Awareness of hypertension guidelines and the diagnosis and evaluation of hypertension by primary care physicians in Nigeria.

BACKGROUND: The availability of numerous hypertension guidelines seems not to have impacted significantly on the burden of hypertension. We evaluated awareness of hypertension guidelines among primary-care physicians (PCPs) in Nigeria and its relationship to hypertension diagnosis and work up. METHODS: Anonymous self-administered questionnaires were filled in by PCPs categorised into two groups: hypertension guideline aware (GA) and unaware (GU). RESULTS: The 403 participating PCPs had a mean age and experience of 40 ± 11.34 and 14 ± 11.10 years, respectively, with 46.7% (n = 188) of them being GA. Out of the 19 questions assessed, GA and GU PCPs performed better in seven and two questions, respectively, while the two subgroups had a similar performance in 10 questions. The performance of the PCPs in government and private practice was similar. CONCLUSIONS: There is a gap between guideline recommendations and hypertension care in Nigeria that is further widened by PCPs' unawareness of the guidelines. Popularising hypertension guidelines among PCPs may significantly improve hypertension care and reduce the burden of disease.

Acute kidney injury in Lagos: Pattern, outcomes, and predictors of in-hospital mortality.

CONTEXT: The pattern of acute kidney injury (AKI) differs significantly between developed and developing countries. AIMS: The aim of th study was to determine the pattern and clinical outcomes of AKI in Lagos, Southwest Nigeria. SETTINGS AND DESIGN: A retrospective review of hospital records of all patients with a diagnosis of AKI over a 20-month period. SUBJECTS AND METHODS: Records of 54 patients were reviewed. Information retrieved included, bio-data, etiology of AKI, results of laboratory investigations, and patient outcomes. STATISTICAL ANALYSIS USED: Continuous data are presented as means while categorical data are presented as proportions. The Student's t-test was used to compare means while Chi-square test was used to compare percentages. Logistic regression analysis was used to determine the factors that predicted in-hospital mortality. RESULTS: Twenty-seven (50%) of the patients were male. The mean age of the study population was 39.7 years ± 16.3 years. Sepsis was the etiology of AKI in 52.1% of cases. Overall, in-hospital mortality was 29.6%. Patients who died had a shorter mean duration of hospital stay (9.2 days vs. 33.9 days [P < 0.01]), lower mean serum bicarbonate (19.5 mmol/L vs. 22.9 mmmol/L [P = 0.02]), were more likely to be admitted unconscious (82.4% vs. 17.6% [P = 0.01]) and to have been admitted to the Intensive Care Unit (37.5% vs. 7.9% [P = 0.01]). In addition, when dialysis was indicated, patients who did not have dialysis were more likely to die (58.3% vs. 41.7% [P = 0.02]). CONCLUSIONS: The pattern of AKI in this study is similar to that from other developing countries. In-hospital mortality remains high although most of the causes are preventable.

Awareness of hypertension guidelines and the diagnosis and evaluation of hypertension by primary care physicians in Nigeria

Background: The availability of numerous hypertension guidelines seems not to have impacted significantly on the burden of hypertension. We evaluated awareness of hypertension guidelines among primary-care physicians (PCPs) in Nigeria and its relationship to hypertension diagnosis and work up.Methods: Anonymous self-administered questionnaires were filled in by PCPs categorised into two groups: hypertension guideline aware (GA) and unaware (GU). Results: The 403 participating PCPs had a mean age and experience of 40 ± 11.34 and 14 ± 11.10 years, respectively, with 46.7% (n = 188) of them being GA. Out of the 19 questions assessed, GA and GU PCPs performed better in seven and two questions, respectively, while the two subgroups had a similar performance in 10 questions. The performance of the PCPs in government and private practice was similar.Conclusions: There is a gap between guideline recommendations and hypertension care in Nigeria that is further widened by PCPs' unawareness of the guidelines.Popularising hypertension guidelines among PCPs may significantly improve hypertension care and reduce the burden of disease

Pattern of intradialytic complications at the Lagos University Teaching Hospital.

BACKGROUND: The safety of haemodialysis (HD) procedure has improved greatly over the years but, the procedure is not without risks; complications still occur during dialysis. In this study, we report on the pattern of intradialytic complications seen over a one year period at the dialysis centre of the Lagos University Teaching Hospital Lagos (LUTH), Nigeria. METHOD: We reviewed the dialysis and hospital records of consecutive patients with chronic kidney disease (CKD) who received haemodialysis treatment in the dialysis centre during the period between January and December 2010. Data comprised patients' demographics, aetiology of kidney failure and complications encountered during the HD treatment sessions. RESULTS: The study involved 201 patients with CKD; there were 113 (56.2%) males, the mean age was 47.5 +/- 15.7years. There were 140 (69.7%) new patients and 61 (30.3%) old patients. The most common aetiology of CKD was hypertension (42.8%) followed by glomerulonephritis (15.9%). A total of 1010 haemodialysis sessions were recorded with complications occurring in 36.2% of the HD sessions. The most frequently encountered complication was hypertension which occurred in 15.2% of HD sessions followed by hypotension 8.5%. Hypotension occurred more frequently during first HD session (18.4%) compared with subsequent sessions (6.1%) X2 = p < 0.001. Patients who experienced hypertension had significantly higher pre-dialysis systolic blood pressure (BP) values (mean 168 +/- 28.6mmHg vs 149.3 +/- 20.1mmHg) and pre-dialysis diastolic BP (100.6 +/- 18mmHg vs 90.3 +/- 11.4mmHg) compared with those who did not p <0.001. CONCLUSION: Hypertension was the most frequently encountered complication. Hypotension was still commonly encountered especially during first HD treatments. Clinicians must make concerted to optimise blood pressure in patients undergoing haemodialysis therapy.