Management of an incompetent mid-second (mid-2nd) trimester absent ecto-cervix: a case series. Cervical amplification pre-cerclage insertion.

BACKGROUND: Cervical cerclage is a treatment for an incompetent cervix, the latter being a contributor to spontaneous preterm birth. There is significant difficulty with a transvaginal cerclage insertion for the absent vaginal or ecto-cervix in the mid-2nd trimester period resulting in a higher risk of late miscarriages, extremely preterm labour with increased neonatal morbidity and mortality. METHODS: A retrospective review of 5 consecutive cases managed by a surgical technique-modified high vaginal cerclage insertion at 18-20 weeks-and adjunct protocols which included vaginal progesterone use, serial infection screening and lifestyle advice, over a 12-month period ending in August 2021, is presented. Inclusion criteria included minimal or absent ecto-cervix, singleton pregnancies with an incompetent cervix attending for a vaginal cerclage whilst exclusion criteria were the usual contraindications to a cerclage insertion. Primary outcome was delivery after 34 weeks whilst seconday outcomes included maternal hemorrhage, bowel/bladder injury, chorioamnionitis and neonatal admission. RESULTS: A increased gestational latency of 13 gestational weeks (range 12-18). Mean gestational age at delivery was 36 weeks +1 (253 days) with a range of 241-264 days. Delivery after 34 weeks gestational age was 100% with no maternal surgical complications and corresponding neonatal outcomes. CONCLUSION: There is a potential therapeutic benefit of this technique and adjunct management, in managing an incompetent mid-2nd trimester absent ecto-cervix.

Iron Deficiency Anemia in Nigerians with Heart Failure (IDAN-HF): Therapeutic efficacy of iron replacement: An interventional study.

BACKGROUND: Recent evidence has reported significant improvement in clinical profile, quality of life, and prognosis of heart failure subjects with iron replacement. AIMS: This study aimed to determine the safety and outcome of parenteral iron replacement among heart failure subjects in Nigeria. METHOD: A randomized interventional study was done at the Cardiology Clinic of LAUTECH Teaching Hospital, Ogbomoso, Nigeria. One hundred and forty subjects with heart failure were recruited. Iron deficiency and anemia were determined according to standardized criteria. Parenteral iron dextran was administered to a block randomized group of 30 of those identified with iron deficiency and compared with controls. The primary outcome was the six minutes' walk test (6 MWT) after 8 weeks while the Kansas City Cardiomyopathy Questionnaire (KCCQ) score was used to assess the quality of life as a secondary outcome. Statistical analysis was done with the SPSS 20.0. P value <0.05 was taken as statistically significant. RESULTS: Iron deficiency was present in 84 (60.0%) of all study participants. Iron dextran was fairly tolerated with mild to moderate adverse reactions reported in 7 (23.3%) subjects who had an iron infusion. Improvement in the 6 MWT distance (390.1 ± 92.6 vs. 156.9 ± 72.5 meters, P < 0.05) and the KCCQ score (84.5 ± 3.7 vs. 64.2 ± 12.5%, P < 0.05) among iron-deficient heart failure subjects who received iron dextran was significantly higher than those who did not receive the iron replacement. Functional classification according to the New York Heart Association (NYHA) profile and heart rate were also much improved after the iron replacement than those who did not receive it. CONCLUSION: Parenteral iron dextran therapy was fairly tolerated among heart failure subjects. Iron replacement is associated with improved quality of life, better temporal clinical profile, and functional classification among Nigerians with heart failure. Iron replacement therapy can be an additional therapeutic option in heart failure management among Africans to improve prognosis.

Air Quality Index and Respiratory Symptoms among Garri Processing Workers in Ogbomoso, Nigeria.

BACKGROUND: Epidemiological studies have linked morbidity and mortality of individuals to exposure to atmospheric gaseous and particulate matter especially fine particles (PM2.5) and coarse particles (PM10).The process of garri (cassava crisps) production (frying with firewood) is associated with production of gaseous and particulate matter which contribute to ambient particulate matter air pollution. The objective of this study was to determine the impact of air quality indices on the prevalence of respiratory symptoms among the garri processing workers in Ogbomoso. METHODOLOGY: A comparative cross-sectional study was carried out among 351 garri processing workers in Ogbomoso as subjects and 351 residents of Ogbomoso metropolis as controls that were age, sex and height-matched. A semi-structured questionnaire was used to obtain sociodemographic profiles and respiratory symptoms of participants and document physical examination findings. Particulate matter counter was used for air quality sampling. RESULTS: The mean age of subjects was 41.7 ± 14.9 years and that of controls was 41.6 ± 14.7 years (p =0.960). The two groups were also matched for socioeconomic status, sex and height. Prevalence of respiratory symptoms was higher at 48.4% among the garri workers than the control group which was 29.1% (p<0.001). Cough was the predominant symptom with a prevalence of 29.3% and 10.5% among the subjects and controls respectively. The mean count of PM1.0 in garri processing locations was significantly higher than that recorded in Ogbomoso metropolis; 73.77±42.08 vs 15.04±6.66mg/m3 (p<0.0001). CONCLUSION: Garri processing work is associated with significant increase in ambient air pollution and increased prevalence of respiratory symptoms among the workforce compared to the control population. Effective preventive strategies including education and provision of safety masks may reduce the occupational hazards associated with garri processing factory workers in Nigeria.

PATTERN OF ANAEMIA AND ITS CORRELATES IN NIGERIANS WITH HEART FAILURE.

BACKGROUND: Heart failure often coexists with many comorbidities, including anaemia. However, the pattern of anaemia in heart failure and its clinical and echocardiographic associations have not been adequately studied among Nigerians. OBJECTIVE: To describe the pattern of anaemia, its clinical characteristics, and its echocardiographic associations among heart failure subjects in Nigeria. METHODOS: One hundred and forty subjects with heart failure were recruited from the cardiology clinics of two teaching hospitals in southwest Nigeria: Ladoke Akintola University of Technology and Bowen University Teaching Hospitals, Ogbomoso. Complete blood analyses, among other tests, were done. Statistical analysis was done with Statistical Package for the Social Sciences (SPSS) 20.0. P <0.05 was taken as statistically significant. RESULTS: Anaemia, as defined by the World Health Organisation, occurred in 106 (75.7%) of the heart failure patients. The patterns of anaemia among participants include combined anaemia of chronic diseases (ACD) with iron deficiency in 64 (45.7%) patients, and ACD alone in 40 (28.6%). Anaemia was more significantly associated with previous diagnosis of diabetes mellitus, presence of pulmonary hypertension, and heart failure with reduced ejection fraction. Mean systolic and diastolic blood pressures, ejection fraction, and fractional shortening were significantly lower among heart failure subjects with anaemia, while serum creatinine, left atrial dimension, left ventricular end diastolic dimension, and left ventricular mass index were significantly higher among heart failure subjects with anaemia compared to those without anaemia. CONCLUSION: Anaemia occurs very frequently among heart failure patients in southwest Nigeria. It is associated with many poor prognostic factors, including diabetes mellitus, pulmonary hypertension, and kidney failure.

Antihypertensive Medications Adherence Among Nigerian Hypertensive Subjects in a Specialist Clinic Compared to a General Outpatient Clinic.

BACKGROUND: Poor adherence to antihypertensive medications has been linked with increased cardiovascular risk and mortality in many population. Africans have been shown to have a worse prognosis from hypertension, poorer blood pressure control, and increased risk of complications arising from hypertension compared to Caucasians. AIM: The aim was to describe the level of adherence to antihypertensive medications, its determinants and whether any difference exist between those attending specialty clinic or general outpatient department (GOPD) Clinic in a Nigerian University Teaching Hospital. SUBJECTS AND METHODS: An analytical cross-sectional study. The Morisky scale was used to assess for adherence to antihypertensive medications. Clinical and demographic data were taken. Statistical analysis was performed using SPSS 17.0. (Chicago, IL, USA). P < 0.05 was taken as statistically significant. RESULTS: A total of 114 hypertensive subjects were recruited for this study. Seventy-nine were from the cardiology clinic whereas 35 were from the GOPD. They consisted of 60 males (52.6%, 60/114) and 54 females (47.4%, 54/110). The mean age was 63.6 (14.1) years. High adherence, low adherence and medium adherence as defined by Morisky scale was found in 36.8% (42/114), 23.9% (27/114) and 39.5% (45/114), respectively. Adherence level was higher among those attending specialty clinic despite shorter duration of hypertension and use of more medications. More than four-fifth of those attending cardiology clinic had at least medium level of adherence compared to a little bit over half of those attending GOPD clinic. Those with good adherence were likely to be older, had a higher level of education and higher average monthly income than those with poor adherence. CONCLUSION: Poor adherence to medications is very common in the hypertensive Nigerians. Hypertensive subjects attending specialty clinic seems to have a better adherence to antihypertensive medications possibly due to the level of health education and information provided to patients. Effective health education and regular screening for compliance and adherence is a potential way to reduce cardiovascular risk associated with uncontrolled hypertension.

Prevalence of traditional cardiovascular risk factors among staff of Ladoke Akintola University of Technology, Ogbomoso, Nigeria

Aim: The aim was to describe the frequency of occurrence of traditional cardiovascular (CV) risk factors among selected university workers in Ladoke Akintola University of Technology (LAUTECH) Nigeria.Materials and Methods: A cross­sectional study of 206 staff of LAUTECH, Ogbomoso, Nigeria had an assessment for nine traditional CV risk factors. Demographic and clinical parameters were taken. Blood sample was taken to determine the random blood sugar and lipid profile. 12­lead resting electrocardiography (ECG) was done for all participants. Statistical analysis was performed with the aid of Statistical Package for Social Sciences (SPSS)version 17.0 (Chicago Ill., USA)Results: The study population included 96 males (46.6%) and 110 females. The mean age was 45.3 ± 7.9 years (range 27-73 years). The prevalence of CV risk factors were as follows: Hypertension 84 (40.8%), visceral obesity 92 (44.7%), generalized obesity 79 (38.3%), low high density lipoprotein 113 (54.9%), impaired blood glucose 16 (7.8%), diabetes mellitus 3(1.5%),hypercholesterolemia 102 (49.5%), left ventricular hypertrophy­ECG 24 (11.7%), elevated low density lipoprotein­cholesterol 99 (48.1%). About ­ (72.3%) had two or more CV risk factors clustered together. Females had a higher prevalence of CV risk factors and its clusters than their male counterparts. Of those diagnosed with hypertension in this study, more than half had never been told they werehypertensive 48 (57.1%). Conclusion: This study suggests a very high prevalence of CV risk factors among University Staff in LAUTECH,Ogbomoso, Nigeria. Clustering of CV risk factors is more prevalent among women. Appropriate preventive strategy in terms of education and modification of risk factors are important to reduce the burden of CV diseases among this population

Prevalence of traditional cardiovascular risk factors among staff of Ladoke Akintola University of Technology, Ogbomoso, Nigeria.

AIM: The aim was to describe the frequency of occurrence of traditional cardiovascular (CV) risk factors among selected university workers in Ladoke Akintola University of Technology (LAUTECH) Nigeria. MATERIALS AND METHODS: A cross-sectional study of 206 staff of LAUTECH, Ogbomoso, Nigeria had an assessment for nine traditional CV risk factors. Demographic and clinical parameters were taken. Blood sample was taken to determine the random blood sugar and lipid profile. 12-lead resting electrocardiography (ECG) was done for all participants. Statistical analysis was performed with the aid of Statistical Package for Social Sciences (SPSS) version 17.0 (Chicago Ill., USA) Results: The study population included 96 males (46.6%) and 110 females. The mean age was 45.3 ± 7.9 years (range 27-73 years). The prevalence of CV risk factors were as follows: Hypertension 84 (40.8%), visceral obesity 92 (44.7%), generalized obesity 79 (38.3%), low high density lipoprotein 113 (54.9%), impaired blood glucose 16 (7.8%), diabetes mellitus 3 (1.5%), hypercholesterolemia 102 (49.5%), left ventricular hypertrophy-ECG 24 (11.7%), elevated low density lipoprotein-cholesterol 99 (48.1%). About - (72.3%) had two or more CV risk factors clustered together. Females had a higher prevalence of CV risk factors and its clusters than their male counterparts. Of those diagnosed with hypertension in this study, more than half had never been told they were hypertensive 48 (57.1%). CONCLUSION: This study suggests a very high prevalence of CV risk factors among University Staff in LAUTECH, Ogbomoso, Nigeria. Clustering of CV risk factors is more prevalent among women. Appropriate preventive strategy in terms of education and modification of risk factors are important to reduce the burden of CV diseases among this population.

Gender specific pattern of left ventricular cardiac adaptation to hypertension and obesity in a tertiary health facility in Nigeria.

BACKGROUND: Cardiac adaptation to hypertension and obesity may be related to many factors such as race, gender and haemodynamic status. Some gender specific associations with left ventricular structure and function have been described among Caucasians. OBJECTIVES: To describe the sex specific pattern of left ventricular adaptations to obesity and hypertension among Nigerians. METHODOLOGY: It was a cross sectional study carried out at LAUTECH Teaching Hospital, Osogbo, Nigeria. 313 subjects had full echocardiography performed. Participants were divided into four groups: normal, obese, hypertensives and obese-hypertensives. Indices of LV adaptation were compared between the groups. SPSS 16.0 was used for analysis. RESULTS: Relative to normal subjects, LV mass (LVM), LV mass index (LVMI) and wall thickness were significantly higher among hypertensive men and obese hypertensive men. They were similar between normal and obese men. However, LVM, LVMI and wall thickness were increased among obese women compared to normal women while they were similar among obese, hypertensive and obese-hypertensive women. Men with concurrent obesity and hypertension presented with a further increase of LVM and wall thickness above values in the merely obese or hypertensive subjects. Female obese-hypertensive seem to present more with eccentric hypertrophy than male obese-hypertensive subjects (17.2% vs. 9.1% respectively, p<0.05) while male obese-hypertensive seem to present more with concentric hypertrophy (54.5% vs. 43.1% respectively, p>0.05) than female obese-hypertensive subjects. CONCLUSION: Structural, functional and geometric LV adaptation to obesity and hypertension varies between the two genders among Nigerians. The impact of isolated obesity on LV adaptation in women appears very significant.

Impact of urbanization and gender on frequency of metabolic syndrome among native Abuja settlers in Nigeria.

BACKGROUND: Metabolic syndrome (MetS) is an important cause of morbidity and mortality. Nigeria is currently undergoing rapid epidemiological transition. The objective was to study whether urbanization is associated with increased prevalence of MetS between native rural Abuja settlers and genetically related urban dwellers. MATERIALS AND METHODS: It was a cross-sectional study. Three hundred and forty-two urban native Abuja settlers and 325 rural dwellers were used for the study. Fasting blood lipid, glucose, waist circumference, blood pressure, and body mass index were determined. MetS was defined according to three standard criteria. SPSS 16.0 was used for statistical analysis. P<0.05 was used as statistically significant. RESULTS: Obesity, hypertriglyceridemia, and hypertension were commoner among urban dwellers than rural dwellers. MetS was associated more with the female gender. Urbanization significantly increases the frequency of MetS using the three standard definitions. The prevalence of MetS using International Diabetes Federation, World Health Organization, and National Cholesterol Education Program Adult Treatment Panel III among rural versus urban dwellers were 7.7% vs. 14.9%, P<0.05; 0% vs. 0.9%, P>0.05; and 3.7% vs. 13.7%, P<0.05, respectively. CONCLUSION: This study shows that MetS is a major health condition among rural and urban Nigerians and that urbanization significantly increases the prevalence of MetS. This can be explained on the basis of higher prevalence of dyslipidemia, obesity, and hypertension in urban setting, possibly as a result of stress, diet, and reduction in physical activity. Effective preventive strategy is therefore required to stem the increased risk associated with urbanization to reduce the cardiovascular risk associated with MetS among Nigerians.

Coexistence of Cor triatriatum sinistrum and a prominent Eustachian valve mimicking a Cor triatriatum dextrum.

Cor triatriatum is among the rarest of all congenital cardiac abnormalities accounting for 0.1-0.4% of all congenital heart disease. Its coexistence with a very prominent Eustachian valve which mimics a Cor triatriatum dextrum is an exceptionally rare finding in an asymptomatic adult. We report the case of a 44 year old male who presented to our department on observing a pulse rate of 44 beats per minute during a home blood pressure check with his digital sphygmomanometer. Clinical examinationwas however, unremarkable and resting electrocardiography showed sinus rhythm with atrial premature complexes. The diagnosis was made on a two dimensional transthoracic echocardiography. Isolated atrial premature complexes and bradycardia may be a clinical presentation of Cor triatriatum in adult population. Although extremely rare, its coexistence with a prominent Eustachian valve may remain asymptomatic into adult life.

End digit preference in blood pressure measurement in a hypertension specialty clinic in southwest Nigeria.

BACKGROUND: One of the observer errors associated with blood pressure (BP) measurement using a mercury sphygmomanometer is end digit preference (EDP) which refers to the occurrence of a particular end digit more frequently than would be expected by chance alone. Published reports, mainly from outside Africa, have shown a high prevalence ranging from 22 to 90% of end digit zero in BP readings taken by healthcare workers (HCWs). This study examined the prevalence of EDP and patients' and physicians' characteristics influencing the occurrence of EDP. METHODS: A retrospective review was undertaken of BP readings of 114 patients seen over a two-month period at our hypertension specialty clinic. RESULTS: Nurses and physicians displayed a high frequency of preference for end digit zero in systolic blood pressure (SBP) and diastolic blood pressure (DBP) readings. The preference for end digit zero was, however, higher for nurses than for physicians (SBP: 98.5 vs 51.2%, p < 0.001; DBP: 98.5 vs 64.3%, p < 0.001). Among the physicians, the consultant staff displayed the least preference for end digit zero compared to resident doctors. There was no statistically significant difference in gender, age, weight, height and BMI of those with BP readings with end digit zero compared with those with non-zero end digits. CONCLUSION: The high prevalence of EDP for zero argues for the training, retraining and certification of HCWs in BP measurement and the institution of a regular monitoring and feedback system on EDP in order to minimise this observer error.

Some emerging issues in medical admission pattern in the tropics.

BACKGROUND: There is a changing pattern in terms of medical admissions worldwide with an alarming increase in the prevalence of noncommunicable diseases, especially in the tropics over the last decade. The aim of this study was to describe the pattern of medical admission and highlight emerging issues of noncommunicable diseases in a Nigerian University Teaching Hospital. MATERIALS AND METHODS: A retrospective review of medical admission at the Ladoke Akintola University of Technology Teaching Hospital, Osogbo, South Western Nigeria, over a 3 years period (January 2005 to December 2007). Data were retrieved from the medical records of all medical admission over the study period. RESULTS: During the study period, 1786 patients were admitted into the medical wards. This consisted of 1089 males (61.0%) and 697 females (39.0%). Their ages ranged from 14 to 96 years with mean ages of 51 ± 16.89 years. Subjects ≥60 years of age accounted for 27.3% and 29.8% of total males and female admissions which were the largest age group. Noncommunicable diseases were responsible for 47.99% of total medical admissions. The indications for admission in order of frequency include cerebrovascular accidents 239 (13.4%), diabetes mellitus 194 (10.9%), tuberculosis 151 (8.5%), and chronic kidney disease 116 (6.5%). Hypertension was the underlying risk factor in majority of patients with CVD and CKD. CONCLUSION: Noncommunicable disease accounted for a significant number of admissions over 3 year duration. The elderly accounted for a major age group admitted for medical diseases. Therefore, preventive strategies against noncommunicable disease and effective geriatric care are advocated.

The clinical value of the Tei index among Nigerians with hypertensive heart failure: correlation with other conventional indices.

BACKGROUND: Various conventional methods are used for functional evaluation and risk stratification in heart failure. A combined index of global myocardial performance called the Tei index has been described. The aim of this study was to evaluate the correlation of the Tei index with other conventional indices of systolic and diastolic function among Nigerians with hypertensive heart failure. METHODS: Fifty-five subjects with hypertensive heart failure and 30 controls were examined, a clinical history was taken, and echocardiography was performed on them. The subjects were categorised into four groups based on their ejection fraction (normal ejection fraction, mild, moderate and severe heart failure). The Tei index was calculated as the sum of the isovolumic relaxation and contraction time, divided by the ejection time. Statistical analysis was done using SPSS 16.0. RESULTS: The Tei index was significantly higher among subjects with hypertensive heart failure compared with the controls (0.91 ± 0.33 vs 0.28 ± 0.16, p < 0.005). The Tei index also increased with the severity of the heart failure and was inversely correlated with ejection fraction (r = -0.697, p < 0.001) and fractional shortening (r = -0.580, p = 0.001). It was directly correlated with mitral E/A ratio (r = 0.246, p = 0.030), left ventricular internal diastolic dimension (r = 0.414, p = 0.002), left ventricular internal systolic dimension (r = 0.596, p < 0.001) and deceleration time (r = 0.219, p = 0.032). CONCLUSION: The Tei index correlated significantly with other conventional indices of systolic and diastolic function among Nigerians with hypertensive heart failure. It can be used as a risk-stratification index similar to other traditional indices of systolic and diastolic function.

Cor triatriatum in an 86-year-old woman: initial presentation with pulmonary hypertension discovered during preoperative evaluation.

Cor triatriatum is a congenital heart malformation that is characterised by the division of the left or right atrium into two separate chambers by a membrane or diaphragm. Reports among adults are scarce, as most cases are diagnosed during childhood. The risk of mortality is increased when cor triatriatum is complicated by pulmonary hypertension. This is a report of an 86-year-old woman with World Health Organization Group 2 pulmonary hypertension secondary to cor triatriatum, discovered during preoperative workup. Echocardiography showed a membrane dividing the left atrium into two. Doppler studies revealed a reversal of normal flow, similar to mitral stenosis. The right ventricle was dilated, with reduced long axis 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.

Case report of a 26 year old primigravida with patent ductus arteriosus (PDA) in heart failure.

Congenital heart disease is an important cause of maternal morbidity and mortality during pregnancy. Pregnancy alters the circulatory and respiratory physiology with attendant deleterious effect on the mother with congenital heart disease and the foetus. Additional insult to the circulatory physiology by other factors coexisting together with congenital heart disease can further reduce the cardiac reserve in pregnancy and precipitate heart failure. These factors include anaemia, thromboembolism, hypertension, multiple pregnancy, strenuous physical activity, extremes of temperature and the normal physiological edema of pregnancy.Patent ductus arteriosus (PDA) can present for the first time in pregnancy. Moderate to large PDA result in significant volume overload, left ventricular dilation and dysfunction. In the woman with a hemodynamically important PDA, pregnancy may precipitate or worsen heart failure. We report a successful pregnancy in a 26 year old primigravida with previously undetected patent ductus arteriosus with preeclampsia who presented in heart failure. This case highlights the importance of intensive careful examination of pregnant patients to identify such conditions.

Effect of systemic hypertension on right ventricular morphology and function: an echocardiographic study.

BACKGROUND: Hypertension is an important cardiovascular risk factor worldwide. It is associated with left ventricular hypertrophy (LVH). Both diastolic and systolic dysfunction may occur in hypertensive heart disease. The ventricles are structurally and functionally interdependent on each other. This was an echocardiographic study intended to describe the impact of left ventricular pressure overload and hypertrophy due to hypertension on right ventricular morphology and function. METHODS: One hundred subjects with systemic hypertension and 50 age- and gender-matched normotensive control subjects were used for this study. Two-dimensional (2-D), M-mode and Doppler echocardiographic studies were done to evaluate the structure and function of both ventricles. Data analysis was done using the SPSS 16.0 (Chicago, Ill). Statistical significance was taken as p < 0.05. RESULTS: Age and gender were comparable between the two groups. Hypertensive subjects had significantly increased left ventricular end-diastolic dimensions, posterior wall thickness, interventricular septal thickness, left atrial dimensions and left ventricular mass and index. The mitral valve E/A ratio was reduced among hypertensive subjects when compared to normal controls (1.15 ± 0.75 vs 1.44 ± 0.31, respectively; p < 0.05). A similar pattern was found in the tricuspid E/A ratio (1.14 ± 0.36 vs 1.29 ± 0.30, respectively; p < 0.05). Hypertensive subjects also had reduced right ventricular internal dimensions (20.7 ± 8.0 vs 23.1 ± 3.1 mm, respectively; p < 0.001) but similar peak pulmonary systolic velocity. The mitral e/a ratio correlated well with the tricuspid e/a ratio. CONCLUSION: Systemic hypertension is associated with right ventricular morphological and functional abnormalities. Right ventricular diastolic dysfunction may be an early clue to hypertensive heart disease.

Epidemiology of conventional cardiovascular risk factors among hypertensive subjects with normal and impaired fasting glucose.

BACKGROUND: Impaired fasting or glucose tolerance and/or diabetes can occur with hypertension, which theoretically predicts a worse cardiovascular risk profile, and consequently requires intensive cardiovascular risk management. OBJECTIVES: To characterise the frequency of the occurrence of conventional cardiovascular risk factors among hypertensive subjects with impaired fasting blood glucose. METHODS: We studied 120 hypertensive subjects and 80 age- and sex-matched normotensive controls. Relevant history, clinical examination, laboratory and other tests were undertaken. Body mass index was determined. Informed consent was obtained from all participants, and ethical approval was obtained. RESULTS: There was no statistically significant difference between the age and gender of the hypertensive subjects and the controls (55.1+/-10.83 v. 54.7+/-10.89 years, p=0.76). The serum fasting lipids were higher, but not statistically significantly, among the hypertensives than the controls (triglycerides 1.23+/-0.50 v. 1.22+/-0.48, p=0.900; total cholesterol 4.51+/-1.52 v. 4.38+/-0.84, p=0.842; LDL 2.51+/-1.41 v. 2.4+/-0.63, p=0.811, respectively). The prevalence of impaired glucose tolerance among newly presenting hypertensive subjects was 30.0%. Hypertriglyceridaemia (38.9% v. 6.0%, p=0.038), hypo-HDL cholesterolaemia (52.7% v. 31.0%, p=0.028) and visceral obesity (52.8% v. 27.4%, p=0.036) were statistically more prevalent among hypertensive subjects with impaired glucose tolerance than among those with normal glucose tolerance. CONCLUSION: The prevalence of impaired glucose tolerance among newly presenting hypertensive subject is very high, and they have more clusters of cardiovascular risks than those without impaired glucose tolerance. The former therefore need intensive cardiovascular assessment and appropriate preventive and treatment modalities. Glucose parameters of newly presenting hypertensive subjects must be determined to evaluate their cardiovascular risk profile.

Burden of obesity in essential hypertension: pattern and prevalence.

UNLABELLED: Obesity continues to be an epidemic worldwide. There also continues to be a relationship between obesity and hypertension both causal and consequentially. The study aims at determining the prevalence and pattern of overweight and obesity among our patients being managed for essential hypertension. MATERIAL AND METHODS: The study was a cross sectional study. Consecutive patients diagnosed with essential hypertension were recruited from two university teaching hospitals in the South West of Nigeria. Demographic data such as age, gender, weight and height were obtained from patients at recruitment. Patients with congestive heart failure, secondary hypertension, chronic kidney disease, and other chronic diseases were excluded. Pregnant women were also excluded. Obesity was defined according to WHO classification. Statistical analysis was done by the Statistical Package for Social Sciences version 11.0. RESULTS: One thousand one hundred and two (1102) consecutive hypertensive patients were recruited. Two hundred and eighty six (286) were dropped due to evidence of overt heart failure (98) and chronic kidney disease and others (188). There were (420) males (51.5%) and 396 females (48.5%), mean age 54.97 (±13.14) years. (Range 10-91). 7.6% (62) were underweight (36 males, 26 Females): 260 (31.9%) were overweight, consisting of 148 males and 112 females: 135 (16.5%) had mild obesity consisting of 48 males and 87 females: 43(5.3%) had moderate obesity with 15 males and 28 females while 30(3.7%) had severe obesity (consisting of 22 females). CONCLUSION: About two thirds of the hypertensive patients seen in two teaching hospitals in the South West of Nigeria in this study were either overweight or obese. Therefore lifestyle modification geared toward weight reduction should be emphasized in these patients.