Relationship between P-wave dispersion, left ventricular mass index and function in Nigerian hypertensive patients.

Hypertension is the most prevalent cardiovascular disorder in the world. It is associated with target-organ damage in various organs and ECG changes. P-wave dispersion (PWD), which represents inhomogeneous atrial conduction and discontinuation of impulses, has been observed, when prolonged, to predict atrial fibrillation, particularly in the setting of hypertension. This study of PWD in 150 hypertensive patients and controls sought to determine the prevalence of PWD in Nigerian hypertensives and its relationship to left ventricular mass index and left ventricular function. Mean PWD in normal subjects was 32.14 ± 4.72 ms and was significantly shorter than that in hypertensive patients at 38.29 ± 8.02 ms. In the total population, 51.3% had prolonged PWD ( > 33.46 ms); 70% in the hypertensives and 32.7% of controls. The only significant difference in hypertensives with prolonged and normal PWD was the waist circumference. There was a negative correlation between PWD and ejection fraction (r = -0.17, p = 0.03), but not with diastolic function.

Community based diabetes risk assessment in Ogun state, Nigeria (World Diabetes Foundation project 08-321).

OBJECTIVE: The study assessed the risk of developing type 2 diabetes Mellitus in Ogun State, Nigeria. MATERIALS AND METHODS: Finnish Medical Association diabetes risk score was administered across 25 communities facilitated by non-communicable disease clinics established under a World Diabetes Foundation project. Subjects in the high risk group had blood glucose estimated. RESULTS: 58,567 respondents included 34,990 (59.6%) females and 23,667 (40.3%) males. Majority (61.2%) were between 25 years and 54 years. Considering waist circumference, 34,990 (38.1%) females and 23,667 (5.3%) males had values above 88 cm and 102 cm respectively. Overall, 11,266 (19.2%) were obese and 28.9% overweight using body mass index (BMI). More females had elevated BMI than males. Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) of all subjects were 129.54 mm Hg ± 23.5 mm Hg and 76.21 mm Hg ± 15.5 mm Hg respectively. Prevalence of hypertension (Joint National Committee VII classification) was 27.7%. More subjects had normal DBP than SBP (68.2% vs. 42.5% P < 0.05). Mean fasting blood glucose (FBG) of all subjects was 5.5 mmol/L ± 0.67 mmol/L. Using a casual blood glucose >11.1 mmol/L and/or FBG >7 mmol/L, the total yield of subjects adjudged as having diabetes was 2,956 (5.05%). Mean total risk score was 5.60 ± 3.90; this was significantly higher in females (6.34 ± 4.16 vs. 4.24 ± 3.71, P < 0.05). A total of 2,956 (5.05%) had high risk of developing DM within 10 years. CONCLUSION: The risk of developing DM is high in the community studied with females having a higher risk score. There is urgent need to implement diabetes prevention strategies.

QT Interval prolongation and dispersion: Epidemiology and clinical correlates in subjects with newly diagnosed systemic hypertension in Nigeria.

BACKGROUND: The use of easily obtainable clinical and laboratory parameters to identify hypertensive patients with increased cardiovascular risk in resource limited settings cannot be overemphasized. Prolongation of QT intervals and increased dispersion has been associated with increased risk of cardiovascular death. The study aimed at describing the epidemiology of QT interval abnormalities among newly diagnosed hypertensive subjects and associated clinical correlates. MATERIALS AND METHODS: One hundred and forty newly diagnosed hypertensive subjects and 70 controls were used for this study. Clinical and sociodemographic characteristics were obtained. Twelve lead resting electrocardiography, QT dispersion, heart rate corrected minimum and maximum QT intervals were determined manually. Increased QTcmax was defined at QTcmax >440msec. QT parameters were compared between various groups. SPSS 16.0 was used for data analysis. RESULTS: The hypertensive subjects were well matched in age and gender distribution with controls. QTmax and QTcmax were significantly higher among hypertensive subjects than controls (379.7±45.1 vs. 356.7±35.6, 447.5± 49.0 vs. 414.5 ±34.7 ms, respectively, P<0.05). QTd and QTcd were also significantly higher among hypertensive subjects than controls (62.64±25.65 vs. 46.1±17.2, 73.8 ±30.0 vs. 52.5±18.8, respectively, P<0.05). Seventy three (52.14%) of the hypertensive subjects had QTcmax >440ms compared to 21.43% of controls, P=0.01. Increased QTc dispersion was present in 36.4% of hypertensive subjects. Hypertensive subjects with QT abnormalities had significantly higher mean waist hip ratio, mean body mass index and a higher proportion of smoking than controls. CONCLUSION: QT prolongation and increased QTc dispersion are common among newly diagnosed hypertensive Nigerians and seem to be significantly associated with obesity. Effective antihypertensive therapy and control of obesity are important management modality for newly diagnosed hypertensive patients.

Relationship between left ventricular geometric pattern and systolic and diastolic function in treated Nigerian hypertensives.

INTRODUCTION: Despite a high worldwide prevalence of left ventricular hypertrophy among black patients, the association of a specific left ventricular geometric pattern with left ventricular dysfunction is rare. The aim of this study was to explore the possibility of such an association in Nigerian hypertensives. METHODS: This was a retrospective study consisting of 188 treated hypertensives. Echocardiography was used to allocate the patients to the following four groups: normal geometric pattern, concentric remodelling, eccentric hypertrophy and concentric hypertrophy. RESULTS: The mean age of the study population was 55.95 +/- 10.71 years. There were 75 females (39.9%). Concentric hypertrophy occurred in 72 (38.3%) patients and concentric remodelling in 53 (28.2%). Only 30 (16%) had a normal left ventricular geometric pattern. Hypertensive subjects with eccentric hypertrophy had the lowest ejection fraction, fractional fibre shortening and left ventricular ejection time but these did not reach statistical significance. The mean left atrial dimension was highest in the subjects with eccentric hypertrophy. CONCLUSION: In this study population of treated Nigerian hypertensives, concentric remodelling and hypertrophy were the predominant left ventricular geometrical patterns.

Quality of sleep among hypertensive patients in a semi-urban Nigerian community: a prospective study.

BACKGROUND: Sleep complaints are common in patients with chronic medical disorders; however, the prevalence of "poor sleep" in patients with chronic hypertension is not yet known in Nigeria. In the general population, insomnia negatively impacts quality of life. OBJECTIVE: The objective of this study was to examine the quality of sleep among Nigerian hypertensive patients. The study aimed to measure the prevalence of "poor sleep" in hypertensive patients and to examine the association between quality of sleep and the severity of hypertension in this population. METHODS: Quality of sleep was measured using the Pittsburgh Sleep Quality Index (PSQI) in chronic hypertensive patients attending a tertiary hospital in Nigeria. This was compared with normal control subjects. RESULTS: The mean age of the hypertensive patients was 58.15 +/- 9.65 years (range, 19 - 76 years). This did not differ from the controls at 58.7 +/- 10.8 years. A total of 80 (60.6%) respondents were females with a mean age of 58.3 +/- 12.2 years while 52 (39.4%) were males with a mean age of 58.8 +/- 11.7 years. The mean body mass index (BMI) was 26.42 +/- 4.13 kg/m2 (range, 18.9 - 36.4 kg/m2), with 63.1% of the respondents being either overweight or obese. The mean systolic blood pressure was 167.4 +/- 21.8 mm Hg (range, 100 - 210 mm Hg) while the mean diastolic blood pressure was 96.7 +/- 14.9 mm Hg (range, 60 - 130 mm Hg). Fifty-six (42.4%) hypertensive subjects were "poor sleepers" (global PSQI > 5), with a global mean PSQI of 5.03 +/- 3.28. This was significantly more than 17.3% of control subjects, with a mean global PSQI of 3.10 +/- 0.83. Among the hypertensives, there was no statistically significant relationship between the global PSQI and the age (P = 0.653), sex (P = 0.710), BMI (P = 0.253), systolic (P = 0.145), and diastolic blood pressure (P = 0.827). CONCLUSIONS: Poor sleep is common in hypertensive patients and may be associated with lower health-related quality of life. Large-scale, prospective, longitudinal studies on quality of sleep in hypertensive patients are needed to confirm the high prevalence of impaired quality of sleep in this population and to examine the association between severity of hypertension and quality of sleep while controlling for potential confounding variables. We hypothesize that severity of hypertension directly influences quality of sleep, and poor quality of sleep may worsen hypertensive conditions.

The pattern and prognostic features of QT intervals and dispersion in patients with acute ischemic stroke.

BACKGROUND: Ischemic stroke, which is perhaps the commonest subtype of stroke, is associated with electrocardiographic (ECG) changes. Some of these changes have been thought to be due either to the stroke state itself or pre-existing heart disease. Some, particularly QT intervals, have been associated with increased mortality. OBJECTIVE: The aim is to investigate the pattern of QTcmax, QTd and QTcd in patients with ischemic stroke and to compare these changes in patients without pre-existing heart disease in order to determine their prognostic importance. METHODS: Sixty-four patients with acute ischemic stroke were compared with 60 controls observing the various ECG changes. Patients without pre-existing heart disease were isolated and compared with the total cohort. RESULTS: Thirty-five (54.7%) of the patients had ischemic-like ECG changes made up of ST depression (29.7%), T-wave inversion (21.8%) and U wave (9.3%). Twenty-eight (43.8%) had QTcmax prolongation. Twenty-four (37.5%) of the patients had no pre-existing heart disease. The QT was similar when compared with the total cohort except in QTcmax, where there was significant difference (447.3+/-72.2 vs. 408.6+/-40.3 msecs). Mortality rate of the total cohort at 28.1% was significantly higher than in those without pre-existing heart disease at 8.3%, suggesting that presence of pre-existing heart disease contributed to mortality. QTcmax (r=0.293 p=0.045) and days on admission (r=-0.543 p=0.001) were the other variables that correlated with mortality in the total cohorts. CONCLUSION: Ischemic-like and repolarisation ECG changes are common in our patients with acute ischemic stroke. These changes tend to be due to pre-existing heart disease rather than the stroke state.

Pattern and factors affecting the outcome of pregnancy in hypertensive patients.

The pattern and factors affecting the outcome of pregnancy in hypertensive patients at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria between January 1997 and December 2002 were studied. There were 2,393 deliveries, with 127 (5.3%) patients fulfilling the criteria for hypertensive disorder of pregnancy. 26.2% had de-novo (gestational) hypertension, 19.7% had pre-eclampsia (PET) superimposed on chronic hypertension and 54.1% had PET/eclampsia. All patients with prepregnancy chronic hypertension had superimposed PET or eclampsia in this study. The PET/eclampsia group had the worst maternal and fetal outcomes as demonstrated by maternal mortality (6.1%), fetal mortality (36.4%), fetal respiratory distress (66.7%) and abruptio (6.1%). They also had more target organ damage (18.2%). 50.8% of these were categorized as high risk. Furthermore, patients in the PET/eclampsia group tended to be illiterate, attended antenatal clinic (ANC) less regularly and had more maternal and fetal adverse outcomes. Twenty percent of the patients had poorly controlled blood pressures (BP) at discharge, and only one out of five of the chronic hypertensive patients attended the medical hypertension clinic on discharge. These poor outcomes further emphasize the need for patient education; regular antenatal clinic attendance; prompt treatment of elevated BP; compliance with postnatal clinic follow-up, including medical outpatient care in these patients.