Evaluating the Effectiveness of African School of Hypertension for Non-Physician Health Workers, a Qualitative Study: QuASH Hypertension Study.

Background: The implementation of task sharing and shifting (TSTS) policy as a way of addressing the shortage of physicians and reducing the burden of hypertension in Africa birthed the idea of the African School of Hypertension (ASH). The ASH is saddled with the responsibility of training non-physician health workers across Africa continent in the management of uncomplicated hypertension. Aim: To get feedback from some faculty members and students who participated in the first ASH programme. Methods: This was a cross-sectional exploratory qualitative study conducted among eight students and eight faculty members. Feedback from the program was obtained by conducting in-depth interviews centred on description of course content; expectations and knowledge acquired from ASH; level of interaction between students and faculty members; challenges faced during the ASH; level of implementation of acquired training; and suggestions to improve subsequent ASH programs. Results: The course content of the ASH was described as simple, appropriate and adequate while interaction between students and faculty members were highly cordial and engaging. New knowledge about hypertension management was acquired by the students with different levels of implementation post-graduation. Some identified challenges with the ASH program were poor internet connectivity during lectures, non-uniformity of TSTS policies and hypertension management guidelines across Africa, technical problems with hypertension management app and low participation from other African countries apart from Nigeria. Some recommendations to improve ASH program were development of a uniform hypertension management guideline for Africans, wider publicity of the ASH, interpretation of lectures into French and Portuguese languages and improvement of internet connectivity. Conclusion: The ASH programme has largely achieved its objectives with the very encouraging feedback received from both faculty members and the students. Steps should be taken to address the identified challenges and implement the suggested recommendations in subsequent ASH program to sustain this success.

Blood Pressure Control and its Determinants among Patients with Chronic Kidney Disease in a Nigerian Tertiary Hospital: A Cross-Sectional Study.

Background: Hypertension is a common cardiovascular risk factor associated with adverse renal and cardiovascular outcomes in chronic kidney disease patients. Significant reduction in these adverse outcomes could be achieved through adequate blood pressure control in those with hypertension. This study aimed to determine the prevalence of poor blood pressure control and associated factors among chronic kidney disease patients with hypertension in a Nigerian tertiary hospital. Methodology: This was a cross-sectional study that determined the prevalence of poor blood pressure control and its associated factors among chronic kidney disease patients with hypertension. Poor blood pressure control was defined as blood pressure ≥ 140/90mmHg. Factors associated with blood pressure control were determined on multivariate analysis. P-value less than 0.05 was considered significant. Results: A total of 494 chronic kidney disease patients with hypertension were studied. The mean age of patients was 48.77+13.06 with a range of 17-95 years. There were 303 (61.3%) males and 191 (38.7%) females. A total of 44.5% of the patients had end-stage renal disease while all patients were on antihypertensive medications. The common causes of chronic kidney disease were hypertension (35%), diabetes mellitus (26.5%), and chronic glomerulonephritis (12.1%).Poor blood pressure control was found in 74.4% of chronic kidney disease patients. The predictors of poor blood pressure control were age (AOR: 0.65; CI: 0.45-0.94; p=0.02), use of multiple anti-hypertensives (AOR: 1.99; CI: 1.36-2.90; p=<0.001) and the presence of significant proteinuria (AOR: 1.47; CI: 1.02-2.14; p=0.04). Conclusion: The majority of patients with chronic kidney disease had poor blood pressure control. Those who were young had significant proteinuria, and those who used≥ 3 antihypertensive medications were more likely to have poor blood control. There is a need to optimize BP management in chronic kidney disease patients in order to reduce adverse outcomes.

Pattern of prescription of anti-hypertensive medications in a tertiary health care facility in Abuja, Nigeria.

INTRODUCTION: Marked changes have been made in the pharmacotherapy of hypertension over the years. In sub-Saharan Africa, hypertension pharmacotherapy is often thought to include only thiazide diuretics, beta blockers and centrally acting medications and, it is unclear if and how often calcium channel blockers, angiotensin converting enzyme inhibitors and angiotensin receptor blockers are used. OBJECTIVE: To examine the anti-hypertensive prescription pattern in a tertiary health centre in Nigeria to determine how it conforms to current guidelines. METHOD: 590 newly diagnosed hypertensive patients presenting at the Cardiology Unit of University of Abuja Teaching Hospital over a three-year period were studied. RESULT: Calcium channel blockers were the most frequently prescribed anti-hypertensive medications (66.9% of all cases) and centrally acting medications were prescribed in only 5.01% of cases. Single-pill combination either alone or in combination with other antihypertensive medications were prescribed in 17.3% cases. Of these, calcium channel blocker-based combinations constituted the most frequently used multiple drug combinations. 94.6% of the patients required more than one medication for blood pressure control. CONCLUSION: Anti-hypertensive pharmacotherapy in Abuja, Nigeria, compares favorably with the current recommendations in the prescription pattern of anti-hypertensive medications.

Prevalence of metabolic syndrome among hypertensive patients in Abuja, Nigeria.

BACKGROUND: It is well known that factors like high blood pressure, hyperglycemia, dyslipidemia, obesity and hyperuricemia tend to cluster together giving rise to what is called metabolic syndrome. In spite of the high prevalence of hypertension in Nigeria, there is a dearth of data describing the prevalence of metabolic syndrome in Nigerian hypertensive patients. We therefore set out to look at the prevalence of metabolic syndrome in hypertensive patients presenting to the cardiology clinic of a tertiary institution in Abuja, Nigeria. METHODS: Metabolic syndrome was defined in patients according to the World Health Organisation's definition. RESULTS: Of the 362 patients studied, 56.9% were male and 43.1% were female. The mean age was 51.80 +/- 11.63 years, mean duration of hypertension was 8.90 +/- 3.95 years, mean body mass index was 29.36 +/- 6.12 kg/m2 and mean arterial blood pressure was 110.28 +/- 18.17 mm Hg. Overall, 13.0% of the study population had metabolic syndrome; 16.7% of females and 10.2% of males. CONCLUSION: The prevalence of metabolic syndrome among hypertensive patients in Abuja, Nigeria is comparable to rates observed in some general populations in Europe. This might imply the epidemiological transition in disease pattern already being experienced in many parts of sub-Saharan Africa.

Left atrial myxoma mimicking mitral stenosis.

Cardiac myxoma is a benign (non-malignant) neoplasm that represents the most common primary tumour of the heart. We present the case of a 36 year old woman with background hypertension who presented with features of left ventricular failure and seizures, and was found during transthoracic echocardiography to have left atrial myxoma protruding through the mitral valve orifice. She subsequently had excision of the atrial myxoma. The usefulness of early transthoracic echocardiography in any patient presenting with features of heart failure even when the aetiology seems obvious cannot be over-emphasised.

Self-reported screening of nephrologists for chronic kidney disease: a nationwide survey.

BACKGROUND: The incidence of chronic kidney disease (CKD) is increasing, with major health and economic implications. World Kidney Day was established to increase the general public's awareness of CKD. The purpose of this report was to document the self-awareness of CKD by nephrologists practicing in one country, Nigeria. METHODS: Self-administered questionnaires addressing self-awareness about CKD were distributed to nephrologists attending a meeting of the Nigerian Association of Nephrology. RESULTS: Twenty-eight (35.4%) of the respondents admitted to being at risk for CKD; 93.7% reported having urinalysis done in the past, but only 50.6% had done it within the last 12 months. Similarly, 74.7% had at least had a serum creatinine measurement. Only 12.7% had ever had their glomerular filtration rate (GFR) estimated. CONCLUSION: Self-screening for CKD among Nigerian nephrologists is suboptimal. This self-neglect may translate into poor CKD screening practices for their patients.

Prevalence of dyslipidemia in normoglycemic subjects with newly diagnosed high blood pressure in Abuja, Nigeria.

BACKGROUND: High blood pressure and dyslipidemia additively increases the risk of cardiovascular disease. There is a high prevalence of high blood pressure in Nigeria, but there are little data regarding the prevalence of dyslipidemia in subjects with high blood pressure. OBJECTIVE: In this observational prospective study, we examined the prevalence of dyslipidemia in newly diagnosed normoglycemic subjects with high blood pressure. METHODS: A total of 171 subjects presenting with high blood pressure for the first time in the cardiology and nephrology clinics at the University of Abuja Teaching Hospital were studied. Height, weight, and blood pressure were measured. Total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were determined in fasting plasma. The total cholesterol/HDL-C and non-HDL-C values were calculated. These measures were then classified according to the 2001 report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. RESULTS: Of the 171 subjects studied, 84 (49%) were male and 87 (51%) were female. Low HDL-C was present in 71 (45.8%), elevated LDL-C in 29 (17%), elevated total cholesterol in 19 (11.1%), and elevated triglyceride in 13 (7.6%), whereas eight (4.7%) of the study population had combined elevated total cholesterol and triglyceride. Female subjects had higher total cholesterol and lower HDL-C than male subjects, but these differences were not statistically significant. Obese subjects, compared to the nonobese, had significantly higher LDL-C and total cholesterol/HDL-C ratios in males and significantly higher triglyceride levels in females. CONCLUSIONS: Given the prevalence of dyslipidemia seen in this study, we suggest that fasting lipid measurements should be performed in all Nigerians with high blood pressure. These data suggest the need for health education and lifestyle modifications in hypertensive Nigerians to reduce both types of risk factors.