Anthony O Akintomide

Relationship of ultrasonographically determined kidney volume with measured GFR, calculated creatinine clearance and other parameters in chronic kidney disease (CKD).

INTRODUCTION Kidney length has traditionally been used as a predictor of chronic kidney disease (CKD); however, kidney volume (KV) rather than length has been emphasized by researchers as a true predictor of kidney size in states of good health and disease. Since KV can be assumed to be a predictor of kidney mass or remaining surviving nephrons in CKD patients, we theorized that the KV should reflect the functional capacity of the kidneys, i.e. the glomerular filtration rate (GFR). METHODOLOGY Forty CKD patients were recruited and investigated. Measured GFR was determined by calculating the average of endogenous creatinine clearance (mCrCl) and urea clearance (mUrCl) while predicted GFR was determined using Cockcroft and Gault, Hull and Modification of Diet in Renal Disease (MDRD) equations. KV was assessed ultrasonographically using the formulae of Dinkel et al. and Solvig et al. for ellipsoid organ. The relationship between the KV and GFR was assessed using Spearmans correlation coefficient while Bland and Altman tests were used to assess intraobserver variation and agreement between measured and predicted GFR. RESULTS The results showed a weak but positive correlation between KV and various indices of GFR, best with measured CrCl (correlation coefficient ranged between 0.408 and 0.503; P < 0.05), and which was not improved after normalization for body surface area (BSA). We also found a significant correlation between the measured CrCl and various values of estimated CrCl. CONCLUSION Ultrasonographically determined KV was found to correlate with GFR and hence can be used to predict it in established CKD, particularly in resource-poor settings.

Shifting trends in the pharmacologic treatment of hypertension in a Nigerian tertiary hospital: a real-world evaluation of the efficacy, safety, rationality and pharmaco-economics of old and newer antihypertensive drugs

The current prescription patterns for essential hypertension and the efficacy, safety, tolerability and cost-effectiveness of the newer antihypertensive drugs were evaluated in Nigerian patients. The findings were compared with that of a previous study conducted in the same tertiary hospital 10 years earlier. A cross-sectional evaluation of blood pressure (BP) control in a hypertension clinic was undertaken among 150 Nigerian patients aged 61±12 years (55% females), with a duration of treatment on a particular drug class or combination of 9±3 months. The initial blood pressure was 176±20/108±11 mmHg and 22% of the patient had concurrent diabetes mellitus. Thiazide diuretics (D) alone or in combination remained the most commonly prescribed drugs in 56% of all patients. There were significant increases in the prescriptions of calcium channel blockers (CCBs) (51%), P<0.0001, and ACE-inhibitors (ACEIs) (24%), P<0.0001, but a slight reduction in the use of methyldopa, and fixed drug combinations (P<0.01) compared to the previous study. The fall in systolic blood pressure on D (r=0.65, P<0.001) or CCB (r=0.48, P<0.02) was significantly correlated with the initial systolic blood pressure, but not age. More patients achieved normotension BP<140/90 mmHg on CCB monotherapy (71%), than D monotherapy (56%). Combination therapy with ACEIs+D or methyldopa+thiazides normalized BP in 63 and 68%, respectively. Pulse pressure, a surrogate marker for cardiovascular complications and mortality in essential hypertension, was significantly reduced (P<0.01) equally by all treatments, with 95% confidence intervals ranging from −28 to −1 mmHg. However, hypertensive-diabetic (HT-DM) patients (n=33) exhibited no significant change in pulse pressure in response to treatment. Adverse drug reactions that occurred in 11% were impotence or postural dizziness with D, headache and pitting oedema with CCB, and dry cough with ACEI. Pharmaco-economic comparison of the drug classes revealed that for every US dollar (

Relationship of anthropometric indicators with blood pressure levels and the risk of hypertension in Nigerian adults

) spent per month, the percentage of treated patients attaining normotension was 18.6 for D, 4.73 for CCB, 3.5 for ACEI+D and 13.6 for methyldopa+thiazides. A combination of ACEI+CCB or D was the preferred treatment for hypertensive-diabetic Nigerians, but only 24% attained a BP<130/85 mmHg. These results demonstrate a shift in trend to a more rational and efficacious treatment of hypertension over a 10 year period. This may be associated, at least in part, with the intensive and continuous education of the prescribers in rational drug use and the introduction of a hospital formulary. Methyldopa is still a highly efficacious and cost-effective drug in this population. Black HT-DM Africans still constitute a subgroup who not only require more and costlier antihypertensive drugs, but whose BP control is suboptimal, and exhibit a poor therapeutic response to other risk factors (pulse pressure) that constitute a continuing risk for cardiovascular mortality.

Assessment of exercise capacity in African patients with chronic heart failure using six minutes walk test.

Background and purpose: Studies on cardiovascular risks in relation to anthropometric factors are limited in Sub-Sahara Africa. The aims of this study were to examine the relationship between anthropometric parameters and blood pressure; and to evaluate body mass index (BMI) across the range of underweight and obesity as a primary risk factor of hypertension in adult Nigerians. Material and methods: 2097 adults aged between 20 and 100 years consented and participated in this door-to-door survey. All participants underwent blood pressure and anthropometric measurements using standard procedures. The population study was separated in normotensive and hypertensive males and females and the possible risk for hypertension were categorized into different classes of value based on BMI definition. Results: The relative risks (odds ratio [OR] and 95% confidence interval [CI]) of developing hypertension among the obese compared with the underweight, normal weight, and overweight persons were (OR 5.75; CI 5.67–5.83), (OR 1.73; CI 1.65–1.81), and (OR 1.54; CI 1.46–1.62) for all the participants, respectively. Among obese (BMI ≥ 30.0 Kg/m2) males, the OR for hypertension was three times (OR 2.78; CI 2.76–2.80) that of normal weight (BMI ≥ 18.5–24.9 Kg/m2) males. Females with obesity had a risk of hypertension three times (OR 3.34; CI 3.33–3.35) that of normal weight females. Conclusion: Our results indicated that the there was a significant positive correlation of obesity indicator with blood pressure. In Nigeria, we found a strong gradient between higher BMI and increased risk of hypertension among all ages. Approaches to reduce the risk of hypertension may include prevention of overweight and obesity.

Evaluation of renal volume by ultrasonography in patients with essential hypertension in Ile-Ife, south western Nigeria

Background: The purpose of this study was to assess the functional capacity during a 6-minute corridor walk and a 6-minute bicycle ergometry exercise in patients with chronic heart failure (CHF). Method: Thirty five patients with stable CHF were recruited for the study. Each subject performed six minutes corridor walk and 6-minute bicycle ergometry testing. The 6-minute walk required the subjects to walk at a self selected speed on a 20 meter marked level ground for 6-minute. All the subjects also performed a 6-minute exercise on a stationary bicycle ergometer with initial resistance of 20 watts and increased by 10 watts after 3-minutes. The perceived rate of exertion was assessed using a modified Borg Scale after each exercise mode. The maximum oxygen consumption was derived using American College of Sport Medicine equations. Results: Result showed high positive correlation between distance walked in the 6-minute and the maximum volume of oxygen (VO2 max) (r = 0.65, P < 0.01). The average distance walked was 327 m ± 12.03 m. The VO2 max estimated during bicycle ergometry was higher (13.7 ± 1.9 L) than during the six minutes walk (8.9 ± 1.2 L). Conclusion: Six minutes walk could be useful to evaluate exercise tolerance in patients with chronic heart failure, while the bicycle ergometer could be more appropriate in the assessment of maximum functional capacity in these patients.

Oral therapy with combined enalapril, prazosin and hydrochlorothiazide in the acute treatment of severe hypertension in Nigerians

Background and aims: To determine renal volume in adult patients with essential hypertension and correlate it with age, sex, body mass index (BMI), body surface area (BSA) and duration of hypertension. Patients and methods: A total of 150 patients (75 males, 75 females) with essential hypertension and normal renal status were evaluated sonographically in this prospective study. Fifty healthy individuals (25 males, 25 females) without hypertension were also evaluated as control. Renal volume was then calculated from the kidneys length, width and anterio-posterior diameter using the formula L×W×AP×0.523. Results: The range of renal volume obtained was 51.65–205.02 cm3, with a mean of 114.06±29.78 cm3 for the left kidney and 47.37–177.50 cm3 with a mean of 106.14±25.42 cm3 for the right kidney. The mean volumes of the right and left kidneys in males (112.98±25.56 cm3 and 123.11±32.49 cm3, respectively), were significantly higher than in females (99.31±23.07 cm3 and 105.01±23.77 cm3, respectively). Renal volume correlated significantly with BSA and BMI, but decreased with age. The renal volume showed no correlation with duration of hypertension. Conclusion: Renal volume is higher in the left than the right kidney in hypertensive patients of both sexes and female hypertensive patients have smaller kidney size compared to males. The study also shows that volume of both kidneys decreases with age and positive correlation between renal volume, BSA and BMI. However, there is no correlation between renal size and duration of hypertension.

Two dimensional and Doppler echocardiographic evaluation of patients presenting at Obafemi Awolowo University Teaching Hospitals Complex Ile Ife Nigeria a prospective study of 2501 subjects

Objective: The efficacy, safety, tolerability and speed of onset of the hypotensive action of the combination of oral enalapril (10 mg) prazosin (1 mg) and hydrochlorothiazide (50 mg) has been assessed in 12 Nigerians with severe hypertension (Diastolic BP ≥115 mmHg). Patients:The ages of the patients ranged from 30–60 years, and the serum creatinine from 52–732 μmol⋅l−1. The initial blood pressure was 200/130 mmHg.Results:The combination significantly reduced systolic and diastolic blood pressure respectively. The hypotensive action appeared within 0.5 h and led to a fall in BP to 175/120 mmHg, and the peak action occurred at 4 h, when the BP was 138/99 mmHg, and it persisted upto 24 h (160/101 mmHg). Despite the significant fall in blood pressure, no reflex tachycardia was observed. Transient dizziness was seen in 2 patients, but otherwise all claimed improvement in clinical status and a clearer sensorium. Conclusion:The combination may be a useful oral treatment for the rapid control of severe hypertension in Blacks.

Cardiovascular responses to treadmill exercise in Nigerian hypertensives with left ventricular hypertrophy

Background Echocardiography remains a key noninvasive cardiac investigative tool in the management of patients, especially in a developing economy like Nigeria. In this study, we investigated the indications for transthoracic echocardiography and spectrum of cardiac disease found in patients referred to our cardiac unit for echocardiography. Methods A prospective two-dimensional, pulsed, continuous, and color-flow Doppler echocardiographic evaluation was done using the transthoracic approach in 2501 patients over an eight-year period. Univariate data analysis was performed for mean age, gender, clinical indications, and diagnoses. Results The subject age range was less than 12 months to 97 years (mean 52.39 years). There were 1352 (54.06%) males and 1149 (45.94%) females. The most common indication for echocardiography was hypertension (52.1%) followed by congestive cardiac failure (13.9%). Others were for screening (6.1%), arrhythmias (5%), cerebrovascular disease (5%), chest pain (3.3%), chronic kidney disease (3.2%), congenital heart disease (2.6%), cardiomyopathy (1.8%), rheumatic heart disease (1.7%), diabetes mellitus (1.3%), thyrocardiac disease (1.2%), ischemic heart disease (1.2%), and pericardial disease (1.1%). The echocardiographic diagnosis was hypertensive heart disease in 59.4% of subjects and normal in 14.1%. Other echocardiographic diagnoses included rheumatic heart disease (3.1%), congenital heart disease (2.1%), cardiomyopathy (1.7%), pericardial disease (1.1%), and ischemic heart disease (0.1%). Conclusion Hypertension and its cardiac complications is the most common echocardiographic indication and diagnosis at our unit.

Gender differences in the variables of exercise treadmill test in type 2 diabetes mellitus

BACKGROUND Left ventricular hypertrophy (LVH) is an independent risk factor for adverse cardiac outcomes in hypertensive patients. OBJECTIVE This study is designed to assess the cardiovascular responses to treadmill exercise among Nigerian hypertensives with echocardiographically proven LVH. MATERIALS AND METHODS Fifty hypertensive patients with LVH (27 males and 23 females) between 30 and 65 years of age were studied in Nigeria. 50 hypertensive patients without LVH and 50 normal subjects who were age and sex matched served as controls. All patients and control subjects underwent M-mode, 2-D and Doppler ECHO-studies and the Bruce protocol treadmill exercise test. RESULTS The study showed that the estimated maximal oxygen consumption (MVO2) in MET reduced progressively from 8.39 ± 1.26 (normotensive control) to 7.62 ± 1.33 (hypertensive without LVH), 6.27 ± 0.99 (hypertensive with LVH) (P<0.0001ANOVA). The duration of exercise (s) was also reduced in that order from 455.4 ± 79.1 to 411.6 ±8 2.3, 315.8 ± 75.6 respectively (P<0.0001). The systolic blood pressure (SBP) and pressure rate product (PRP) during maximal exercise were also increased in hypertensives with LVH and hypertensive without LVH when compared to normotensive controls. The hypertensives with LVH and hypertensives without LVH also showed significant limitation to heart rate increase with exercise compared to normotensive controls (P<0.003). CONCLUSION This study demonstrated significant impairment of exercise capacity in hypertensives with or without LVH compared to normotensive subjects. Both earlier recognition and improved understanding of LVH may lead to more effective therapeutic strategies for this cardiovascular risk factor.

Echocardiographic Assessment of Left Ventricular Geometric Patterns in Hypertensive Patients in Nigeria

BACKGROUND Exercise capacity, like some other variables of exercise stress test, is a strong predictor of cardiovascular and overall mortality. Many confounding factors, including gender, have been found to affect exercise capacity. This study evaluated whether exercise capacity differs in age-matched type 2 diabetic Nigerian men and their women counterparts and the hemodynamic variables of exercise treadmill test that correlate with exercise capacity in them. MATERIALS AND METHODS A total of 61 type 2 diabetics (male = 34; female = 27) aged 30 to 60 years who were recruited through the Medical Out-patient Department of OAUTHC, Ile Ife, Nigeria, underwent symptom-limited maximal treadmill exercise using Bruce protocol. RESULT Patients had comparable clinical and demographic patterns. There was no gender difference in the chronotropic response to exercise. Males had faster heart rate recovery (HRR) than females. Though both sexes had similar resting systolic blood pressure (SBP), males had significantly higher peak SBP than females (216.2 ± 23.7 mmHg vs 203.3 ± 21.7 mmHg; P = 0.03). Exercise capacity was significantly higher in males (7.5 ± 2.0 METs) than females (6.4 ± 1.5 METs); P = 0.01. Significant correlates of exercise capacity in both sexes were fasting plasma glucose, resting diastolic blood pressure, Duke Treadmill Score, and HRR. Majority of the patients were in moderate DUKE risk subgroup and there was no statistically significant difference between males and females in this regard. CONCLUSION Gender difference occurs in the exercise capacity of diabetic patients and the factors associated with this disparity may be related to gender differences in resting heart rate and HRR, both reflecting a withdrawal of vagal tone.