Hypertension in Sub-Saharan Africa: a Massive and Increasing Health Disaster Awaiting Solution

Increased blood pressure is the leading risk for death globally. While this is also true in sub-Saharan Africa; there are many hypertension issues that are unique to the region. A prime and important example is that in most countries in the region; population blood pressure is increasing; while in most countries in the rest of the globe; population blood pressure is decreasing

Efficacy of newer versus older antihypertensive drugs in black patients living in sub-Saharan Africa.

To address the epidemic of hypertension in blacks born and living in sub-Saharan Africa, we compared in a randomised clinical trial (NCT01030458) single-pill combinations of old and new antihypertensive drugs in patients (30-69 years) with uncomplicated hypertension (140-179/90-109 mm Hg). After ≥4 weeks off treatment, 183 of 294 screened patients were assigned to once daily bisoprolol/hydrochlorothiazide 5/6.25 mg (n=89; R) or amlodipine/valsartan 5/160 mg (n=94; E) and followed up for 6 months. To control blood pressure (<140/<90 mm Hg), bisoprolol and amlodipine could be doubled (10 mg per day) and α-methyldopa (0.5-2 g per day) added. Sitting blood pressure fell by 19.5/12.0 mm Hg in R patients and by 24.8/13.2 mm Hg in E patients and heart rate decreased by 9.7 beats per minute in R patients with no change in E patients (-0.2 beats per minute). The between-group differences (R minus E) were 5.2 mm Hg (P<0.0001) systolic, 1.3 mm Hg (P=0.12) diastolic, and 9.6 beats per minute (P<0.0001). In 57 R and 67 E patients with data available at all visits, these estimates were 5.5 mm Hg (P<0.0001) systolic, 1.8 mm Hg (P=0.07) diastolic and 9.8 beats per minute (P<0.0001). In R compared with E patients, 45 vs 37% (P=0.13) proceeded to the higher dose of randomised treatment and 33 vs 9% (P<0.0001) had α-methyldopa added. There were no between-group differences in symptoms except for ankle oedema in E patients (P=0.012). In conclusion, new compared with old drugs lowered systolic blood pressure more and therefore controlled hypertension better in native African black patients.

[Epidemiology of obesity in the work milieu, Douala, Cameroon]. / Epidémiologie de l'obésité en milieu du travail à Douala, Cameroun.

Obesity is a worldwide public health problem, and its burden has been poorly explored in Cameroon, especially in work place. We therefore carried out in April 2010, an analytic cross-sectional study aiming to determine the prevalence of obesity, associated risk factors and health risk in six randomly selected enterprises based in Douala. Among the 552 participants, 383 (69.4%) were males. Most of the workers (55.4%) were aged less than 35 years old. There was 191 (34.60%) office staff as against 361 (65.40%) labourers. In each participant, blood pressures, and fasting blood glucose were recorded, as well as obesity indexes comprising body mass index and waist circumference. They were calculated and data analyzed using SPSS 16 and Win Pepi 11.8. The prevalence of obesity in workers was 23.4%, and was more pronounced in women than in men (36.1% vs 17.8%; P < 0.005). The workers aged > or = 45 years old exhibited highest obesity rate than other age group (P = 0.03). Importantly, the prevalence of hypertension was two fold greater in obese workers than non obese (P < 0.005; RR = 2.1; IC 95%: 1.57-2.83). 271 (49.1%) of the workers were overweight. Among the obese subjects, those with visceral obesity: 56 (43.4%) females with a waist circumference > 88 cm and 41 (31.8%) men with a waist circumference > 102 cm were at very high health risk. Obesity was significantly associated with excessive alcohol consumption (P = 0.013) and high salt diet (P = 0.022). This study reveals a high burden of obesity in the work place in Douala and outlines the urgent needs of implementation of prevention programme in that milieu.

[Cardiac surgery in Cameroon. Results at one year of the pilot phase]. / Chirurgie cardiaque au Cameroun. Résultats à un an de la phase pilote.

In the framework of implementation of his national program for control and prevention of cardiovascular diseases, Cameroonian government has set up a cardiac surgery project. We report in this manuscript results of one year follow up of the patients operated during the pilot phase. From September 22 till 26, 2008, 11 patients have been operated in Cameroun. Surgical procedures were 5 mitral mechanic valve replacement, 2 aortic mechanic valve replacement, 1 atrial septal defect closure, 2 pace maker implantation. No intrahospital death was observed. One patient died at 11th month after the operation due to mitral valve thrombosis and attributed to lack of compliance. One patient presented low cardiac output, pneumonia and a pleural effusion. 2 patients presented 2 minor complications consisting of pericarditis and superficial wound infection. The results of the pilot phase of cardiac surgery in Cameroon are effective. However, the sustainability of the program require human, material capacity building, and funding mechanism as well.

[Relationship between pulse pressure, visual impairement and severity of diabetic retinopathy in sub-Saharan Africa]. / Relation entre pression pulsee, troubles visuels et severite de la retinopathie diabetique en Afrique sub-Saharienne.

OBJECTIVE: To determine the relationship between pulse pressure, traditional risk factors, vision impairment and different clinical forms of diabetic retinopathy. METHODS: A cross-sectional study was conducted between December 1st, 2004 and July 16th, 2005 within the care centers of Kinshasa, DRC. The origin population (n=3010 diabetics) served to estimate the diabetic retinopathy prevalence while a random sample of 301 diabetics participated to this analytic study: age>or=20 years, anthropometry, components of blood pressure, fasting glycaemia, optometry, fundoscopy, stages of diabetic retinopathy. RESULTS: The rate of diabetic retinopathy was 31.6% 95 CI: 26.3-36.9 in Kinshasa town. In the random sample, diabetic retinopathy was non proliferative in the majority (90%). Subjective decrease of acuity was associated with diabetic retinopathy in the sample (OR=2.7; 95% CI 1.1-5.4; p<0.05), among women (OR=2.7; 95% CI 1.3-5.7; p<0.05), and in patients with type 2-diabetes (OR=2; 95% CI 1.1-3.4; p<0.05). Objective decrease of acuity was associated with diabetic retinopathy in the study sample (OR=3.6; 95% CI 1.1-12.6; p<0.05). Visual impairment was significantly associated with diabetic retinopathy in women (OR=3.6; 95% CI 1.1-12.6; p<0.05) and proliferative diabetic retinopathy. Pregnancy after diabetes mellitus onset was a significant risk factor of diabetic retinopathy for women (OR=3.2; 95% CI 1.1-13.2; p<0.05). Using logistic regression analysis, family history of diabetic retinopathy (OR=3.2; 95% CI 1.2-8.8; p<0.05), diabetes duration >/=4 years (OR=3.4; 95% CI 1.4-8.5; p<0.01), and pulse pressure>or=60 mmHg (OR=5; 95% CI 2-12.8; p<0.001) were the independent and significant predictors of diabetic retinopathy. CONCLUSION: Urgent programme of prevention and control of diabetic retinopathy and its risk factors is needed.

Relation entre pression pulsee; troubles visuels et severite de la retinopathie diabetique en Afrique sub-saharienne

Objectif: Determiner la relation entre la pression pulsee; les facteurs de risque traditionnels; les troubles visuels et la prevalence des differentes formes cliniques de la retinopathie diabetique. Materiel et methodes : Une etude transversale a ete menee entre le 1er decembre 2004 et le 16 juillet 2005 dans les centres de sante a Kinshasa. RDC. La population mere (n=3010 diabetiques) a servi a estimer la prevalence de la retinopathie diabetique tandis qu_fun echantillon representatif (n=301) a ete soumis a une approche analytique : age.20 ans; anthropometrique; composantes de la pression arterielle; glycemie a jeun; optometrie; fond d_foeil; severite de la retinopathie diabetique. Resultats : La baisse subjective etait associee a la retinopathie diabetique dans l_fechantillon (Or=2;7 IC951;1-5;4 ; p0;05) et en cas de diabete de type 2 (OR1;1-3;4 ;p0;05). La baisse subjective de l'acuite visuelle etait associee a la retinopathie diabetique dans l'echantillon (OR1;1-12;6 ;p0;05). Le risque de deficience visuelle etait plus que triple par la retinopathie diabetique chez les femmes (OR1;1-12;6 ;p0;05). Porter une grossesse apres le diagnostic de diabete multipliait par 3 le risque de retinopathie diabetique chez les femmes (OR1;1-13;2 ;p0;05). Apres regression logistique; le risque multivarie de retinopathie diabetique etait predit de facon independante par les antecedetnss familiaux de diabete sucre (OR1;2-8;8 ; p0;05); la duree du diabete . 4 annees (OR1;4-8;5 ;p0;01); la pression pulsee .60 mmHg (OR2- 12;8 ;p0;001). Conclusion : Un programme de prevention et de controle de la retinopathie diabetique et de ses facteurs de risque est souhaite pour l le benefice de l'urgence