Maladies non transmissibles et comorbidités chez les séniors dans le service de medécine interne du CHU de Bouaké / Non-Communicable Diseases and Comorbidities in Seniors in the Internal Medicine Department of the University Hospital of Bouake

. Les maladies non transmissibles chez le sujet âgé sont négligées en Afrique car l'espérance de vie n'était aussi élevée qu'aujourd'hui. Quel en était donc le panorama, il y a 10 ans ? Objectif : Améliorer les connaissances des maladies non transmissibles et des comorbidités chez les sujets âgés. Méthodes. Il s'agissait d'une étude transversale, rétrospective à visée descriptive du 1er janvier 2009 au 31 décembre 2013 dans le service de Médecine Interne du Centre Hospitalier Universitaire de Bouaké (CHU). Elle portait sur 151 patients hypertendus âgés de 65 ans et plus. Résultats. L'âge moyen était de 75 ans avec des extrêmes de 65 ans et 93 ans. Le sex-ratio était de 1,07. Les comorbidités étaient marquées principalement par le diabète (47%). Les motifs d'hospitalisation étaient dominés par les signes neurologiques (70%). L'hypertension artérielle (HTA) systolique isolée représentait 48% et l'HTA de grade III 23%. Ses principales complications étaient les accidents vasculaires cérébraux (AVC) (62%) et les cardiopathies (32%). Ces AVC étaient surtout ischémiques (78%). L'HTA était associée à d'autres facteurs de risque cardiovasculaire (78%) notamment la pression pulsée (52%) et le diabète (47%). Les Inhibiteurs de l'enzyme de conversion (IEC) étaient les plus prescrits (64%). La mortalité était de 23%. Conclusion. Les facteurs de risque cardiovasculaire constituent depuis plus de 10 ans à Bouaké, la morbidité mais surtout la mortalité des séniors, du fait de la gravité de leurs complications.

Department of Internal Medicine, Faculty of Clinical Medicine, College of Health Sciences, Ebonyi State University

INT RODUCTIO N: Th e eld erly h ypert en si ve pa ti ent s of ten h aveincreased prevalence of cardiometabolic risk factors and their attendantco-morbidities. The aim of this study was to determine the prevalenceof cardiometabolic risk factors and blood pressure control among elderlyhypertensive patients, and to determine the influence of modifiablecardiometabolic risk factors on the control of hypertension amongelderly hypertensive patients.SUBJECTS AND METHODS: A case-control comparative and hospital-based study involving a total of 190 consenting elderly (>65 years),hypertensive patients (subjects) (n=100) and normotensive controls(n=90) was carried out over a period of ten months. Using interviewer-administered questionnaire, biodata and information regarding theirlifestyle was obtained. Standard protocols were used to measure bloodpressure, weight, height, waist circumference, fasting plasma glucoseand fasting lipid profile of the subjects. Body mass index was derivedfrom weight and height.RESULTS: The mean age of the subjects was 71.5 ± 6.3 years and thecontrols was 72.3 ± 7.2 years. Forty-eight percent (48%) and 47.8% ofthe subjects and controls were females (p = 0.651). The level of controlof hyperten sion was poor in over two-thirds (68%) of the elderlyhypertensive patients. The prevalence of modifiable cardiometabolicrisk factors burden was higher in the hypertensive subjects when comparedwith the controls. Prevalence of Dyslipidaemia was 76% in the subjectsand 51% in the controls (p = 0.004). Prevalence of Diabetes Mellituswas 40% among the subjects and 17.8% in the controls (p = 0.0001);prevalence of Obesity was 24% in the subjects and 4.4% in the controls(p=<0.001); prevalence of excess alcohol intake was 49% in the subjectsand 14.4% in the controls (p=<0.001). Prevalence of sedentary lifestyle was high in both the subjects (53%) and controls (50%), p=0.679.Poor blood pressure control was predicted by dyslipidaemia and centralobesity.CONCLUSION: The level of control of hypertension was poor amongthe elderly and modifiable cardiometabolic risk factors were relativelyprevalent. Central obesity and dyslipidaemia were predictive of poorcontrol of hypertension. Addressing these factors may therefore improveblood pressure control

"We don't seem to find the ulnar artery in this cadaver": an aberrant origin of ulnar artery

Aberrant origin of ulnar artery that potentially changes its normal anatomical relationship is considerable rare. But when present, it must never be overlooked before carrying invasive procedures on the anteromedial aspect of the arm and forearm by the clinician. This would avoid unprecedented iatrogenic loss of part or entire distal part of the upper limb due to loss of arterial blood supply. While doing the normal dissection of the left upper limb on the 35 year old female cadaver, medical students saw a strangely and superficially placed ulnar artery that arose from the brachial artery way up within the upper part of the middle 3rd of the arm. This superficial ulnar artery coursed within the deep brachial and ante-brachial fascia, making it superficial to all flexor muscles of the flexor compartment of the forearm. It only resumes its normal course at the wrist joint distally. The brachial artery coursed normally and bifurcated at the cubital fossa to give radial artery laterally and common interosseous artery medially. On the other hand, the right upper limb had normal arterial patterning

Pression arterielle pulsee elevee comme facteur de risque d'insuffisance cardiaque chez le sujet age (noir africain)

Objectif : Il s'agissait de mettre en evidence le role pronostique de la pression pulsee elevee dans la survenue d'insuffisance cardiaque chez le sujet age Noir Africain. Population et methode : Dans un travail retrospectif portant sur 2000 patients admis a l'Institut de cardiologie d'Abidjan de 1991 a 2011; Nous avions apparie les facteurs de risques cardio-vasculaires; susceptibles d'entrainer de facon significative une insuffisance cardiaque chez le sujet age noir africain. Neuf facteurs ont ete prise en compte: l'age; le sexe; le diabete; le tabac; la dyslipidemie; l'obesite et le stress; les hypertensions arterielles moyenne et pulsee. Resultats : Les patients a PP elevee ont deux fois plus de risque de presenter une insuffisance cardiaque de type diastolique que ceux ayant une pression pulsee normale (Khi2= 207; 91 dd=1 P 0; 05 OR

Hypertension in a Rural Community in Rivers State; Niger Delta Region of Nigeria: Prevalence and Risk Factors

Background: Hypertension, a known independent and major risk factor for cardiovascular disease which was initially considered to be rare in sub Saharan Africa (SSA), is now a serious endemic threat and an important public health issue. Different studies in SSA have reported higher prevalence of hypertension in urban compared to rural areas. However more recent studies from the rural areas show an increasing pattern in hypertension prevalence. This may be attributed to the rapid 'westernization' of lifestyle in the rural Africa. Only few rural surveys have been conducted in the Nigeria oil-rich Niger Delta region necessitating this study with the aim of determining the hypertension prevalence and risk factors.Methods: This was a rural community-based cross-sectional study involving 500 adults. A questionnaire administered by face-to-face interview was used to assess socio-demographic characteristics of the subjects. Medical history such as prior knowledge of blood pressure status and family history of hypertension were all elicited by the questionnaire. Height and weight measurement were done and body mass indices (BMI) calculated as weight in kilogram divided by the square of height in meters.Results: There were 156 males and 344 females with male to female ratio of 1:2.3. The overall mean age was 41.32±17.0. The mean age for males was 42.84±17.8 and that for females was 40.62±16.6. The prevalence of hypertension in this rural community was 20.2 %. The overall mean systolic blood pressure was 1 2 0.4 6 ± 21.59mmHg (M a l e s123.57±20.41mmHg; females 119.05±22.36 mmHg; p= 0.04) and the mean diastolic blood pressure was 73.86±12.63mmHg (Males 75.52±13.03mmHg; females 73.25±12.3 mmHg; p=0.502). The prevalence was found to be higher in males than females though not statistically significant (Males 20.5%; Females 20.1%; X 0.651; p = 0.72). There was a progressive increase of hypertension prevalence with age. (X for trend = 69.434; p < 0.001). Pearson and Spearman' rho correlation analysis revealed that age, marital status, occupation, educational status and BMI correlated with hypertension in the study subjects while logistic regression analysis showed that BMI and age were the only positive predictors of hypertension in this study .Conclusion: Hypertension and its risk factors, which were initially rare in the rural sub Saharan Africa, is now on the increase in addition to high burden of communicable diseases in this region. The increasingly high 'westernization of lifestyle' may be part of the explanation for this. Hence there is need for an organized and deliberate health campaign and regular screening with adequate management in order to both reduce the incidence of hypertension and to prevent hypertension associated morbidity and mortal

Angiotensin II Type 1 Receptor Antagonists and their Combinations in the Treatment of Hypertension

The pathophysiology of hypertension is not multifactorial in nature; and there is a complex interplay of mechanisms of control and counter-regulatory responses activated by drugs. The problem for clinicians is that it is not really possible to recognise the various clinical phenotypes of hypertension. In other words; the heterogeneity of hypertension remains a clinical problem.1 Current overwhelming evidence is that the most important treatment concept in the management of hypertension is that treatment should reduce blood pressure to goal levels.2 The majority of hypertensive patients will need two or more antihypertensive drugs to control their blood pressure at goal. Conceptually; a strong case can be made for the early use of combination therapy in the treatment of hypertension.3

Beta Blockers and their Combinations in the Management of Hypertension

Beta blockers have been prescribed for the treatment of primary hypertension for a very long time. Currently; it is doubtful whether this is still a good idea. In fact; many are of the opinion that beta blockers should be relegated to a fourth-line drug; if used at all; for the treatment of hypertension. So what happened? Why the change of heart? Basically; two issues are driving this new view of beta blockers.Firstly; beta blockers are cardioprotective when given to patients with a recent myocardial infarction and reduce subsequent mortality significantly. Certain types of beta blockers reduce mortality in patients with heart failure. This efficacy in secondary protection was translated to primary prevention without a critical assessment; and this is particularly the case in hypertension.Secondly; reducing blood pressure by any means may not automatically translate into reduced cardiovascular morbidity and mortality. This happened with beta blockers in the primary treatment of hypertension

Digging a little Bellow the Surface of the relationship between blood Plessure and Obesity: Dichotomous Correlations in Young-Adult Nigerians

The relationship between blood pressure (BP) and obesity is still controversial; and was studied in a population of young-adult Nigerians. Systolic BP (SBP) and diastolic BP (DBP) were measured using an oscillometric device while relevant anthropometric indices were measured and derived using standard protocol. Body fat (BF) was measured by bioelectrical impedance analysis. The Pearson's correlation coefficients were calculated for the general population and based on BP phenotype; and scatter plots generated (for both sexes). The results show that in the general population; SBP was correlated with BF (males; r = +0.093; P 0.01; females; r 0.05) correlated with either BF or BMI. The BP versus BF or BMI curve shows sex variations; and plateaus once the BP value exceeds 120/80 mmHg. This dichotomous relationship implies that weight management may be useful in hypertension prevention in normotensive subjects; but may not be very useful; as a therapeutic option; in hypertensives

Orthostatic hypertension: profile of a Nigerian population

Background: The aim of this study was to determine the prevalence, age, sex distribution and blood pressure (BP) pattern of patients with orthostatic hypertension in a cohort of hypertensives. Method: A total of 179 patients on follow-up treatment in a hypertension clinic were assessed for age, sex and BP in the seated position, and after two minutes in the erect position, on three consecutive visits. Orthostatic hypertension was defined as an increase in systolic blood pressure (SBP) of ≥ 20 mmHg on more than one occasion in the erect position. Orthostatic hypotension was defined as a decrease in BP on more than one occasion, between the seated and erect SBP, of ≥ 20 mmHg. The mean ages of the participants with and without orthostatic hypertension were compared by t-test for any significant difference. The means of the seated SBP of participants with and without orthostatic hypertension were also compared with the t-test. The effect of gender on orthostatic hypertension was tested with a chi-square (χ²). The differences between the mean seated and mean erect SBPs of participants with and without orthostatic hypertension were compared with the paired t-test. Results: Thirty-eight (21.23%) of the participants had orthostatic hypertension. The mean age of those with orthostatic hypertension was not significantly different from that of the participants without orthostatic hypertension (p-value = 0.789). There was no significant effect of gender on orthostatic hypertension (p-value = 0.795). The mean of the seated SBP was significantly lower in the participants with orthostatic hypertension (p-value = 0.008). The mean seated SBP was significantly different from the mean erect SBP for those with orthostatic hypertension, compared to those without orthostatic hypertension (p-value = 0.000 vs. p-value = 0.169). Five (2.79%) of the participants had orthostatic hypotension. Conclusion: Orthostatic hypertension, a form of BP dysregulation, may be more common among treated hypertensives than what is presently known

Iron status and cardiovascular disease risk in black South African women: the PURE study

Objective: To examine the associations between measures of iron status and cardiovascular disease (CVD) risk factors in South African women.Method: In a cross-sectional study; demographic information and health history were obtained during individual interviews using validated questionnaires in the North West Province; South Africa. Anthropometric indices; iron indices; blood pressure; blood glucose and lipid profiles were measured using standard procedures in 1 262 apparently healthy black South African women aged 35 years or older. Iron status was assessed using serum concentrations of ferritin; transferrin receptor (TfR) and TfR:ferritin ratio.Results: Associations between iron status parameters and CVD risk factors were generally weak (r 0.3; p 0.01) and were not retained when adjustment was made for age; body mass index; smoking; alcohol consumption and C-reactive protein in the analysis. Waist circumference (WC) and waist:hip ratio (WHR) were higher in the fourth quartile of serum ferritin than in the third quartile; and also in the third quartile compared to the second quartile (P 0.05). Based on WC and WHR respectively; 31 and 52of the women had excess abdominal obesity. The mean (95 confidence interval) serum TfR concentration was high; at 9.09 ?g/ml (8.77; 9.44); indicating risk of iron deficiency. The mean (95 confidence interval) concentrations of lipids [total cholesterol 4.78 mmol/l (4.64; 4.93); high-density lipoprotein cholesterol 1.45 mmol/l (1.39; 1.52); low-density lipoprotein cholesterol 1.65 mmol/l (1.53; 1.78); triglyceride 1.12 mmol/l (1.07; 1.18)] were within reference ranges.Conclusion: No significant association was found between iron status parameters and established CVD risk factors. However; excessive abdominal adiposity indicated by high WC and WHR contributes significantly to increased serum ferritin concentration in this population

Facteurs de risque cardiovasculaire majeurs selon le sexe en milieu hospitalier

Le but est de décrire les facteurs de risque cardiovasculaire selon le sexe en milieu hospitalier. Matériel et méthodes : L'étude prospective d'avril 2007 à mars 2008 a porté sur 146 patients hypertendus de 2 structures sanitaires à Bamako. La collecte et l'analyse des données ont été réalisées avec SPSS v.11 Résultats : 67% de l'échantillon était de sexe féminin, la moyenne d'âge de 48,82. L'IMC était significativement supérieur dans le sexe féminin ( p< 0,001 ) La répartition par tranche d'âge laissait reconnaître un pic à 30-44 ans dans le sexe féminin contre 45-59 ans dans le sexe masculin. Le surpoids et l'obésité étaient prédominants dans le sexe féminin et la tranche d'âge la plus représentée dans l'obésité est celle des 30-44 ans. L'HTA isolée était la plus fréquente avec 58,90%. 7,53% présentaient les 3 facteurs de risque majeurs. Conclusion : La présence de l'HTA isolée est de loin la plus fréquente. Les autres associations bien qu'augmentant le risque global sont rares et ne diffèrent pas fondamentalement selon le sexe. La tendance au surpoids et à l'obésité dans le sexe féminin mérite d'être confirmée par d'autres études