[Arterial hypertension and control in Brazzaville (Congo): role of ambulatory blood pressure monitoring (ABPM)]. / Hypertension artérielle et niveau de contrôle à Brazzaville (Congo) : place du Holter tensionnel.

OBJECTIVES: To evaluate the rate control in the hypertensive patients and to identify the predictive factors of non-control. METHODS: It was about a cross-sectional study with prospective collection of data over a period of 36 months. It has been held in Brazzaville, and included a consecutive series of 620 hypertensive patients known and treated for at least 6 weeks, having profited from an ambulatory blood pressure monitoring (ABPM) with therapeutic aiming. We used the TONOPORT V and the software Cardiosoft 6.51 of GE Health Care, respectively for the recording and the data analysis. The threshold fixed on the average of 24-hour was BP<130/80 mmHg, and the patients divided into two groups according to whether they were or not controlled. RESULTS: They were 352 men (56.8%) and 268 women (43.2%), old on average of 53.8 ± 9.7 years (ranges: 29 and 89 years). The standard of living of the patients was average in 330 cases (53.2%), weak in 132 cases (21.3%), and high in 71 cases (11.5%). The other associated risk factors were sedentariness in 275 cases (44.4%), overweight/obesity in 134 cases (21.6%), dyslipidemia in 121 cases (19.5%), diabetes mellitus in 90 cases (14.5%), and tobacco addiction in 25 cases (4%). The hypertension, old of 5.8 ± 5.7 years on average, was controlled among 215 patients (34.7%). The 24- hour BP average was 139 ± 14 mmHg for the SBP and 88.2 ± 10.2 mmHg for the DBP. The awake and asleep BP averages were respectively 141 ± 14 mmHg and 133 ± 16.2 mmHg for the SBP, 90.5 ± 10.5 and 81.2 ± 11.1 mmHg for the DBP. The antihypertensive protocol used was a monotherapy in 130 cases (21%), bitherapy in 287 cases (46.3%), tritherapy in 154 cases (24.8%), quadritherapy or more in 27 cases (4.3%). Prevalence of non-dipping was 43%. Age and male gender were the significant predictors of poor control. CONCLUSION: The rate control of hypertension in our study population remains low. Its improvement passes by the education of the hypertensive patients and the improvement of their living conditions.

[Profile of infective endocarditis at Brazzaville University Hospital]. / Profil de l'endocardite infectieuse au centre hospitalier universitaire de Brazzaville.

The goal of this retrospective study was to analyze the current profile of all 35 consecutive patients with infectious endocarditis seen at Brazzaville University Hospital's department of cardiology and internal medicine from January, 2001, through December, 2009. Infectious endocarditis was diagnosed most often when a heart murmur was associated with septicemia and typical vegetations on echocardiography. During this period, 24 women and 11 men were admitted for infectious endocarditis, accounting for 0.9% of admissions. Their median age was 30.6 ± 12.8 years (range: 15 to 66 years), and 69% were women. The preexisting lesions included rheumatic valvulopathy (9 cases), congenital heart disease (3 cases), and heart disease already treated surgically (3 cases). Among the valvular lesions, mitral regurgitation predominated (24 cases), isolated in 17 cases and associated with aortic regurgitation in 7. There were three cases of pure tricuspid regurgitation. A principal portal of infection was found in 24 patients (69%): oral (11 cases), urinary (7 cases), genital (5 cases), and cutaneous (1 case). A blood culture was performed for 14 patients (40%): seven were positive, four of them for streptococci. Vegetations were observed in 32 cases (91.4%) and mutilating valve lesions in 8 (22.8%). The complications included heart failure in 30 cases (86%) and an embolism in 8 (23%). One relapse was noted. Cardiac surgery was indicated for 13 patients (37%) but could not be performed. The hospital lethality rate was 29%. Infectious endocarditis is a rare disorder that can be life-threatening, especialy in the absence of cardiac surgery. Its prevention, although complex, constitutes the key to management in our setting.