Epidemiological profile of hypertensive disease and renal risk factors in black Africa.

OBJECTIVE: To describe the characteristics and renal function of hypertensive patients at their first hospital admission in Sub-Saharan Africa. DESIGN: Retrospective study of all hypertensive patients. SETTING: Department of Cardiology and Internal Medicine of Yalgado Ouedraogo National Hospital in Burkina Faso, a country in Sub-Saharan Africa. PATIENTS: Three hundred and seventeen consecutive hypertensive patients (systolic blood pressure > or = 160 mmHg or diastolic blood pressure > or = 90 mmHg, or both, or patients receiving antihypertensive treatment) referred between 1 November 1988 and 31 October 1990. RESULTS: The hypertensive patients accounted for 36.5% of admissions and included 198 males and 119 females (mean +/- SD age 49 +/- 14 years). Two-thirds of the patients belonged to the poorer socio-economic groups. Hospital admission was necessary because of the symptoms and complications of hypertension: 43% had diastolic blood pressure > 130 mmHg, 73.5% had at least one target organ affected and 38.2% had renal involvement in the form of chronic renal failure or as proteinuria > 1.5 g/24 h. Patients with renal involvement were younger and had blood pressure that responded less well to acute treatment. One-fifth of the patients died during their hospital stay, and most of these had impaired renal function.

[Renal insufficiency in arterial hypertension in black Africa]. / Insuffisance rénale au cours de l'hypertension artérielle en Afrique noire.

OBJECTIVES: The increased risk of renal disease due to high blood pressure observed in Black Americans would suggest ethnic factors are involved. We examined the clinical features of renal disease in patients hospitalized in Ouagadougou, Burkina Faso for high blood pressure to determine the risk factors in this black population. METHODS: From November 1988 to October 1990, 317 patients (mean age 49 +/- 14 years, 62.5% males) under treatment for high blood pressure or with a diastolic pressure > 90 mmHg without antihypertensive therapy were examined at their initial hospitalization. The patients were divided into socio-economic groups according to their professional occupation and level of education. Criteria of renal disease, including raised serum creatinine, proteinuria and blood urea nitrogen, together with factors related to hypertension, including obesity, diabetes mellitus, hypertensive retinopathy, heart failure, coronary artery disease, cerebral vascular events and hypertensive encephalopathy were analyzed. RESULTS: Severe hypertension, diastolic pressure > 130 mm Hg was observed in 43% of the patients. There was a significant inverse correlation between age and diastolic pressure (r = 0.23, p < 0.0001). Response to initial anti-hypertensive treatment was good in 88% and proportional to severity. Hospital mortality was 18.6% (59 patients) including 39 cases during the first two days. Mortality was not correlated with blood pressure, age, sex or socio-economic conditions. Renal disease was observed in 121 patients and chronic renal failure in 117 (44%). Effect of hypertension on at least one target organ was observed in 73.2% of the patients and on at least three target organs in 38.2%. Subjects with renal disease were younger (p < 0.02) and responded less well to treatment than those without renal disease. CONCLUSIONS: These clinical observations confirm the high prevalence of renal failure and the gravity of high blood pressure in Black Africans. In Burkina Faso, hospitalization for high blood pressure often leads to the discovery of terminal renal failure.

Symptomes; etiologie et evolution de 47 cas de fibrillation auriculaire permanente

Etude retrospective realisee au Hospitalier National de Ouagadougou portant sur 47 fibrillations auriculaires permanentes (sur 847 maladies cardiovasculaires) a montre une prevalence de 5;5 pour cent. Il y avait 26 hommes pour 21 femmes. On avait constate une insuffisance cardiaque presente dans 93;6 pour cent des cas. Un accident vasculaire cerebral etait survenu chez 7 patients. Une tachythmie existait dans 22 cas. les etiologies de ces fibrillations auriculaires etaient dominees par les valvulopathies; les cardiopathies hypertensives et les myocardiopathies primitives constituant ainsi 85 pour cent des cas. Le traitement reposait dans tous les cas sur les digitaliques; associes a l'amiodarone 15 fois. Le ralentissement de la frequence cardiaque etant constant; la reduction de la fibrillation auriculaire a ete rerement obtenue