Prevalence, Risk Factors and Cardiovascular Comorbidities of Resistant Hypertension among Treated Hypertensives in a Nigerian Population.

The true prevalence and cardiovascular comorbidities of resistant hypertension (RH) in Nigeria and Africa are not known. We sought to determine the prevalence and cardiovascular comorbidities of resistant hypertension in a treated Nigerian hypertensive population. We analyzed 1,378 patients with essential hypertension from a prospective clinical registry, the Federal Medical Centre Abuja Hypertension Registry. Resistant hypertension was defined as blood pressure ≥140/90 mmHg despite the use of ≥3 guideline-recommended antihypertensive medications including a diuretic, reninangiotensin system blocker and calcium-channel blocker at optimal or best-tolerated doses or blood pressure <140/90 mmHg on ≥4 antihypertensive medications. Resistant hypertension was confirmed with the use of home blood pressure monitoring while adherence was determined by monitoring prescription orders. The prevalence of resistant hypertension was 15.5%, with 12.3% as controlled resistant hypertension and 3.3% as uncontrolled resistant hypertension. Risk factors independently associated with the odds of resistant hypertension were male sex (adjusted odds ratio [AOR]: 1.62, 95% confidence interval [CI] 1.19-2.21, p = 0.002), obesity, and diabetes mellitus. Furthermore, patients with resistant hypertension were more likely to have heart failure with preserved ejection fraction (AOR: 3.36, 95% CI 1.25-9.07, p = 0.017), cerebrovascular disease, and chronic kidney disease. In our treated hypertensive cohort, resistant hypertension was associated with an increased risk of cerebrovascular disease, chronic kidney disease, and heart failure with preserved ejection fraction, and it appears this burden maybe 2-3 times more in those with resistant hypertension compared to those without. Concerted efforts to prevent or promptly treat resistant hypertension in our population will reduce cardiovascular comorbidities.

Diabetes and peripheral artery disease: A review.

Peripheral arterial disease (PAD) refers to partial or complete occlusion of the peripheral vessels of the upper and lower limbs. It usually occurs as part of systemic atherosclerosis in the coronary and cerebral arteries. The prevalence of PAD is expected to continue to increase in the foreseeable future owing to the rise in the occurrence of its major risk factors. Nonhealing ulcers, limb amputation and physical disability are some of its major complications. Diabetes mellitus (DM) remains a major risk for PAD, with DM patients having more than two-fold increased prevalence of PAD compared with the general population. The clinical presentation in people with DM also differs slightly from that in the general population. In addition, PAD in DM may lead to diabetic foot ulcers (DFUs), which precipitate hyperglycaemic emergencies and result in increased hospital admissions, reduced quality of life, and mortality. Despite the epidemiological and clinical importance of PAD, it remains largely under diagnosed and hence undertreated, possibly because it is largely asymptomatic. Emphasis has been placed on neuropathy as a cause of DFUs, however PAD is equally important. This review examines the epidemiology, pathophysiology and diagnosis of lower limb PAD in people with diabetes and relates these to the general population. It also highlights recent innovations in the management of PAD.

Armillifer armillatus infestation in Human; public health scenario of a snake parasite: a report of three cases.

We report cases of Armillifer Armillatus infestation in three Nigerian adults within two and half years in our health facility. The first patient was a 70 year old farmer and a regular consumer of snake meat for over 50 years. He presented in February, 2014 for follow-up visit as he was a known systemic hypertensive patient. He was incidentally discovered to have multiple comma-shaped calcific lesions in the lungs and liver on a chest radiograph. These were better demonstrated on abdominal ultrasound and computed tomographic scans. He was asymptomatic. The second patient was a 42 year old male civil servant who presented in December 2015 with dry cough and right loin pain for five and three days respectively. His past medical history revealed that he had been treated previously for pneumonia. He has never eaten snake meat but consumed Alligator (Amphibious reptile) for many years but stopped about 12 years ago. Similar calcific lesions were also noted in his liver and lung parenchyma on chest radiograph and abdominal ultrasound scan. The third patient was an 80 year old man who presented in April, 2014 with dizziness and diminished urine output of one day duration. He was a farmer who has been consuming snake meat for many years, and has been on management for systemic arterial hypertension and prostatic hypertrophy. Chest radiograph and abdomino-pelvic ultrasound incidentally revealed multiple comma-shaped calcific lesions in the lungs and liver. The liver function test parameters were all within normal limits but the electrolytes were deranged and he was anaemic with a Packed Cell Volume of 27%. A diagnosis of Armillifer Armillatus infestation was made in these patients, and they were conservatively managed with Mebendazole. The third case was catherized and the deranged electrolytes were corrected. The first patient was lost to follow-up, whiles the second and third had no remarkable symptoms on subsequent follow-up visits.

Two-dimensional and Doppler echocardiographic evaluation of patients presenting at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria: a prospective study of 2501 subjects.

BACKGROUND: Echocardiography remains a key noninvasive cardiac investigative tool in the management of patients, especially in a developing economy like Nigeria. In this study, we investigated the indications for transthoracic echocardiography and spectrum of cardiac disease found in patients referred to our cardiac unit for echocardiography. METHODS: A prospective two-dimensional, pulsed, continuous, and color-flow Doppler echocardiographic evaluation was done using the transthoracic approach in 2501 patients over an eight-year period. Univariate data analysis was performed for mean age, gender, clinical indications, and diagnoses. RESULTS: The subject age range was less than 12 months to 97 years (mean 52.39 years). There were 1352 (54.06%) males and 1149 (45.94%) females. The most common indication for echocardiography was hypertension (52.1%) followed by congestive cardiac failure (13.9%). Others were for screening (6.1%), arrhythmias (5%), cerebrovascular disease (5%), chest pain (3.3%), chronic kidney disease (3.2%), congenital heart disease (2.6%), cardiomyopathy (1.8%), rheumatic heart disease (1.7%), diabetes mellitus (1.3%), thyrocardiac disease (1.2%), ischemic heart disease (1.2%), and pericardial disease (1.1%). The echocardiographic diagnosis was hypertensive heart disease in 59.4% of subjects and normal in 14.1%. Other echocardiographic diagnoses included rheumatic heart disease (3.1%), congenital heart disease (2.1%), cardiomyopathy (1.7%), pericardial disease (1.1%), and ischemic heart disease (0.1%). CONCLUSION: Hypertension and its cardiac complications is the most common echocardiographic indication and diagnosis at our unit.