait, age and sex.

RESULTS

Students had a mean risk score of 10.24, junior staff 11.38, and senior staff 12.42. Significant differences were found between the level of risk for the students and that of the senior staff. However, no significant difference existed between the junior and senior staff and no significant difference existed between the level of risk for the students and the junior staff. Further, there was no significant difference in the level of risk for males compared to females.

CONCLUSION

We concluded that the level of cardiovascular risk was low among the subjects selected for this study.

Exudative retinal detachment occurring in a patient with pyogenic liver abscess

This is a report of a rare case of bilateral exudative retinal detachment occurring in a young Nigerian male with pyogenic liver abscess. Detailed ocular and clinical examination with biochemical, haematological and microbiological studies of the blood and liver aspirate were done. Ocular and abdominal scan plus surgical drainage of abscess were also done. The main features were febrile illness with hepatomegaly and sudden loss of eyesight. Visual acuity was light perception in both eyes. The cardiovascular and renal systems were normal. Ocular scan showed bilateral bullous retinal detachment while abdominal ultrasound revealed multiple liver abscess cavities. HIV and HBsAg tests were negative. Pyogenic liver abscess should be regarded as possible cause of exudative retinal detachment and has a potential blinding complication.

Cardiovascular changes in sickle cell anaemia

Sickle cell anaemia (SCA) is the commonest inherited haemoglobinopathy in Nigeria and is associated with high morbidity and mortality, particularly in early childhood in most of the affected population. The cardiac manifestations of SCA are a significant feature of the disease but there is a paucity of information on the cardiovascular involvement in SCA in Nigeria and Africa. The size of the sickle cell problem in the country is growing rapidly and there should therefore be a greater awareness of the cardiac problems associated with SCA. This review highlights the clinical features, changes in cardiac structure and function at rest and on exercise, cardiac pathology and associated heart diseases in SCA as well as the recent global progress made in the understanding of the cardiovascular changes in the disease. Emphasis is laid on data derived from Nigerian studies.

The clinical, electrocardiographic and self-paced walking exercise features of Nigerians with sickle cell anaemia presenting at OAUTHC, Ile-Ife

Most patients with sickle cell anaemia (SCA) show evidence of cardiac dysfunction. This study aimed at clinically and electrocardiographically assessing the exercise capacity of steady state SCA patients using self-paced walking exercise. Forty one (17 males and 24 females) steady state SCA patients between the ages of 15 and 37 years were prospectively studied with 41 age and sex-matched (17 males and 24 females) normal AA controls. All subjects had clinical evaluation, resting 12-lead electrocardiography (ECG), 12 minutes self-paced walking exercise, and were tested for haematological and biochemical abnormalities. The clinical features of the patients reflected a hyperdynamic circulation which was evidenced by faster heart rates, wide pulse pressure, cardiomegaly, loud heart sounds and cardiac murmurs. Non-specific ECG findings were observed in this study. The mean QRS voltage (Sokolow-Lyon criteria) was significantly higher in patients compared to controls (P < 0.05). The mean rate, P wave duration and corrected QT interval of SS patients were significantly higher than the controls. The patients also had a significantly lower mean QRS frontal axis than the controls (P < 0.05) but there was no difference between the two groups in the mean QRS duration and PR interval. There was no abnormal QRS axis in the two groups. The self-paced walking exercise test showed significant limitation of exercise capacity in SCA patients, as evidenced by the significant reduction in speed and distance covered by the patients compared with the controls. While both groups achieved similar post exercise heart rate and systolic BP, the change in heart rate was significantly less in the patients. This study concluded that SCA patients have larger hearts and non-specific ECG changes. They showed significant limitation of exercise capacity with self-paced walking exercise, which was a safe and reproducible measure of cardiac reserve in them.

What does the presence of hypertension portend in the Nigerian with non insulin dependent diabetes mellitus

132 Nigerians with Non Insulin -dependent diabetes mellitus (NIDDM) were divided into two groups (NIDDM) patients with hypertension and those without) and their clinico-laboratory parameters were studied and analyzed. Their mean age (SD) was 59.5+/-9 years. Body mass index (BMI) was 25.2+/-3.5 kg/m2 and the duration of DM was 6.9+/-6 years. The prevalence of hypertension was 55(41.6%) No significant difference were observed in the age, sex ratio and BMI of both groups but the duration of DM showed a statistical difference between the two groups. However, laboratory parameters such as fasting blood glucose, serum urea, creatinine clearance and degree of proteinuria all showed statistically significant difference between the hypertensive and normotensive groups. Also the hypertensive diabetic group were observed to have more end organ damage i.e peripheral neuropathy, diabetic retinopathy and diabetic nephropathy than the normotensive diabetics. We conclude that, hypertension in NIDDM patients has prognostic implications and so more aggressive efforts be made in detecting and controlling hypertension in DM patients.

Thyrotoxicosis and the heart--a review of the literature

Thyroid hormone has effects on both the peripheral circulation and the myocardium. These include a decline in the systemic vascular resistance and an increase in cardiac output and cardiac contractility. Exposure to excess thyroid hormone, as occurs in thyrotoxicosis, can not only aggravate preexisting cardiac disease but also by itself lead to cardiac disease. More patients are being reported with thyrotoxicosis in Nigeria while the facilities for diagnosis and treatment are improving and becoming more available. There should therefore be a greater awareness of the cardiac problems associated with thyrotoxicosis, especially atrial fibrillation and cardiac failure. Initial management of heart disease in thyrotoxicosis should focus on the prompt alleviation of hyperthyroidism combined with judicious use of diuretics, digoxin and beta-blockers.

An open trial of lisinopril ('ZESTRIL') in mild to moderate hypertension in Nigeria

Fifty-one native Nigerian patients with mild to moderate essential hypertension received Lisinopril ('Zestril') in doses of 10 mg to 40 mg once daily. All patients received an initial dose of 10 mg, which was titrated up to a maximum of 40 mg if normotensive diastolic blood pressure had not been achieved. Reduction in mean diastolic blood pressure, when compared with baseline data, was significant (p < 0.001) following 16 weeks of treatment. Of the 46 evaluable patients, 32 (70%) had their blood pressure controlled (i.e. diastolic blood pressure < or = 90 Hg). Lisinopril ('Zestril') was well tolerated, with 27% of patients reporting adverse reactions of which cough was the most common. In conclusion, this study shows that Lisinopril ('Zestril"), when administered to Nigerian patients, is a clinically effective and well-tolerated for mild to Customer to supply Mss.