Gender disparities in pulmonary hypertension at a tertiary centre in Cameroon

Background. Pulmonary hypertension (PH) is a potent cause of heart failure and has been little investigated in the African setting.Objective. To investigate the effects of gender on the clinical presentation, echocardiographic features and outcomes of patients with PH in Douala, Cameroon.Methods. A prospective cohort study was conducted from March 2012 to December 2013 as part of the Pan African Pulmonary Hypertension Cohort study. PH was diagnosed by echocardiography and defined as a right ventricular systolic pressure >35 mmHg in the absence of acute right heart failure. Patients were followed up for a maximum of 12 months for primary endpoint mortality.Results. In total, 130 patients with PH were recruited; 71 (54.6%) were women. The median age was 59.2 years for men and 58.3 years for women (p=0.76). Active smoking and alcohol use were more frequent in men than women (both p<0.001), but women had greater exposure to indoor cooking fumes than men (p<0.001). Previous tuberculosis infection (11.3% v. 1.7%) and S3 gallop rhythm (30.9% v. 11.9%) were more common in women (both p<0.03). Women had a significantly higher mean systolic blood pressure (134 mmHg v. 125 mmHg; p=0.04) and pulse pressure (53.8 mmHg v. 44.9 mmHg; p=0.01) and a lower mean haemoglobin concentration (10.4 g/dL v. 12.4 g/dL; p<0.05) compared with men. Echocardiographic left ventricular (LV) systolic dysfunction was more frequent in men: mean LV ejection fraction 42.6% v. 51.5% (p=0.01) and mean fractional shortening 21.4% v. 28.6% (p=0.01). The overall mortality rate was 20.3%, and rates were similar in the two groups (Kaplan-Meier log rank 1.1; p=0.30).Conclusions. Despite differences in baseline characteristics including cardiovascular risk factors, mortality rates on follow-up were similar in men and women in this study. However, these different baseline characteristics probably suggest differences in the pathogenesis of PH in men and women in our setting that need further investigation

The Burden of High Blood Pressure and Related Risk Factors in Urban Sub-Saharan Africa: Evidences from Douala in Cameroon

Objective: To provide the current burden of high blood pressure and related risk factors in urban setting in Cameroon. Methods:We used the WHO STEPS approach for Surveil-lance of non-communicable diseases and their risk factors to collect data from 2;559 adults aged 15-99 years; residing at Cite des Palmiers in Douala; Cameroon. Results: The level of education was low with up to 60of participants totalizing less than primary school. Smoking habits were 6 times more frequent in men (p0.001) and 85of participants reported alcohol consumption. Sedentary lifestyles at work and at leisure time were prevalent. Women displayed high prevalence of obesity in general.The mean blood pressure and the prevalence of hypertension increased with age in men and women.The prevalence of hypertension was 20.8; and the risk of hypertension significantly increased with clustering of risk factors in the general population (p=0.001) and in men (p=0.008). Conclusions: This study provides additional evidence on the growing problem of hypertension and related risk factors in urban Cameroon; and confirms the feasibility of using the WHO STEPS approach for the surveillance of NCDs in Africa. There is a need for rapid implementation of preventive strategies in the country