Normal limits of electrocardiogram in Africans and their consequences on the prevalence of left ventricular hypertrophy in hypertensive individuals: Insights from the TAHES study.

AIMS: To determine normal limits for major ECG variables, and the electrocardiographic impact of hypertension, in a rural sub-Saharan African setting. METHODS: This cross-sectional study included adults aged ≥25 years from Tanvè Health Study (TAHES) cohort. ECG were recorded at rest at 25 mm/s using a standard 12­lead device. Wave amplitudes and durations were measured. Corrected QT interval (QTc) was calculated using Bazett's formula. Sokolow-Lyon, Cornell and Peguero-Lo Presti criteria were determined to assess left ventricular hypertrophy (LVH). RESULTS: ECG was recorded among 997 out of 1407 TAHES participants. After exclusion of subjects with hypertension or diabetes, normal limits, defined as the 2nd and 98th percentiles, were evaluated in 622 healthy participants (median: 37 years; 60.1% women). The following limits were established in men (women): heart rate: 50 to 100 (55 to 102) beats/min, P wave duration: 80 to 120 (80 to 120) ms, PR interval: 120 to 200 (120 to 200) ms, QTc: 315 to 470 (323 to 465) ms, QRS duration: 50 to 120 (50 to 110) ms. Upper limits (in millimeter) for the Sokolow-Lyon, Cornell and Peguero-Lo Presti for men (women) were 47 (38), 30 (22) and 39 (30), respectively, all above current reference limits. The prevalence of LVH in hypertensive subjects according to these criteria were lower than those estimated according to current LVH criteria. CONCLUSION: The normal limits of ECG variables determined in this African population differ from those in Caucasians, indicating that ethnicity must be considered in ECG interpretation.

May Measurement Month 2018: an analysis of blood pressure screening results from Benin.

Hypertension is the strongest cardiovascular risk factor worldwide. May Measurement Month (MMM) is an international campaign for blood pressure (BP) screening initiated by the International Society of Hypertension. This work aims to estimate the proportion and the levels of awareness, treatment, and control of hypertension in participants of the MMM survey in Benin in 2018. A cross-sectional survey focused on people aged ≥18 years was conducted in May 2018 in nine rural and urban areas in Benin. A sampling of volunteers was done. BP was measured following the MMM protocol. Hypertension was defined as a systolic BP ≥140 mm Hg and/or a diastolic BP ≥90 mm Hg (mean of the second and third readings) and/or taking antihypertensive medication. Linear regression was used to identify BP associations. A total of 2035 people were screened, including 55.9% women. The mean age was 44.2 ± 15.9 years. The percentage with hypertension was 35.4%. Of 721 participants with hypertension, 56.2% were aware of their diagnosis, 39.7% were on antihypertensive medication, and 13.6% were controlled (<140/90 mmHg). The results confirm the significant proportion of hypertension in Benin. Education programs on risk factors, early detection, and better management strategies should be developed.

Use of traditional medicine and control of hypertension in 12 African countries.

BACKGROUND: Use of traditional medicine (TM) is widespread in sub-Saharan Africa as a treatment option for a wide range of disease. We aimed to describe main characteristics of TM users and estimate the association of TM use with control of hypertension. METHODS: We used data on 2128 hypertensive patients of a cross-sectional study (convenience sampling), who attended cardiology departments of 12 sub-Saharan African countries (Benin, Cameroon, Congo, Democratic Republic of the Congo, Gabon, Guinea, Côte d'Ivoire, Mauritania, Mozambique, Niger, Senegal, Togo). To model association of TM use with odds of uncontrolled, severe and complicated hypertension, we used multivariable mixed logistic regressions, and to model the association with blood pressure (systolic (SBP) and diastolic (DBP)) we used mixed linear models. All models were adjusted for age, sex, wealth, adherence to hypertension conventional treatment and country (random effect). RESULTS: A total of 512 (24%) participants reported using TM, varying across countries from 10% in the Congo to 48% in Guinea. TM users were more likely to be men, living in rural area, poorly adhere to prescribed medication (frequently due to its cost). Use of TM was associated with a 3.87 (95% CI 1.52 to 6.22)/1.75 (0.34 to 3.16) mm Hg higher SBP/DBP compared with no use; and with greater odds of severe hypertension (OR=1.34; 95% CI 1.04 to 1.74) and of any hypertension complication (OR=1.27; 95% CI 1.01 to 1.60), mainly driven by renal complication (OR=1.57; 95% CI 1.07 to 2.29) after adjustment for measured confounders. CONCLUSIONS: The use of TM was associated with higher blood pressure, more severe hypertension and more complications in Sub-Saharan African countries. The widespread use of TM needs to be acknowledged and worked out to integrate TM safely within the conventional healthcare.

Barriers to up-titrated antihypertensive strategies in 12 sub-Saharan African countries: the Multination Evaluation of hypertension in Sub-Saharan Africa Study.

BACKGROUND: Sub-Saharan Africa (SSA) faces the highest rate of hypertension worldwide. The high burden of elevated blood pressure (BP) in black people has been emphasized. Guidelines recommend two or more antihypertensive medications to achieve a BP control. We aimed to identify factors associated with prescription of up-titrated antihypertensive strategies in Africa. METHODS: We conducted a cross-sectional study on outpatient consultations for hypertension across 12 SSA countries. Collected data included socioeconomic status, antihypertensive drugs classes, BP measures, cardiovascular risk factors and complication of hypertension. We used ordinal logistic regression to assess factors associated with prescription of up-titrated strategies. RESULTS: The study involved 2123 treated patients with hypertension. Patients received monotherapy in 36.3 vs. 25.9%, two-drug in 42.2 vs. 45% and three and more drugs strategies in 21.5 vs. 29.1% in low (LIC) and middle (MIC) income countries, respectively. Patients with sedentary lifestyle [OR 1.4 (1.11-1.77)], complication of hypertension [OR 2.4 (1.89-3.03)], former hypertension [OR 3.12 (2.3-4.26)], good adherence [OR 1.98 (1.47-2.66)], from MIC [OR 1.38 (1.10-1.74)] and living in urban areas [OR 1.52 (1.16-1.99)] were more likely to be treated with up-titrated strategies. Stratified analysis shows that in LIC, up-titrated strategies were less frequent in rural than in urban patients (P for trend <0.01) whereas such difference was not observed in MIC. CONCLUSION: In this African setting, in addition to expected factors, up-titrated drug strategies were associated with country-level income, patient location and finally, the interplay between both in LIC. These results highlight the importance of developing policies that seek to make multiple drug classes accessible particularly in rural and LIC.

Blood pressure-lowering medicines implemented in 12 African countries: the cross-sectional multination EIGHT study.

OBJECTIVE: In Africa, the number of patients with hypertension is expected to reach 216.8 million by 2030. Large-scale data on antihypertensive medications used in Sub-Saharan Africa (SSA) are scarce.Here, we describe antihypertensive drug strategies and identify treatment factors associated with blood pressure (BP) control in 12 Sub-Saharan countries. SETTING: Outpatient consultations for hypertension in urban tertiary cardiology centres of 29 hospitals from 17 cities across 12 SSA countries between January 2014 and November 2015. PARTICIPANTS: Patients ≥18 years of age with hypertension were enrolled at any visit during outpatient consultations in the cardiology departments MAIN OUTCOME MEASURE: We collected BP levels, demographic characteristics and antihypertensive treatment use (including traditional medicine) of patients with hypertension attending outpatient visits. BP control was defined as seated office BP <140/90 mm Hg. We used logistic regression with a random effect on countries to assess factors of BP control. RESULTS: Overall, 2198 hypertensive patients were included and a total of 96.6% (n=2123) were on antihypertensive medications. Among treated patients, 653 (30.8%) patients received a monotherapy by calcium channel blocker (n=324, 49.6%), renin-angiotensin system blocker (RAS) (n=126, 19.3%) or diuretic (n=122, 18.7%). Two-drug strategies were prescribed in 927 (43.6%) patients including mainly diuretics and RAS (n=327, 42% of two-drug strategies). Prescriptions of three-drugs or more were used in 543 (25.6%) patients. Overall, among treated patients, 1630 (76.7%) had uncontrolled BP, of whom 462 (28.3%) had BP levels ≥180/110 mm Hg, mainly in those on monotherapy. After adjustment for sociodemographic factors, the use of traditional medicine was the only factor significantly associated with uncontrolled BP (OR 1.72 (1.19 to 2.49) p<0.01). CONCLUSION: Our study provided large-scale data on antihypertensive prescriptions in the African continent. Among patients declared adherent to drugs, poor BP control was significantly associated with the use of traditional medicine.

Apport de la saturométrie dans le dépistage des cardiopathies congénitales cyanogènes chez les nouveau-nés au CNHU-HKM Cotonou, faisabilité et résultats préliminaires en 2019 / NA

Introduction : Les cardiopathies congénitales critiques représentant 25% des cardiopathies congénitales et s'accompagnent souvent de désaturation, d'où l'intérêt de l'utilisation de la saturation pulsée en oxygène pour favoriser leur détection chez tous les nouveau-nés avant la sortie de maternité et un traitement adéquat. Au Bénin la saturométrie de dépistage est encore peu utilisée. Cette étude avait pour objectif d'étudier l'apport de la saturométrie dans le dépistage des cardiopathies congénitales cyanogènes au CNHU-HKM de Cotonou en 2019. Méthodes : Il s'agissait d'une étude transversale, descriptive et analytique qui s'est déroulée du 15 mai au 13 novembre 2019 et ayant inclus les nouveau-nés, nés au CNHU- HKM. Tous les enfants ont bénéficié d'un examen clinique et d'un test de saturométrie. L'échographie Döppler cardiaque a été réalisée chez tous les patients et utilisée comme gold standard pour déterminer les performances diagnostiques de la saturométrie pour le dépistage des cardiopathies congénitales cyanogènes. Résultats : un total de 379 nouveau-nés ont été inclus. L'acceptabilité parentale était de 72,64%. La saturométrie a permis de détecter 4 cas d'hypertension artérielle pulmonaire persistante du nouveau-né (HTAPP) associée à un foramen ovale shuntant droite-gauche. La saturométrie de dépistage avait une sensibilité de 100%, une spécificité de 94,93% et une valeur prédictive positive à 17,4%. Malgré son faible caractère discriminant pour les autres causes de désaturation, la valeur prédictive négative était de 100%. L'examen clinique améliore les performances diagnostiques de la saturométrie pour le dépistage des cardiopathies congénitales cyanogènes. Conclusion : La saturométrie est un test de dépistage aisément utilisable dans nos conditions de travail et avec une bonne acceptabilité parentale. Malgré son faible caractère discriminant, ses performances diagnostiques sont excellentes pour le dépistage des cardiopathies congénitales cyanogènes.

ABSTRACT Introduction: Critical congenital heart disease represented 25% of congenital heart disease and are often accompanied by desaturation, hence the interest to use pulse oximeter in order to detect all newborns who have congenital heart disease before discharge after birth. In Benin, pulse oximetry screening is rarely used. This study aimed to study the contribution of s pulse oximetry screening in the detection of cyanotic congenital heart disease at the CNHU-HKM in Cotonou in 2019. Results: 379 newborns were included. The parental acceptability was 72.64%. Pulse oximetry detected 4 cases of newborn pulmonary hypertension with a permeable foramen oval and right to left shunt. Pulse oximetry screening had a sensitivity of 100% and a specificity of 94.93%, a positive predictive value of 17.4%. Despite its low discriminating character for the other causes of desaturation, its negative predictive value was 100%. Clinical examination improves results of pulse oximetry to detect cyanotic congenital heart disease. Conclusion: Pulse oximetry is a screening test easily used in our condition with a good parental acceptability. Despite its low discriminating character, it has an excellent accuracy to detect cyanotic congenital heart disease.

Poor adherence to medication and salt restriction as a barrier to reaching blood pressure control in patients with hypertension: Cross-sectional study from 12 sub-Saharan countries.

BACKGROUND: Sub-Saharan Africa is experiencing a rising burden of hypertension. Antihypertensive medications and diet are the cornerstone of effective hypertension control. AIMS: To assess adherence to medication and salt restriction in 12 sub-Saharan countries, and to study the relationship between adherence and blood pressure control in patients with hypertension. METHODS: We conducted a cross-sectional survey in urban clinics in twelve sub-Saharan countries. Data were collected on demographics, treatment and adequacy of blood pressure control in patients with hypertension attending the clinics. Adherence was assessed by questionnaires completed by the patients. Hypertension grades were defined according to European Society of Cardiology guidelines. Association between adherence and blood pressure control was investigated using multilevel logistic regression analysis, adjusting for age, sex and country. RESULTS: Among the 2198 patients, 77.4% had uncontrolled blood pressure, 34.0% were poorly adherent to salt restriction, 64.4% were poorly adherent to medication and 24.6% were poorly adherent to both. Poor adherence to salt restriction (odds ratio [OR] 1.33, 95% confidence interval [CI] 1.03-1.72), medication (OR 1.56, 95% CI 1.25-1.93) or both (OR 1.91 1.39-2.66) was related to uncontrolled blood pressure. Moreover, poor adherence to both medication and salt restriction was related to a 1.52-fold (95% CI 1.04-2.22), 1.8-fold (95% CI 1.22-2.65) and 3.08-fold (95% CI 2.02-4.69) increased likelihood of hypertension grade 1, 2 and 3, respectively. CONCLUSIONS: High levels of poor adherence to salt restriction and medication were noted in this urban sub-Saharan study; both were significantly associated with uncontrolled blood pressure, representing major opportunities for intervention to improve hypertension control in sub-Saharan Africa.

Cardiac arrhythmia services in Africa from 2011 to 2018: the second report from the Pan African Society of Cardiology working group on cardiac arrhythmias and pacing.

AIMS: Cardiac arrhythmia services are a neglected field of cardiology in Africa. To provide comprehensive contemporary information on the access and use of cardiac arrhythmia services in Africa. METHODS AND RESULTS: Data on human resources, drug availability, cardiac implantable electronic devices (CIED), and ablation procedures were sought from member countries of Pan African Society of Cardiology. Data were received from 23 out of 31 countries. In most countries, healthcare services are primarily supported by household incomes. Vitamin K antagonists (VKAs), digoxin, and amiodarone were available in all countries, while the availability of other drugs varied widely. Non-VKA oral anticoagulants (NOACs) were unequally present in the African markets, while International Normalized Ratio monitoring was challenging. Four countries (18%) did not provide pacemaker implantations while, where available, the implantation and operator rates were 2.79 and 0.772 per million population, respectively. The countries with the highest pacemaker implantation rate/million population in descending order were Tunisia, Mauritius, South Africa, Algeria, and Morocco. Implantable cardioverter-defibrillator and cardiac resynchronization therapy (CRT) were performed in 15 (65%) and 12 (52%) countries, respectively. Reconditioned CIED were used in 5 (22%) countries. Electrophysiology was performed in 8 (35%) countries, but complex ablations only in countries from the Maghreb and South Africa. Marked variation in costs of CIED that severely mismatched the gross domestic product per capita was observed in Africa. From the first report, three countries have started performing simple ablations. CONCLUSION: The access to arrhythmia treatments varied widely in Africa where hundreds of millions of people remain at risk of dying from heart block. Increased economic and human resources as well as infrastructures are the critical targets for improving arrhythmia services in Africa.

Factors associated with noncompliance of sodium restriction in hypertensive and heart failure patients at the National Hospital of Cotonou, Benin.

INTRODUCTION: Nutritional therapy in the treatment of high blood pressure and heart failure is a real challenge in terms of compliance of sodium restriction for success of the treatment. The study aims to assess the level of patient compliance with the sodium restriction by salt consumption, prescribed by care providers and the associated factors. MATERIALS AND METHODS: Total daily salt intake was estimated in a cross-sectional study of 166 hypertensive and heart failure subjects monitored in the cardiology department of the "Centre Hospitalier Universitaire - Hubert Koutoukou Maga" (CNHU-HKM), using two 24-hour recalls combined with a food frequency questionnaire for salt-providing foods. RESULTS: Out of the study, 83.7% of patients had a daily intake above recommendations. Factors associated with the non-compliance of salt restriction were the lack of knowledge of palliative spices and herbs of salty taste (p=0.009) and the consumption of salty snack foods and salty peanuts (p=0.032). CONCLUSION: Nutritional education and support activities should be carried out to improve the salt reduction compliance for these patients.

Factors associated with poor adherence to medication among hypertensive patients in twelve low and middle income Sub-Saharan countries.

INTRODUCTION: Over the past few decades, the prevalence of hypertension has dramatically increased in Sub-Saharan Africa. Poor adherence has been identified as a major cause of failure to control hypertension. Scarce data are available in Africa. AIMS: We assessed adherence to medication and identified socioeconomics, clinical and treatment factors associated with low adherence among hypertensive patients in 12 sub-Saharan African countries. METHOD: We conducted a cross-sectional survey in urban clinics of both low and middle income countries. Data were collected by physicians on demographics, treatment and clinical data among hypertensive patients attending the clinics. Adherence was assessed by questionnaires completed by the patients. Factors associated with low adherence were investigated using logistic regression with a random effect on countries. RESULTS: There were 2198 individuals from 12 countries enrolled in the study. Overall, 678 (30.8%), 738 (33.6%), 782 (35.6%) participants had respectively low, medium and high adherence to antihypertensive medication. Multivariate analysis showed that the use of traditional medicine (OR: 2.28, 95%CI [1.79-2.90]) and individual wealth index (low vs. high wealth: OR: 1.86, 95%CI [1.35-2.56] and middle vs. high wealth: OR: 1.42, 95%CI [1.11-1.81]) were significantly and independently associated with poor adherence to medication. In stratified analysis, these differences in adherence to medication according to individual wealth index were observed in low-income countries (p<0.001) but not in middle-income countries (p = 0.17). In addition, 26.5% of the patients admitted having stopped their treatment due to financial reasons and this proportion was 4 fold higher in the lowest than highest wealth group (47.8% vs 11.4%) (p<0.001). CONCLUSION: This study revealed the high frequency of poor adherence in African patients and the associated factors. These findings should be useful for tailoring future programs to tackle hypertension in low income countries that are better adapted to patients, with a potential associated enhancement of their effectiveness.

Connaissances, attitudes et pratiques sur l'hypertension artérielle, chez les patients d'un centre de santé de premier niveau au sud-ouest du Bénin

Introduction : Au Bénin, en 2008, la prévalence de l'HTA dans le département du Mono au Sud-Ouest, était l'une des plus élevée avec 35,76%. L'objectif cette étude était d'évaluer les connaissances, les attitudes et les pratiques des patients sur l'HTA en vue d'adapter les messages de prévention en direction des populations. Méthode : Etude transversale descriptive avec collecte prospective des données, qui s'est déroulée dans l'arrondissement d'Akodéha du 20 Juillet au 20 Août 2016. Les patients âgés d'au moins 18 ans présents dans le centre de santé, ont été enquêtés de même que ceux qui y ont consulté au cours des 6 mois précédents l'enquête. Les connaissances globales sur l'HTA, les attitudes et les pratiques des enquêtés ont été collectées lors d'un entretien dirigé. Cinq items sont retenus pour l'évaluation : origine/ causes, symptômes, complications, dépistage, durée de traitement. Résultats : Nous avons enquêté 265 patients. La moyenne d'âge était 36,67±10,44 ans et le sex-ratio de 1,03 (M/F : 135/130). Parmi les enquêtés, 46,40% déclaraient savoir lire ou écrire dans une langue quelconque et parmi eux 82,0% ,avaient le niveau primaire ou secondaire et 17,35% le niveau universitaire. Seuls 22,73% des enquêtés ontdéclaré avoir une connaissance sur l'HTA. Les sources d'information sur l'HTA étaient : l'agent de santé (50%), les mass médias (22,05%), les lectures personnelles (17,65%), les tiers (10,29%). Sur les 5 items d'évaluation du niveau de connaissance globale, 96,7% des enquêtés qui déclaraient avoir une connaissance sur l'HTA, avaient des réponses bonnes, côtées au moins à 3/5. Seuls 23,85% des enquêtés déclaraient faire une activité physique régulière. Les repas riches en gras sont préférés par 45,11% et les repas hypersodés par 23,28% des enquêtés. Parmi les enquêtés hypertendus, 44,83% ne suivaient aucun régime et 74,07% ne suivaient aucun traitement médical. Conclusion : Cette étude montre un faible niveau de connais-sance sur l'HTA chez les patients du centre de santé d'Akodéha. Les attitudes et les pratiques ne sont pas favorables pour le contrôle de l'HTA. Les activités de prévention pour un changement de comportement doivent être menées lors du contact médical afin d'améliorer le niveau de connaissance des patients

Epidemiology of lower extremity artery disease in a rural setting in Benin, West Africa: The TAHES study.

BACKGROUND: Data on epidemiology of lower extremity artery disease (LEAD) in general population in Sub-Saharan Africa are sparse. This study aims to estimate the prevalence of LEAD among participants of Tanve Health Study (TAHES), a cohort about cardiovascular diseases (CVD) in a rural setting in Benin. METHODS: The cohort was launched since 2015 among adults aged over 25 years in Tanve, a village in Benin. Ankle-brachial index (ABI) was measured for the first time during the third annual visit of the cohort in 2017. Risk factors data were collected using the WHO STEPS adapted questionnaire in a systematic door-to-door survey. The LEAD was defined as ABI ≤ 0.90. RESULTS: We recorded ABI among 1003 out of 1407 TAHES' participants. A predominance of females (61.4%) was observed. The mean age was 44.4 ±â€¯15.7 years and 49.9% were under 40 years. Regarding CVD risk factors, prevalences were estimated for sedentary behavior (68.2%), harmful use of alcohol (3.9%), fruit and vegetable low intake (96.0%), tobacco smoking (5.2%), Overweight or obesity (Body mass index > 25) (27.7%), raised blood pressure (36.8%) and raised blood glucose (5.4%). Prevalence of LEAD was 5.5% (95%CI: 4.2%­7.1%) in the sample, 7.0% (95%CI: 5.1%­9.4%) in women and 3.1% (95%CI: 1.7%­5.5%) in men. Five individuals (0.5%; 95%CI: 0.2%­1.2%) had incompressible arteries (ABI ≥ 1.40), including four men. In multivariate analysis, LEAD was significantly associated with age ≥ 55 years (OR: 2.17; 95%CI: 1.20­3.92; p = 0.009) and female gender (OR: 2.27; 95%CI: 1.17­4.40; p = 0.014). CONCLUSION: Prevalence of LEAD is high in rural Benin and predominates among women and people over 55 years old.

Socioeconomic Status and Hypertension Control in Sub-Saharan Africa: The Multination EIGHT Study (Evaluation of Hypertension in Sub-Saharan Africa).

Systemic hypertension is a rapidly growing epidemic in Africa. The role of socioeconomic status on blood pressure control has not been well studied in this part of the world. We, therefore, aimed to quantify the association of socioeconomic status both at the individual and at the country level with blood pressure control in Sub-Saharan Africa. We conducted a cross-sectional survey in urban clinics of 12 countries, both low income and middle income, in Sub-Saharan Africa. Standardized blood pressure measures were made among the hypertensive patients attending the clinics. Blood pressure control was defined as blood pressure <140/90 mm Hg, and hypertension grades were defined according to the European Society of Cardiology guidelines. A total of 2198 hypertensive patients (58.4±11.8 years; 39.9% men) were included. Uncontrolled hypertension was present in 1692 patients (77.4%), including 1044 (47.7%) with ≥grade 2 hypertension. The proportion of uncontrolled hypertension progressively increased with decreasing level of patient individual wealth, respectively, 72.8%, 79.3%, and 81.8% (P for trend, <0.01). Stratified analysis shows that these differences of uncontrolled hypertension according to individual wealth index were observed in low-income countries (P for trend, 0.03) and not in middle-income countries (P for trend, 0.26). In low-income countries, the odds of uncontrolled hypertension increased 1.37-fold (odds ratio, 1.37 [0.99-1.90]) and 1.88-fold (odds ratio, 1.88 [1.10-3.21]) in patients with middle and low individual wealth as compared with high individual wealth. Similarly, the grade of hypertension increased progressively with decreasing level of individual patient wealth (P for trend, <0.01). Strategies for hypertension control in Sub-Saharan Africa should especially focus on people in the lowest individual wealth groups who also reside in low-income countries.

[Isolated double-chambered right ventricle (DCRV): a case study conducted at the National University Hospital CNHU-HKM in Cotonou, Benin]. / Ventricule droit à double chambre (VDDC) isolé: à propos d'un cas au CNHU, Cotonou, Bénin.

Double-chambered right ventricle (DCRV) is a very rare cardiac defect in which the right ventricle is divided by anomalous muscle bundle into two chambers. It is associated with other malformations in 80-90% of cases. Clinical presentation varies and depends on the extent of the intraventricular obstruction. We here report the case of a 16-year old teenager with isolated DCRV revealed by recurrent syncopes. The diagnosis was made using Doppler echocardiography. The patient underwent successful surgical resection of the abnormal muscle band.

Feasibility of a cardiovascular cohort in a Sub-Saharan Africa community: preliminary report of the pilot project TAHES (Tanvè Health Study) in Benin.

BACKGROUND: Faced with the growing burden of cardiovascular disease (CVD) including atherosclerotic in Sub-Saharan Africa (SSA), the development of appropriate prediction tools, based on large cohorts, appears useful for prevention. OBJECTIVE: The objective of the pilot project TAHES (Tanvè Health Study) was to explore the feasibility of a large cohort study focused on CVD and risk factors in Benin. METHODS: We implemented a prospective cohort over 2 years. The sample consisted of all people aged 25 years or older who had lived for at least the previous 6 months in the villages of Tanvè or Dékanmè. At baseline in February 2015, behaviours and medical histories were recorded using a standardized questionnaire adapted from the WHO Steps instrument; screening questionnaires for angina, claudication, congestive heart failure, and stroke were applied; anthropometric measures and fasting capillary blood glucose were taken. All participants were included in the follow-up phase. Surveillance of target CVD and deaths was implemented through a medical and a community network. RESULTS: A total of 1,195 participants were enrolled at baseline; women represented 65.5% and the median age was 39 years. The high participation rate (91.4%), the quality of baseline data, and the functionality of the events surveillance network over 8 months indicated good perspective for the feasibility of a large cohort. We recorded a 3.8% prevalence of daily smoking, 3.6% of harmful use of alcohol, 10.7% of obesity, 25.5% of high blood pressure, and 3.5% of diabetes. Prevalence of angina pectoris (2.7%), intermittent claudication (2.0%), congestive heart failure (0.9%), and stroke survival with motor impairment (3‰) were also recorded. Ten deaths occurred during the first 8 months, all within households; a cardiovascular cause was suspected in four cases. CONCLUSION: These preliminary results support the feasibility of establishing a cohort in Benin. It would require technical and resource support.

Profil lipidique des patients traités par statines en service de cardiologie, CNHU, Bénin. Les objectifs cibles de LDL-C sont-ils atteints ?

Introduction : Les maladies cardiovasculaires sont une cause majeure d'incapacité et de décès prématurés à l'échelle mondiale et les dyslipidémies représentent un facteur de risque majeur d'athérosclérose. Le but est d'évaluer l'atteinte des objectifs de LDL-C chez les patients traités par statines dans le service de cardiologie du CNHU-HKM de Cotonou.Méthode : Il s'agit d'une étude rétrospective, portant sur la période du 1er juin 2013 au 31 décembre 2014, nous avons inclus de façon exhaustive les patients de plus 18 ans, hospitalisés et traités par statines. Les données cliniques, biologiques, thérapeutiques et évolutives ont été révisées et une stratification de risque basée les tables SCORE (Systematic Coronary Risk Evaluation) a été faite à postériori.Les taux de LDL-C des patients ont été comparés aux cibles de LDL-C retenues par les recommandations de l'European Society of Cardiology (ESC) 2011. La valeur de p<0,05 est retenu comme seuil de significative.Résultats : Sur 551 patients hospitalisés, 130 patients étaient traités par statines. L'âge moyen est de 60,01 ±12,78 ans, le sex ratio H/F est de 1,65. Chez 53,8% des patients on retrouvait une dyslipidémie avec 40% d'hypercholestérolémie. Les autres facteurs de risque athéromateux étaient dominés par l'HTA (72,3%). Le niveau de RCV était élevé chez 93,8% des patients à l'instauration des statines. La prescription des statines était principalement faite en prévention secondaire. L'objectif de LDL-C cible n'était pas atteint chez 61% des patients. La valeur seuil du LDL-C initiale ≥ 1,6 g/l était prédictive de non atteinte de l'objectif LDL-C. Conclusion : Les objectifs cibles de LDL-C sont atteints chez moins de 4 patients sur 10 dans notre série. Notre étude suggère la nécessité de mettre en place des stratégies appropriées pour l'atteinte des objectifs de LDL-C au cours du traitement par statines

Management of arterial hypertension in Cotonou city, Benin: general practitioners' knowledge, attitudes and practice.

OBJECTIVE: We aimed to assess the management of hypertensive patients by general practitioners in Cotonou city. METHODS: This was a cross-sectional study based on a multicentre survey conducted from 1 May to 31 July 2011. We recruited all consenting general practitioners who worked in public and private centres in Cotonou city. We used the 7th report of the Joint National Committee to assess the management of hypertension by general practitioners. A tested and validated self-questionnaire was used to collect the data on hypertension management by general practitioners. RESULTS: In eight centres that approved the study, 41 general practitioners were included. The definition of hypertension was known by 20 (48.8%) practitioners. Only 25 (61.0%) could describe the conditions for blood pressure measurement. Ten of them were unable to list half of the minimum recommended tests for hypertension, and the majority (92.7%) did not have any idea of global cardiovascular risk. The blood pressure goal was known by only 18 (43.9%) practitioners. Lifestyle (82.9%) and monotherapy (70.7%) were the therapeutic modalities most prescribed. Antihypertensive agents commonly used by practitioners were calcium channel blockers (82.9%), angiotensin converting enzyme inhibitors (53.7%) and diuretics (36.6%). The general practitioners referred their patients to cardiologists mainly for uncontrolled hypertension (63.4%) and the onset of acute complications (56.1%). CONCLUSION: The general practitioners' knowledge of hypertension was insufficient and their management did not reflect international guidelines.

Optimizing the management of acute coronary syndromes in sub-Saharan Africa: A statement from the AFRICARDIO 2015 Consensus Team.

BACKGROUND: Whereas the coronary artery disease death rate has declined in high-income countries, the incidence of acute coronary syndromes (ACS) is increasing in sub-Saharan Africa, where their management remains a challenge. AIM: To propose a consensus statement to optimize management of ACS in sub-Saharan Africa on the basis of realistic considerations. METHODS: The AFRICARDIO-2 conference (Yamoussoukro, May 2015) reviewed the ongoing features of ACS in 10 sub-Saharan countries (Benin, Burkina-Faso, Congo-Brazzaville, Guinea, Ivory Coast, Mali, Mauritania, Niger, Senegal, Togo), and analysed whether improvements in strategies and policies may be expected using readily available healthcare facilities. RESULTS: The outcome of patients with ACS is affected by clearly identified factors, including: delay to reaching first medical contact, achieving effective hospital transportation, increased time from symptom onset to reperfusion therapy, limited primary emergency facilities (especially in rural areas) and emergency medical service (EMS) prehospital management, and hence limited numbers of patients eligible for myocardial reperfusion (thrombolytic therapy and/or percutaneous coronary intervention [PCI]). With only five catheterization laboratories in the 10 participating countries, PCI rates are very low. However, in recent years, catheterization laboratories have been built in referral cardiology departments in large African towns (Abidjan and Dakar). Improvements in patient care and outcomes should target limited but selected objectives: increasing awareness and recognition of ACS symptoms; education of rural-based healthcare professionals; and developing and managing a network between first-line healthcare facilities in rural areas or small cities, emergency rooms in larger towns, the EMS, hospital-based cardiology departments and catheterization laboratories. CONCLUSION: Faced with the increasing prevalence of ACS in sub-Saharan Africa, healthcare policies should be developed to overcome the multiple shortcomings blunting optimal management. European and/or North American management guidelines should be adapted to African specificities. Our consensus statement aims to optimize patient management on the basis of realistic considerations, given the healthcare facilities, organizations and few cardiology teams that are available.