Prevalence of hypertension and determinants of poor blood pressure control in patients with Type 2 diabetes mellitus attending a Tertiary Clinic in Lagos, Nigeria.

Objective: The objective is to determine the prevalence of comorbid hypertension and blood pressure (BP) control among patients with Type-2-diabetes-mellitus attending a tertiary-hospital in Lagos, and identify the determinants of poor BP control. Materials and Methods: A cross-sectional study of 238 consecutive patients with Type-2-diabetes Mellitus (DM) at the adult diabetes-clinic of a tertiary health-facility in Lagos, Nigeria over a 5-month period. Data were retrieved with the aid of structured-investigator-administered-questionnaire, physical examination, and review of hospital record. Hypertension was defined as BP ≥140/90 mmHg and target BP control was defined as <130/80 mmHg. Logistic regression analysis was used to identify the independent determinants of poor BP control. Results: Comorbid hypertension was present in 187 (78.6%) of study participants with males (68/87 [78.8%]) and females (119/151 [78.2%]) similarly affected, P = 0.907. Older age (62.9 ± 10.1 vs. 54.9 ± 9.6 years) and obesity (35.3% vs. 17.6%) were associated with comorbid hypertension, P < 0.05. Awareness, treatment, and medication adherence rates were 96.3%, 100%, and 46%, respectively. Only 17.1% (n = 32/187) had BP controlled to target. Waist circumference (WC) (adjusted odd ratio: 1.04, 95% confidence interval [CI]: 1.01-1.06) and poor glycemic control (adjusted odd ratio: 5.39, 95% CI: 2.07-13.99) were the predictors of poor BP control. Conclusion: The prevalence of co-morbid hypertension in Type 2 DM patients in our setting is high and the BP control rate is low. Increasing WC and poor glycemic control are the independent determinants of poor BP control. Individualized weight reduction and glycemic control strategies may help achieve target BP control.

Résumé Objectif: L'objectif est de déterminer la prévalence de l'hypertension comorbide et du contrôle de la pression artérielle (PA) chez les patients atteints de diabète sucré de type 2 fréquentant un hôpital tertiaire à Lagos et d'identifier les déterminants d'un mauvais contrôle de la pression artérielle. Matériaux et méthodes: Une étude transversale de 238 patients consécutifs atteints de diabète sucré (DM) de type 2 à la clinique de diabète pour adultes d'un établissement de santé tertiaire à Lagos, au Nigéria, sur une période de 5 mois. Les données ont été récupérées à l'aide d'un questionnaire structuré administré par l'investigateur, d'un examen physique et d'un examen des dossiers hospitaliers. L'hypertension a été définie comme une pression artérielle ≥140/90 mmHg et le contrôle de la PA cible a été défini comme une pression artérielle inférieure à 130/80 mmHg. L'analyse de régression logistique a été utilisée pour identifier les déterminants indépendants d'un mauvais contrôle de la PA. Résultats: L'hypertension comorbide était présente chez 187 (78,6 %) des participants à l'étude, les hommes (68/87 [78,8 %]) et les femmes (119/151 [78,2 %]) ayant été touchés de la même manière, P = 0,907. L'âge plus avancé (62,9 ± 10,1 contre 54,9 ± 9,6 ans) et l'obésité (35,3 % contre 17,6 %) étaient associés à une hypertension comorbide, P était inférieur à 0,05. Les taux de sensibilisation, de traitement et d'observance thérapeutique étaient de 96,3 %, 100 % et 46 %, respectivement. Seulement 17,1 % (n = 32/187) ont vu leur tension artérielle contrôlée pour cibler. Le tour de taille (WC) (rapport impair ajusté: 1,04, intervalle de confiance à 95%[IC]: 1,01-1,06) et mauvais contrôle glycémique (rapport impair ajusté: 5,39, IC à 95%: 2,07-13,99) étaient les prédicteurs d'un mauvais contrôle de la PA. Conclusion: La prévalence de l'hypertension comorbide chez les patients atteints de DM de type 2 dans notre milieu est élevée et le taux de contrôle de la PA est faible. L'augmentation de la WC et un mauvais contrôle glycémique sont les déterminants indépendants d'un mauvais contrôle de la PA. Des stratégies individualisées de réduction de poids et de contrôle glycémique peuvent aider à atteindre le contrôle de la PA cible. Mots-clés: Contrôle de la pression artérielle, hypertension comorbide, contrôle glycémique, Nigeria, diabète sucré de type 2.

The impact of sex on blood pressure and anthropometry trajectories from early adulthood in a Nigerian population: insights into women's cardiovascular disease risk across the lifespan.

BACKGROUND: Sex disparities in blood pressure and anthropometry may account for differences in cardiovascular (CV) risk burden with advancing age; modulated by ethnic variability. We explored trajectories of blood pressures (BPs) and anthropometric indices with age on the basis of sex in an urban Nigerian population. METHODS: We conducted a secondary analysis on data from 5135 participants (aged 16-92 years; 2671(52%) females) from our population-based cross-sectional study of BP profiles. We utilized the WHO STEPS and standardized methods for documenting BPs, body mass index (BMI) and waist circumference (WC). Data was analyzed using Analysis of variance (ANOVA), Spearman correlation analysis and mean difference in variables (with 95% confidence interval). We explored the influence of age and sex on BP profiles and specific anthropometric indices using generalized regression analysis. RESULTS: In those aged 15-44 years, males had significantly higher systolic BP (SBP) and pulse pressure (PP). However, mean SBP and PP rose more steeply in females from 25 to 34 years, intersected with that of males from 45 to 54 years and remained consistently higher. Difference in mean BPs (95% Confidence Interval) (comparing < and > 45 years) was higher in females compared to males for SBP (17.4 (15.8 to 19.0) v. 9.2 (7.7 to 10.7), DBP (9.0 (7.9 to 10.1) v. 7.8 (6.7 to 8.9)), and PP (8.4 (7.3 to 9.5) v. 1.4 (0.3 to 2.5)). Females had significantly higher BMI and WC across all age groups (p < 0.001). Age more significantly correlated with BPs, BMI and WC in females. Interaction models revealed that SBP was significantly predicted by age category in females from (15-54 years), while DBP was only significantly predicted by age in the 15-34-year category (p < 0.01). BMI and WC were significantly predicted by age only in the 25-34-year category in females, (p < 0.01). CONCLUSIONS: Our population demonstrates sex disparity in trajectories of SBP, PP, BMI and WC with age; with steeper rise in females. There is a need to focus on CV risk reduction in females, starting before, or during early adulthood.

Prevalence of obesity and an interrogation of the correlation between anthropometric indices and blood pressures in urban Lagos, Nigeria.

Adverse cardiovascular outcomes are linked to higher burden of obesity and hypertension. We conducted a secondary analysis of data for 5135 participants aged ≥ 16 years from our community-based hypertension prevalence study to determine the prevalence of obesity and association between multiple anthropometric indices and blood pressure (BP). The indices were waist circumference (WC), body mass index (BMI), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), a body shape index(ABSI), abdominal volume index (AVI), body adiposity index (BAI), body roundness index (BRI), visceral adiposity index (VAI) and conicity index (CI). We performed statistical analyses to determine the association, predictive ability, cutoff values and independent determinants of hypertension. Crude prevalence of obesity was 136 per 1000 (95% confidence interval 126-146). BMI had the strongest correlation with systolic and diastolic BP (rs = 0.260 and 0.264, respectively). Indices of central adiposity (AVI, WC, WHtR, BRI) were the strongest predictors of hypertension (≥ 140/90 mmHg), and their cut-off values were generally higher in females than males. WHR, age, BMI and CI were independent determinants of hypertension ≥ 140 mmHg (p < 0.05). We conclude that, based on this novel study, measures of central adiposity are the strongest predictors and independent determinants of hypertension in our population, and cut-off values vary from previously recommended standards.

Hypercholesterolaemia among urban residents in Lagos State: The knowledge, attitudes, prevalence and risk factors.

BACKGROUND: Hypercholesterolaemia, a modifiable risk factor for cardiovascular disease (CVD), is particularly increasing in urban areas of underdeveloped nations. This research assessed the knowledge of, attitude towards, prevalence of and risk factors for hypercholesterolaemia in an urban local government area of Lagos State. METHODS: This descriptive cross-sectional research was conducted among 229 adult residents who were selected through a multistage sampling method. Data were collected with a structured interviewer-administered questionnaire. Anthropometric measures were assessed using standard tools while the lipid profile was assessed by finger pricks using a CardioChek® professional analyser. Participants with knowledge scores of at least 50% were considered as having good knowledge and scores below 50% were considered as poor knowledge. Data analysis was done using SPSS version 20.0. P < 0.05 was taken as statistically significant. RESULTS: The mean age of the respondents was 38.9 ± 4.6 years. More than a third 89 (38.9%) of the respondents had high blood total cholesterol, 39 (17.0%) had high low-density lipoprotein and 8 (3.4%) had high triglycerides. Overall, 110 (48.0%) of the participants had good knowledge of hypercholesterolaemia and 131 (57.2%) of them had positive attitudes towards hypercholesterolaemia as a risk factor of CVD. Being a female (odds ratio [OR] = 2.16; 95 confidence interval [CI] = 1.19-3.91) and consumption of baked food (OR = 1.94; 95% CI = 1.054-3.57) were significant predictors of high cholesterol among respondents. CONCLUSION: Cholesterol levels were high in this sample of urban Nigerians. Overall, 110 (48.0%) of the respondents had a good level of knowledge while 131 (57.2%) had positive attitudes. Being a female and consuming baked food were significant predictors of high cholesterol among the respondents. This calls for gender-specific interventions for women and health education on dietary modification.

Medication adherence and patient satisfaction among hypertensive patients attending outpatient clinic in Lagos University Teaching Hospital, Nigeria.

BACKGROUND OF THE STUDY: Low adherence is an essential element responsible for impaired effectiveness and efficiency in the pharmacological treatment of hypertension. Patient satisfaction is an important measure of healthcare quality and is a crucial determinant of patients' perspective on behavioural intention. AIMS: This study determined the association between medication adherence and treatment satisfaction among hypertensive patients attending hypertension outpatient clinic in Lagos University Teaching Hospital (LUTH), Nigeria. MATERIALS AND METHODS: Setting - The study setting was LUTH; a descriptive cross-sectional study was conducted. Study design - Hypertensive patients were consecutively recruited from the outpatient clinic. Medication adherence was assessed using the 8-item Morisky Medication Adherence Scale and treatment satisfaction was assessed using the 14-item Treatment Satisfaction Questionnaire for Medication. STATISTICAL ANALYSIS: Univariate and linear regression analyses were conducted using STATA software version 14.1 (StataCorp LP, College Station, TX, USA). Statistical significance was set at P ≤ 0.05. RESULTS: A total of 500 respondents with a mean age of 58.9 ± 13.3 years participated in the study. Overall, majority (446 [89.2%]) of the respondents in this study had 'moderate' adherence to antihypertensive medication. However, only five (1.0%) respondents reported 'high' adherence. Mean scores were highest in the moderate adherence category for all satisfaction domains and overall domain. Treatment satisfaction was associated with medication adherence, and was statistically significant (P = 0.000). CONCLUSION: One in every hundred patients had high adherence to hypertensive medication in this study, and there was a positive association between treatment satisfaction and medication adherence. Continuous patient-specific and tailored adherence education and counselling for hypertensive patients is recommended.

Prevalence of hypertension and blood pressure profile amongst urban-dwelling adults in Nigeria: a comparative analysis based on recent guideline recommendations.

BACKGROUND: Hypertension is the major risk factor for cardiovascular diseases and prevalence rates are critical to understanding the burden and envisaging health service requirements and resource allocation. We aimed to provide an update of the current prevalence of hypertension and blood pressure profiles of adults in urban Nigeria. METHODS: Cross sectional population-based survey in Lagos, Nigeria. Participants were selected using stratified multistage sampling. Relevant sections of the World Health Organization STEPwise approach to chronic disease risk factor surveillance were utilized for data collection. Blood pressures were categorized based on both the current American College of Cardiology/American Heart Association (ACC/AHA) 2017 guidelines and the pre-existing Joint National Committee on Hypertension 7 (JNC7) (2003) categories. RESULTS: There were 5365 participants (51.8% female), age range of 16-92 years, and mean age ± SD 37.6 ± 13.1. The mean ± SD systolic and diastolic blood pressures were 126.8 ± 18.6 and 80.6 ± 13.2 respectively. There was significant correlation between both systolic and diastolic blood pressures and age (Pearson correlation 0.372 and 0.357 respectively and p = 0.000 in both instances). The prevalence of hypertension was 55.0% (3003) and 27.5% (1473) based on the ACC/AHA 2017 guideline and the JNC7 2003 guidelines respectively. Body mass index was positively correlated with systolic and diastolic BP (p = 0.000). CONCLUSIONS: Over half of the adult population in this major Nigerian city are classified to have hypertension by the recent guideline. There is an urgent need to develop and implement strategies for primordial prevention of hypertension (and obesity) and to restructure our healthcare delivery systems to adequately cater for the current and emerging hypertensive population.

Demographic characteristics and causes of death for persons brought in dead to emergency department of a Tertiary Health Facility in South-West Nigeria.

INTRODUCTION: Identifying the demographic characteristics and causes of death in persons 'brought-in-dead' (BID) will inform possible strategies for the prevention of their occurrence. OBJECTIVE: To characterise the demography as well as document the autopsy-determined underlying and immediate causes of death in BID cases presenting to the emergency department (ED) of a tertiary health facility. METHODS: This is a 5-year retrospective descriptive study of 253 autopsied-BID cases. Data were obtained from ED 'death-register' and the hospital 'autopsy-register'. The underlying and immediate causes of death were classified and analysed across the age groups of 21-40, 41-60 and >60 years. RESULTS: The age of the cases ranged from 22 to 101 years with a median of 56.0 (38-72) years. Almost half [110(43.5%)] of the cases were in the age-group >60 years. The male-to-female ratio was 1.04:1, and their ages were comparable. Non-communicable diseases accounted for 216 (85.4%) of the underlying causes of death. Three major specialities contributing to death were medicine 117 (46.2%), oncology 45 (17.0%) and surgery/trauma 42 (16.6%). Specialties of medicine and surgery/trauma were predominantly in age groups >60 years (60.0%) (P ≤ 0.0001) and 20-40 years (31.5%) (P = 0.0001), respectively. The chief underlying causes of death in the specialities of medicine, oncology and surgery/trauma were cardiovascular diseases (61 [52.1%]), breast cancer (11 [24.4%]) and road traffic accidents (31 [73.8%]), respectively. Overall immediate causes of death included heart failure (21.3%), unspecified circulatory collapse (17.0%), central nervous system pathologies (16.6%) and haemorrhagic shock (10.7%). Heart failure (33.6% [37/110]) and haemorrhagic shock (28.8% [21/73]) were the most common immediate causes of death in the >60 years' and 20-40 years' age groups, respectively. CONCLUSION: Non-communicable diseases are the leading causes of death in persons 'BID'. Deaths from medical conditions, especially heart failure, occurred mainly in the elderly. Deaths from trauma and haemorrhage occurred predominantly in the young.

Prevalence and pattern of cardiovascular-related causes of out-of- hospital deaths in Lagos, Nigeria.

BACKGROUND: In developed countries 50% - 75% of deaths from cardiovascular-diseases occurs out-of-hospital. In Nigeria where patronage of orthodox health facilities is low, the impact of cardiovascular-related diseases on out-of-hospital mortality has been sparsely studied. OBJECTIVES: To determine the prevalence and pattern of cardiovascular-related causes of out-of-hospital deaths in Lagos, Nigeria. METHODS: A 5-year retrospective review of all autopsied medical decedents brought-in-dead (BID) to a Nigerian tertiary health facility to identify cardiovascular-related causes of death. RESULTS: A total of 90 cardiovascular-related deaths out of 176 medical BID cases were identified, giving a prevalence of 51.1%. Mean age was 65.2 ± 15.6 years. Male: Female ratio was 1.4: 1, the females were older (68.29 ± 14.89) vs (61.63 ± 15.55) years. Age group > 60 years accounted for 63.3% of deaths. Commonest primary diseases were hypertensive heart disease (48.9%) and cerebrovascular accident (24.4%). Myocardial infarction occurred in 8.9%. Heart failure, cerebral dysfunction and unspecified circulatory collapse were the causes of death in 54.4%, 23.3% and 14.4% respectively. CONCLUSION: Cardiovascular-related diseases are major contributors to out-of-hospital medical deaths occurring chiefly in those >60 years. Hypertensive heart disease and heart failure are the greatest contributors to this cardiovascular-related disease mortality.