Implementation of maternal guidelines for gravid teenagers with hypertensive disorders in KwaZulu-Natal

Background: The worldwide phenomenon of teenage pregnancy among 13­9-year-olds is complicated by obstetric conditions. Among the top three causes of maternal mortality, hypertension is the third in South Africa. Quality maternal care is assured by obstetric practitioners (OPs) implementing guidelines specific for management of hypertension in pregnancy. Objective: The objective of this study was to investigate implementation of maternal guidelines for hypertension in pregnancy among teenagers. Methods: As a retrospective quantitative research design was used, 173 maternal records of pregnant teenagers from 13 to 19 years were sampled from six district hospitals and Community Health Centres (CHCs) between 01 January 2017 and 31 December 2019 to undergo systematic random sampling. A pretested structured checklist was used to record data from sampled maternal records. Statistical Package for Social Sciences (SPSS) version 26 was used for data analysis, and results were presented using simple descriptive statistics. Results: Research results indicated that teenagers who suffered from hypertension intrapartum and postpartum did not receive maternal care according to the guidelines for maternity care in South Africa. Blood pressure was not measured of six (3.47%) intrapartum and five (2.9%) postpartum teenagers. Seventeen (9.8%) hypertensive postpartum teenagers received their antihypertensives. Conclusion: Public health institutions (PHIs) compromised provision of quality maternal care among teenagers, evidenced by incomplete intrapartum and postpartum assessment, diagnosis and management of hypertensive disorders in pregnancy (HDP).

Association between angiotensinogen M235T gene polymorphism and risk of hypertension: A case control study among Ethiopian patients

Background: Hypertension is a major public health problem in both developing and developed nations because it is highly prevalent and is associated with complications. Numerous enviromnental and genetic variables are linked to the occurrence of the disease. It may be influenced by the renin-angiotensin-aldosterone system, M'hich preserves bodily homeostasis. The angiotensinogen gene 11235T polymorphisms that has an effect on the activity of the renin-angiotensin-aldosterone system are related to the high hvpertension risk. The aim of this study was to find out the association between angiotensinogen Nf235T gene polymorphism and the risk of developing hypertenMon. Methods: A total of 306 samples - 153 patients Il'ith hvpertension and 153 age- and ser-matched healthy controls were selected using a simple random sampling technique. Clinical and biochemical variables were measured to assess the associated riskfactors. Blood samples from the patients and matched controls were used to isolate deoxyribonucleic acid. The AGT 11235T genotypes u:ere identified using polymerase chain reaction and analyzed by agarose gel electrophoresis. Logistic regression with a 95% confidence interval (CI) was employed to assess the risk correlations ofAGT gene M235Tpolymorphisms with hypertension. Results: Our analysis showed that the AGT-TT genotype (odds ratio [OR] = 3.11, 95% CL = 1.67­5.79, P< 0.001) and T allele (OR = 2.18, 95% CL = 1.56­3.04, P< 0.001) are considerably higher in hypertensive patients than in healthy controls. Our study also identified the clinical risk factors for hypertension, such as, total cholesterol, triglycerol, low density lipoprotein-cholesterol, and high density lipoprotein-cholesterol Inels, which were significantly higher in patients compared to controls (P< 0.001). Conclusion: The A GT M235T genes of the TT genotype and the T allele are associated with an increased risk of hypertension among the Ethiopian patients. A population-based epidemiological study is needed corroborate the association between AGT and HTN

Determinants of visit-to-visit systolic blood pressure variability among Ghanaians with hypertension and diabetes mellitus

Objective: To identify the determinants of systolic blood pressure variability (SBPV) among Ghanaians. Design: We undertook a secondary analysis of data collected in a prospective study Setting: The study involved patients with hypertension and or diabetes receiving care in five hospitals in Ghana Main outcome measures: We assessed determinants of SBPV among 2,785 Ghanaian patients. We calculated the standard deviation (SD) of systolic BP recordings of 3 to 10 visits per patient over 18 months as a measure of SBPV. A multivariate linear regression analysis was fitted to identify factors independently associated with risk visit-to-visit SBP standard deviation. Results: The mean SD of individual patient visit-to-visit SBP overall was 14.8±6.3 mm Hg. Those with hypertension and diabetes had the highest SD of 15.4 ±6.2 mm Hg followed by 15.2 ±6.5 mm Hg among those with hypertension only and then 12.0 ± 5.2 mm Hg among those with diabetes only, p<0.0001. Factors independently associated with SBPV with adjusted ß coefficients (95% CI) included age: 0.06 (0.03 ­ 0.08) for each year rise in age, eGFR -0.03 (-0.05 - -0.02) for each ml/min rise, low monthly income of <210 Ghana cedis 1.45 (0.43-2.46), and secondary level of education -1.10 (-1.69, -0.50). Antihypertensive classes were associated with SBPV, the strongest associations being hydralazine 2.35 (0.03 ­ 4.68) and Methyldopa 3.08 (2.39 ­ 3.77). Conclusion: Several socio-demographic and clinical factors are associated with SBPV. Future studies should assess the contribution of SBPV to CVD outcomes among indigenous Africans and identify actionable targets.

Hypertension maligne à l'hôpital Fousseyni Daou de Kayes, au Mali: aspects épidémio-cliniques et pronostiques / Malignant hypertension at the Fousseyni Daou hospital in Kayes, Mali: epidemiological and prognostic aspects

L'hypertension artérielle maligne (HTAM) est un problème de santé publique en Afrique subsaharienne. L'objectif de cette étude était de décrire le profil épidémio-clinique et les facteurs pronostiques de l'HTAM à Fousseyni DAOU de Kayes. Méthodes. Nous avons réalisé une étude rétrospective et descriptive du 1er janvier 2016 au 31 juin 2022 à l'unité de néphrologie de l'hôpital Fousseyni Daou de Kayes. Étaient inclus, les patients hypertendus ou normotendus sous traitement hospitalisés avec une rétinopathie hypertensive (RH) de stade II ou III (selon la classification de Kirkendall) associée à une ou plusieurs autres atteintes viscérales et ayant un dossier médical complet. Résultats. Au total 117 cas d'HTAM ont été enregistrés sur 7011 dossiers examinés, dont 53,8% d'hommes (63 cas). L'âge moyen était de 39,47 ans. La moyenne de la pression artérielle à l'admission était de 187/114 mmHg. La RH était de stade II et III dans 59,8% et 40,2% des cas. L'insuffisance rénale était retrouvée chez 93,1% des patients (109 cas) dont 63,7% d'insuffisance rénale chronique (IRC) contre 36,7% d'insuffisance rénale aiguë (IRA). L'hypertrophie ventriculaire gauche a été retrouvée dans 80,4% des cas. L'issue globale des patients a été favorable dans 59% (69 cas) contre 31,6% (37 cas) de décès et 9,4% (11 cas) de sortie contre avis médical. Les facteurs associés au risque de décès étaient surtout la RH stade III, la dyslipidémie, l'IRC terminale et l'hyponatrémie. Conclusion. L'HTAM reste un problème de santé publique au Mali et touche préférentiellement les sujets jeunes avec une morbi mortalité élevée

Sex-related differential prevalence of central obesity in diabetes mellitus: a multi-centred survey in North-Central Nigeria

Contrary to the old dictum that central obesity is more common among men than women, recent reports have shown a gradual reversal of this trend, as suggested by some studies. Objective: To compare the prevalence of central obesity among men and women with Diabetes mellitus in NorthCentral Nigeria. Methods: This multi-centred, cross-sectional study was conducted across 20 hospitals in Abuja, Nasarawa State, and Niger State, involving 1040 participants. Some obesity indices (body mass index, waist circumference and waist-toheight ratio) were measured. Results: The prevalence of central obesity (waist circumference criterion) was significantly higher in the females compared to male participants (89.6% vs 51.6%, χ2 = 1231.37, p<0.001), similar to the prevalence determined by waistheight ratio criterion (female vs male, 88.8% vs 71.5%, χ2 = 58.83, p<0.001). Following correction for age, duration of diabetes mellitus, blood pressure, blood glucose, and glycated haemoglobin using logistic regression, female gender remained a significant determinant of central obesity (OR = 2.76, 95% CI 1.81-3.83, p = 0.004). Conclusion: The prevalence of central obesity was higher among women than men in a cross-section of patients with diabetes mellitus in North-Central Nigeria

Effect of intermittent fasting on cardiovascular parameters of young adult offspring of hypertensive parents

Background: Offspring of hypertensive parents have been reported to have alteration on their sympathovagal balance and have exaggerated response to stressful conditions. Many Christians observe a period of fasting at the beginning of every year, which imposes some stress on their bodies. Objective: This study aims to investigate the effect of 21-day intermittent fasting on some cardiovascular parameters in offspring of hypertensive and normotensive parents. Materials and Methods: Eighty young adults (20­28 years) were divided into equal number of male and female offspring of hypertensive and normotensive parents based on questionnaire. Their body weight, height, waist circumference (WC), body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded 1 week before the fasting period began and then weekly for 3 weeks, in which they fasted. Results: The weight, BMI, and WC reduced during fasting, but the reductions were not significant (P > 0.05). The SBP and DBP were higher in male offspring of hypertensive parents than all other groups. SBP was also significantly (P < 0.05) higher in males than females before fast and during fast. Fasting significantly reduced the SBP in the male offspring of both hypertensive and normotensive parents. The HR reduced in the females during fast but increased from a lower level in males to a value not significantly different from prefasting level. Conclusion: Fasting reduces the high SBP and DBP in male offspring of hypertensive parents, which is beneficial to their cardiovascular system.

Profil pharmaco-doppler pénien des patients coronariens souffrant de dysfonction érectile à l'Institut de Cardiologie d'Abidjan une série de 30 cas / Penile pharmaco doppler profile of coronary patients with erectile dysfunction at the Abidjan Cardiology Institute: a series of 30 cases

Contexte et objectif. La maladie athéromateuse dont la coronaropathie étant une pathologie diffuse peut être prévenue par le contrôle des facteurs de risqué cardiovasculaire. Le but de cette étude était de décrire les caractéristiques pharmaco doppler pénien des patients coronariens souffrant de dysfonction érectile. Méthodes. Il s'agissait d'une série analytique des cas suivie entre juin 2020 et février 2021. Elle concernait des patients ayant des lésions athéromateuses significatives à la coronographie et souffrant de dysfonction érectile. Nous avons évalué les caractéristiques pharmaco doppler pénien. La qualité d'érection était appréciée par le score de rigidité Erectile Hardness Score (EHS). Résultats. Trente-six patients étaient inclus. L'âge moyen était de 56 ± 8,4 ans. le pic de Vitesse systolique au repos (PSVr) moyen des patients était de 13,7 cm/s ± 5,9. Le pic de vitesse systolique post injection (PSV pi) moyen des patients était de 23,9 cm/s ± 5,4. Les causes étaient principalement artérielles de 75%. La qualité d'érection était appréciée selon le score EHS : E1 (83%), E2 (22%), E3 (5%) et E4 (3%). Conclusion. La dysfunction érectile est associée aux facteurs de risque cardiovasculaire selon plusieurs études. L'echodoppler pénien avait occupé une place importante dans le diagnostic étiologique. Les causes retrouvées étaient principalement artérielles avec une baisse de PSVpi<25 cm/s.

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

Cardiovascular risk factors and renal impairment among young adults in a tertiary institution in Southwest Nigeria

Background: Specific research is sparse on renal dysfunction among homogenous group of young adults. This study estimated the prevalence of renal dysfunction among apparently healthy young adults and determine association (if any) between renal dysfunction and some cardiovascular risk factors. Methodology:Undergraduates (18-37 years) of a tertiary institution were studied on 2017 World Kidney Day. Their biodata, blood pressure, anthropometry, total cholesterol and estimated glomerular filtration rate were determined. Data was analyzed using SPSS version 20.0. Results:A total of 640 students were studied (M:F=1:3.8). Their mean age was 23.1±2.8 years. Thirty-three(5.2%) participants had renal dysfunction (eGFR < 60ml/min/1.73m2). The mean age of subjects with renaldysfunction (eGFR < 60ml/min/1.73m2) was significantly higher with an inverse association to renal function (p = 0.005). Two hundred and fifty-seven(40.2%) and 58 (9.1%) participants were pre-hypertensive and hypertensive respectively; overweight, abdominal obesity and hypercholesterolaemia were found among 12.2%, 14.2% and 8.1% of subjects respectively. The mean body mass index (p = 0.009) and serum total cholesterol (p = 0.003) were significantly higher among females. There was a higher prevalence of renal dysfunction among females even though this was not to the significant level (5.9 v 2.2%, p = 0.12). Conclusions:The prevalence of renal dysfunction among young adults is lower than current global estimates. The prevalence of cardiovascular risk factors for CKD were lower than that of older adults with no significant association to renal dysfunction. Increasing age was found to be significantly associated with reduced renal function.

Determinants of Blood Pressure Control among Hypertensive Patients Attending a Rural Teaching Hospital in Southern Nigeria

Hypertension (HTN) is the commonest cardiovascular risk factor in sub-Saharan Africa. It is a global public health threat, often associated with significant morbidities and mortality with rising prevalence both in rural and semi-urban areas of economically disadvantaged countries. Aim: This study aimed to assess the determinants of blood pressure control among patients with hypertension receiving care at the Irrua Specialist Teaching Hospital in Southern Nigeria. Patients and Methods: A cross-sectional study of 502 consenting hypertensive adults receiving care at the Irrua Specialist Teaching Hospital, Irrua in Edo State, South-south Nigeria. A pre-tested semi-structured interviewer-administered questionnaire was used to collect data which was analyzed using SPSS version 21 and the level of significance was set at P < 0.05. Results: Five hundred and two participants (226 males, 276 females) completed the study with a mean age of 52.98 ± 12.82 years. Optimal blood pressure control was found in 15.5% of the study participants. Blood pressure control was significantly associated with being married (OR 1.549, CI: 1.040­2.309), having a monthly household income of over N50,000 (OR 1.691, CI: 0.999-2.863), engaging in physical activity (OR = 1.537, CI: 0.989-2.388), and not being obese evidenced by a normal Waist Hip Ratio (OR = 2.276, CI: 1.555-3.332). Conclusion: Blood pressure control to target goal was low in the study population and achieved only in less than one­fifth of respondents on antihypertensive therapy. Numerous socio-demographic and lifestyle variables were shown to be associated with blood pressure control. Physicians should emphasize medication adherence and lifestyle modification approaches in hypertensive adults.

Day and night blood pressure variability among older persons in South­Western Nigeria

Background: Hypertension is the largest contributor to the global burden of disease. Emerging risk factors for cardiovascular disease include blood pressure variability (BPV), but evidence on BPV is lacking among older Nigerians. We reported BPV in a cohort of older persons at the University College Hospital (UCH), Ibadan. Methods: We conducted a retrospective cohort study of respondents aged >50 years within the Ibadan Ambulatory Blood Pressure Registry at the UCH, Ibadan, Nigeria. Socio-demographic characteristics, lifestyle habits and anthropometric measurements were obtained. Results: Among 639 respondents, 332 (52.0%) were female. The blood pressure (BP) variables were strongly associated with age. Compared with younger age groups, mean diastolic BP (DBP) was less at an older age, whereas mean pulse pressure was greater. During the wake-up and sleep periods, mean DBP and mean arterial BP were less with each increasing age category, whereas mean pulse pressure was larger with each increasing age category. BP dipping, systolic, diastolic and mean arterial BP decreased with age. Overall, timed BPV increased significantly with increasing age. The prevalence of white­coat hypertension was greater among older participants than younger participants. Most respondents in the 50­59 years' age group were non-dippers (55.8%), whereas 33.7% of older respondents were reverse-dippers. Conclusion: Older persons experienced a greater abnormal circadian blood variation and greater BPV than younger people. In Nigeria, follow­up data are needed to determine the prognostic significance of these data in this population

Body mass index, blood pressure, and cognitive impairment among type 2 diabetic patients in a primary care setting, North-Central Nigeria

The long-term effects of certain clinical factors on cognition cannot be overemphasized. The morbidity of Cognitive Impairment (CI) in patients with type 2 diabetes has been found to increase when associated with some clinical factors. The main objective of this study was to determine the relationship between CI and Body Mass Index (BMI) as well as CI and Blood Pressure (BP), among type 2 diabetic patients attending the primary care unit of a tertiary hospital. It was a descriptive hospital-based crosssectional study. Ethical approval was obtained from the Ethical Review Committee of the University of Ilorin Teaching Hospital (UITH) before the commencement of the study. Data was collected from 274 adult type 2 diabetic patients attending the Family Medicine clinics of the hospital, from March through May 2017. Interviewer-administered structured and semi-structured questionnaires were used to obtain information from the respondents. The Mini-Mental State Examination (MMSE) was used to assess CI among respondents. The BMI and BP of participants were obtained following standard procedure. Data was collated and analyzed using the Statistical Package for Social Sciences version 21 (SPSS- 21). The elderly constituted a higher proportion of participants 55.4%. Respondents were mainly females (70.8%), married (78.8%), and educated (78.1%). The clinical factor that had a statistically significant association with CI was the BMI of participants with a chi-square value (χ2) of 11.139 and a p-value of 0.048. Blood pressure had no statistically significant association with CI (χ2 of 5.181 and p-value of 0.159). CI is common in our clinics with a prevalence of 27% seen in this study. BMI had a statistically significant association with CI while BP was not. Hence, maintaining a normal weight may help in controlling CI. Physicians in primary care should routinely screen type 2 diabetic patients for CI as well as control risk factors for it.

Is vitamin D status associated with non-communicable disease risk in children? A cohort study

Background: Studies in children and adults have reported variations in 25-hydroxyvitamin D (25(OH)D), body mass index (BMI) and blood pressure (BP) over time. Furthermore, there has been a reported association of 25(OH)D with BMI, BP and lipid levels in some cross-sectional and longitudinal studies. Methods: This is a longitudinal study of a group of adolescents with measurements of 25(OH)D, BP, anthropometry and lipids at the ages of 11, 12 13, 15 and 18­20 years. For age-related changes, year 12 participants (n = 261) were matched with year 18­20 participants (n = 368), resulting in 200 paired participants. Longitudinal analyses using the Generalized Estimating Equations (GEE) comprised the following groups of participants, Year 11 (n = 288), Year 12 (n = 253), Year 13 (n = 292), Year 15 (n =238) and Year 18­20 (n = 368). The relationship of 25(OH)D with BMI, BP and lipid levels over a period of 10 years was assessed. Results: There were significant increases in mean BMI and BP, and decreases in 25(OH)D levels with age (all p-values < 0.0001).In females, systolic BP was significantly higher in older participants (18­20) years than younger participants (12 years), but 25(OH)D was significantly higher in younger than older participants. In males, there was significant increase in BP in participants between age 12 years and 18­20 years. 25(OH)D, total cholesterol (TC) and low-density lipoprotein (LDL-C) were significantly lower in 18­20-year-old participants compared with 12-year-old participants. Longitudinally, 25(OH)D was inversely associated with LDL-C. Conclusion: There is evidence of changes in 25(OH)D, BMI and BP in adolescents over a period of 10 years. After adjusting for covariates, BMI and LDL-C were significantly negatively associated with 25(OH)D, which suggests that vitamin D status might be associated positively with favourable lipid profiles in children and adolescents.

Impact of adapted physical activity on blood pressure and hypertension control in the militaries of Kinshasa Garrison, Democratic Republic of Congo: A randomized controlled trial

Context and objective. Major handicap for operational conditioning of troops, hypertension requires innovative approaches for its prevention and management. The present study aimed to evaluate the impact of adapted physical activity (APA) on BP level of sedentary soldiers from Kinshasa garrison and the rate of hypertension control in those with high BP. Methods. Open, parallel randomized controlled trial carried out at Camp Lt-Colonel Kokolo (CVEC) from June 2016 to October 2017) in sedentary soldiers (57.6 %, hypertensives) allocated for 8 weeks to APA (n=119) or control (n=110). The randomization procedure used permuted blocks of four consecutive participants. The outcomes were baseline-adjusted betweengroup difference in BP level (all participants), in rate of BP control among hypertensives. Results. At the last available visit in 226 participants (119 vs 107), the baseline-adjusted BP difference between active and control group by intentionto-treat was 5.1 (95 % CI 1.2 -10.8)/3.0 (0.1-6.9) mmHg lower in the active group. The effect of APA was also significant across pre-specified categories of participants based on age, officers' rank, and hypertension status. Among 129 analyzed drug treated hypertensives (68 vs 61), the rate of BP control remained unchanged in the control group (43.8 to 44.3%) but increased (43.5% to 85.3 %) in the active group yielding a baseline-adjusted between group difference of 40.7 (32.2; 49.2) %. The probability to achieve hypertension control was greater (HR: 3.38 [95% CI: 1.48- 4.84] in the active group. PP analysis of 122 soldiers (80 vs 42) with data at all scheduled visits yielded confirmatory results for BP reduction and for hypertension control by APA. The changes in BP were positively correlated with concomitant reductions in heart rate. Conclusion. Exercise training induced a significant BP reduction in sedentary militaries and improved the control rate among those with drug treated hypertension

Diastolic versus systolic dysfunction in patients with chronic liver disease ­ a single center study in South-South, Nigeria

Objectives: The term cirrhotic cardiomyopathy (CCM) has been used to describe the constellation of cardiovascular abnormalities including diastolic and systolic dysfunctions in patients with chronic liver disease (CLD). CCM contributes to morbidity and mortality associated with CLD. The aim of the study was to evaluate the left atrial and ventricular geometry, systolic and diastolic functions in patients with CLD. Material and Methods: This was a cross-sectional analytical study that involved 80 patients with CLD seen at University of Calabar Teaching Hospital, Calabar, Nigeria, and 80 apparently healthy controls matched for age/ gender. The participants were interviewed, examined and had resting transthoracic echocardiography. The data were analyzed using IBM SPSS version 20.0. Results: A total of 160 subjects were recruited into the study with a male to female ratio of 2.8:1. There was no difference in the mean age of cases and controls (P = 0.115). Systolic function of the left ventricle was similar in the two arms. However, left ventricular diastolic dysfunction, left atrial enlargement, and increased left ventricular mass index (LVMI) were more prevalent among the patients with CLD compared to controls (P < 0.05). Conclusion: The study demonstrated increased left atrial diameter, increased LVMI associated with diastolic dysfunction, and preserved systolic function at rest among CLD patients. Keywords: Chronic liver disease, Diastolic dysfunction, Systolic dysfunction

Variation between pragmatic and standardised blood pressure measurements in a Nigerian primary care clinic

Background: A significant difference in the blood pressure (BP) value of a patient taken by different health workers has been a subject of discussion among health workers. This study investigated the variations between usual-care and guideline-concordant BP measurement protocols and evaluated the implications of the disparities on diagnosis and treatment decision.Methods: A cross-sectional study was conducted among 206 participants. The usual-care and guideline-concordant BP readings taken from each participant by the regular clinic nurses and research-trained nurses, respectively, were obtained.Results: Majority of the regular clinic nurses following the usual-care protocol used the left arm for BP measurement (59.7%). The systolic BP (SBP) and diastolic BP (DBP) readings were higher on the right arm in 55.3% and 39.2% of the participants, respectively. The mean guideline-concordant BP was 7.67 mmHg higher than the mean usual-care for SBP (p ≤ 0.05) and 7.14 mmHg higher for DBP (p ≤ 0.05). The proportion of participants classified as having hypertension and uncontrolled BP was 11.8% and 15.0% lower when using usual-care BP compared to guideline-concordant BP, respectively. Fifty-one (24.8%) respondents were advised incorrect treatment based on usual-care BP measurement. The Bland-Altman plot showed that limits of agreement were wider than within the 10 mmHg clinical reference range and unacceptable for clinical purposes.Conclusion: The usual-care and guideline-concordant BP measurement protocols were significantly different, and the disparity had significant consequences on the diagnosis and treatment of hypertension. Health workers should strictly adhere to the guidelines on BP measurement to avoid mismanagement of patients

Physical activity pattern and its association with glycaemic and blood pressure control among people living with diabetes (PLWD) in the Ho Municipality, Ghana

BACKGROUND: Physical activity (PA) offers considerable health benefits for diabetic patients. However, extensive high levels of inactivity has been reported among diabetic patients. This study sought to assess the patterns of physical activity and its relationship with two management-relevant outcomes (glycaemic and blood pressure control)among people living with diabetes in the Ho Municipality, Ghana. METHODS: A hospital-based cross-sectional study was carried out from January 2017 to April 2017 among 150 purposively recruited diabetic patients who were receiving care at the diabetes clinics of the Volta Regional Hospital and the Ho Municipal Hospital. A semi structured questionnaire was used in capturing socio-demographic information. Physical activity was assessed using the International Physical Activity Questionnaire Short Form. Glycaemic and blood pressure control were evaluated within a three-month period from patients' records. RESULTS: Physical activity estimates among participants were 21.33%, 48% and 30.67% for high, moderate and low PA respectively. Glycaemic control among the study participants was 33.33% and blood pressure control was 58.67%. Both glycaemic and blood pressure control were significantly associated with PA. CONCLUSION:In this group of PLWD in the Ho Municipality, high levels of inactivity, uncontrolled glycaemia and blood pressure exist. However, glycaemic and blood pressure control may be modulated by moderate-intensity physical activity

Serum Ferritin and Blood Pressure modulation in first-time and regular blood donors

Background:The health benefits ofblood donation are well known. However, the overall effect of long term regular blood donation on body iron store and blood pressure need to be evaluated among voluntary blood donors.Objective:To determine the effect of long term, regular blood donation onbody iron store and blood pressure amongregular voluntary non-remunerated blood donors in Lagos, Nigeria.Methods:Consenting adult blood donors (n = 320), ranging from the first time to regular blood donors were studied over six months. Supine blood pressure (BP) readings were taken twice at 30 minutes interval with a mercury sphygmomanometer. Venous whole blood was drawn into EDTA anti-coagulated and plain tubes for haematological parameters and serum ferritin estimation using Enzyme-linked Immunosorbent Assay (ELISA) method. Results:The mean serum ferritin levels declined significantly from 95.5ng/mL amongfirst time donors to 68.9ng/mL among Category IIIdonors (p = 0.035). Male voluntary blood donors had increased risk of low serum ferritin level (OR = 5.02; 95%CI= 1.12-22.51; p = 0.035). Lower values of serum ferritin were recorded more frequently among donors within the 21-30 year age category (OR = 1.54; 95%CI = 1.0-2.71; p= 0.042). Long term regular voluntary blood donation was associated with significant reduction in mean systolic blood pressure (p = 0.01).Conclusion:Long term blood donation resulted in the reduction of blood pressure. Progressive increase in the duration of donation resulted in reduced iron stores even as haemoglobin concentration levels remained acceptable for blood donation

Sleep quality and new onset postpartum hypertension

Background: Chronic sleep deficiency is a stressful situation which has an association with high blood pressure. After delivery, mothers have disrupted sleep due to frequent awakenings by their infants. What is not known is how significant this relationship is in women during the postpartum period as well as other factors that may affect their Sleep quality. Sleep quality is a measure of duration and disruption. Aim and Objectives: Study is aimed at determining the relationship between Sleep quality and new onset postpartum hypertension. The specific objectives are; to determine the Sleep quality of mothers in the postpartum period using the Pittsburgh Sleep quality index (PSQI), identify factors that affect Sleep quality of mothers in the post-partum period and determine blood pressure patterns of mothers in the postpartum period. Materials and Methods: This was a longitudinal study. Using systematic random sampling, a sample size of 126 women were recruited between June and August 2016 in the Postnatal clinic of the 37 Military Hospital. Written consent was obtained from participants. Sitting blood pressure was checked and recorded and a modified form of the Pittsburgh Sleep quality index (PSQI) was used to assign a global score for Sleep quality. A global score of more than 5 indicated poor Sleep quality in that mother. Clients were first recruited at the 1st postnatal visit with follow-up at the 2nd routine postnatal visit (6weeks). Only mothers whose blood pressures were normal during pregnancy and upon discharge from hospital were included. For categorical data, Pearson's chisquare test was used for comparisons and logistic regression as used to determine significant factors that contribute to new onset hypertension in postpartum women. A P-value less than 0.05 was considered significant. Results: Majority of mothers (92.1% and 90.5% at first and second visits respectively) had poor Sleep quality. Mothers who slept away from their babies at the sixth week visit had better sleep. Mean global Sleep quality scores had no significant association with new onset hypertension but mean scores of some Age , p=0.001, OR =1.20 (C.I: 1.09-1.32) and some sleep components sleep disturbance, p=0.041, OR =1.86(C.I: 1.02-3.37), and use of sleep medicine, p=0.031, OR =1.54 (C.I:1.04- 2.29) were significantly associated with new onset postpartum hypertension. Conclusion: Global poor Sleep quality is not associated with increased odds of new onset hypertension but the Sleep quality components, sleep disturbance and increased use of sleep medicine, were significantly associated with new onset hypertension in mothers

Correlation of some predisposing intrinsic conditions with the morphological integrity of the Achilles tendon

Background: Most studies have focused on ill-tendons with a little insight on how intrinsic factors correlate with the Achilles tendon (AT) morphology. Aim: This study aims at establishing how blood pressure (BP), blood glucose (BG), and body mass index (BMI) correlate with the morphology of the AT with emphasis on width changes. Materials and Methods: Participants were volunteers who were recruited during and after an organized health fair by the Medical Students' body of All Saints University, School of Medicine, Commonwealth of Dominica. A total of 336 people, consisting of 135 males and 201 females volunteered for the study. The most dominant age group was between 60 and 65 years. A self-administered questionnaire was used to acquire necessary information, and a preliminary clinical procedure was used to check for BP, BG, and BMI. Ultrasound examination was done in B-mode using a linear array high-frequency probe with a mediolateral approach at the AT. Results: Among the participants, 42.68%, 69.75%, and 30.38% had normal BP, BG, and BMI readings, respectively. BP, BG, and BMI statistically supported the hypothesis.Individuals with extreme BP, BG, and BMI had their AT width wider when compared with individuals with normal systemic readings. Sonographic examination revealed most participants with normal tendon morphology while some identifiable changes were observed among others. Conclusion: This study suggests that BP, BG, and BMI could affect the morphological integrity of the AT. It indicates that asymptomatic high blood sugar and BP could weaken the AT, leading to pain which may appear unrelated to the physician and patient