Ebenezer Adekunle Ajayi

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

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.

Ambulatory blood pressure profile and left ventricular geometry in Nigerian hypertensives.

Background: Left ventricular hypertrophy (LVH) is an independent cardiac risk factor in hypertensives and the structural classification of left ventricular (LV) geometry provides additional prognostic information. Ambulatory blood pressure (ABP) monitoring has been shown to be superior to office blood pressure (BP) in relation to hypertension LVH. We investigated ambulatory BP variables in relation to LV geometric patterns in Nigerian hypertensives. Materials and Methods: A total of 130 patients (males = 96, females = 34) with hypertension had their 24-hours ambulatory BP and trans-thoracic 2D/M- mode echocardiography. Data were analyzed with SPSS 13.0. P < 0.05 was considered statistically significant. Results: The mean age of the patients was 54.08±11.88 years. The prevalence rate of abnormal LV geometry was 48.4%. Mean ambulatory Systolic BP (day time, night time and 24-hour-average) was significantly higher in patients with LVH compared with those without LVH. Day-night systolic and diastolic BP decay (i.e. percentage nocturnal decline in BP) was also significantly lower in LVH group than in the group without LVH. Patients with eccentric LVH had abnormal day time mean ambulatory systolic BP, night time mean ambulatory systolic BP, elevated day time and night time systolic BP loads, as well as non-dipping diastolic BP pattern. Significant correlates of LV mass index in this study population were mean ambulatory systolic BP (day time: r = 0.355, P = 0.004; night time: r = 0.343, P = 0.005; 24- hour average: r = 0.358, P = 0.004) and day-night decay (systolic: r = -0.388, P = 0.007; diastolic: r = -0.290, P = 0.022) as well as 24-hour systolic BP variability. Conclusion: The presence of LVH in hypertension was associated with higher mean ambulatory systolic BP and lower percentage nocturnal decline in systolic and diastolic BP than its absence which appeared to be worse in patients with eccentric LV geometry when compared with other geometric patterns.

A five‑year review of the pattern and outcome of cardiovascular diseases admissions at the Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria

Background: In Nigeria, there is increasing urbanization and westernization of the population with resultant increase in non-communicable diseases. Though records of hospital admissions may not indicate the actual prevalence of such diseases in the community, it may provide clues about pattern and assist in disease-specific health promotion and education. Objective: We, therefore, undertook this study to describe the pattern and outcome of cardiovascular diseases (CVD) admissions in a new referral hospital in Nigeria. Methods: A five-year retrospective analysis of CVD admissions into the Medical Wards of Ekiti State University Teaching Hospital from May 2008 to April 2013 was done. SPSS IBM 20 software was used to analyze data. Results: A total of 3,076 medical admissions were recorded with 1,009 (32.80%) being CVD. Mean age of CVD patients was 61.16±15.95 years. Patients aged >65 years accounted for 478 (47.8%) of the admissions. The 3 major CVD admissions were cerebrovascular diseases (47.7%), heart failure (27.6%), and hypertensive diseases (22.0%). Deaths due to CVD were 192 (19.0%) comprising mostly 136 (13.51%), 43 (4.26%), and 12 (1.19%) of deaths due to cerebrovascular disease, heart failure, and hypertensive diseases, respectively. Most deaths occurred within 3 days of admission with a decline in mortality with increasing length of hospital stay thereafter. Mean duration of hospitalization was 8.76±7.23 days. Conclusion: Admissions from CVD to the medical wards in this hospital are high, so is mortality from them. We advocate for preventive strategies to reduce the burden of CVD and improved health care facilities to improve outcomes of their treatment.

Adherence to Antihypertensive Medications and Some of Its Clinical Implications in Patients Seen At a Tertiary Hospital in Nigeria

Abstract: Background: Adherence to antihypertensive is crucial to treatment success in subjects with hypertension. This study is aimed at assessing antihypertensive drug adherence using validated tool and its relationship with some demographic and clinical parameters in outpatient hypertensive subjects. Methods:The Morisky Medication Adherence Scale (MMAS-4) was used to assess drug adherence status in 150 hypertensive patients who were consecutively recruited in a Medical Outpatient Department of a Tertiary Health Centre. All the patients had resting 12- lead electrocardiogram (ECG) done to determine left ventricular hypertrophy (LVH). Data were analyzed with SPSS 13 and statistical significance of p< 0.05 was used. Results: One hundred and fifty hypertensive patients with a mean age of 61.53± 9.72years were recruited over a period of 6 months. Sixty seven (44.7%) were good drug adherers while 55.3% were not. Patients with poor antihypertensive adherence had higher Sokolow- Lyon ECG score (34.46 ± 7.87 vs. 22.96 ± 7.07; p= 0.07) as well as longer P wave duration on ECG (0.15 ± 0.03 vs. 0.12± 0.04; p= 0.03). There was higher rate of ECG LVH among patients with poor drug adherence (47.0%) compared to patients with good drug adherence (4.5%). Significant correlates of poor drug adherence were age (r= - 0.221; p=0.022) and BMI (r= 0.431; P<0.001). Conclusion:The rate of poor drug compliance was high with preponderance of LVH in poor adherer. Physicians will do well to engage their hypertensive patients on hypertension and its treatment with a view to improving drug adherence in them. Keywords: Medication, adherence, hypertension, electrocardiogram

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

Left ventricular (LV) hypertrophy is an important predictor of morbidity and mortality in hypertensive patients, and its geometric pattern is a useful determinant of severity and prognosis of heart disease. Studies on LV geometric pattern involving large number of Nigerian hypertensive patients are limited. We examined the LV geometric pattern in hypertensive patients seen in our echocardiographic laboratory. A two-dimensional, pulsed, continuous and color flow Doppler echocardiographic evaluation of 1020 consecutive hypertensive patients aged between 18 and 91 years was conducted over an 8-year period. LV geometric patterns were determined using the relationship between the relative wall thickness and LV mass index. Four patterns of LV geometry were found: 237 (23.2%) patients had concentric hypertrophy, 109 (10.7%) had eccentric hypertrophy, 488 (47.8%) had concentric remodeling, and 186 (18.2%) had normal geometry. Patients with concentric hypertrophy were significantly older in age, and had significantly higher systolic blood pressure (BP), diastolic BP, and pulse pressure than those with normal geometry. Systolic function index in patients with eccentric hypertrophy was significantly lower than in other geometric patterns. Doppler echocardiographic parameters showed some diastolic dysfunction in hypertensive patients with abnormal LV geometry. Concentric remodeling was the most common LV geometric pattern observed in our hypertensive patients, followed by concentric hypertrophy and eccentric hypertrophy. Patients with concentric hypertrophy were older than those with other geometric patterns. LV systolic function was significantly lower in patients with eccentric hypertrophy and some degree of diastolic dysfunction were present in patients with abnormal LV geometry.

Aetiology and Management Outcome of Upper Gastrointestinal Bleeding in Adult Patients Presenting at Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria

BACKGROUND AND AIM : Upper gastrointestinal bleeding (UGIB) is one of the commonest gastrointestinal emergencies. Endoscopy done within the first 24 hours of bleeding has been shown to be the most reliable means of establishing the source of upper gastrointestinal haemorrhage. This study was carried out to determine the aetiology and management outcome of patients with UGIB presenting at our facility located in Southwest Nigeria. MATERIALS AND METHOD : 67 patients who presented with UGIB and underwent upper gastrointestinal endoscopy between April 2010 and March 2011 at the Ekiti State University Teaching Hospital (EKSUTH), Ado- Ekiti, Southwest Nigeria were retrospectively studied, relevant data extracted and analysed. RESULTS : The demographic data of the patients showed a mean age of 41.84± 12.81 years, (ages ranged from 17 to 75 years), 40 (59.7%) were males while 27 (40.3%) were females giving a male to female ratio of 1.5:1. Clinical presentations included haematemesis and melena in 26 (38.8%), followed by haematemesis in 22 (32.8%) and melena in 19 (28.4%) of the patients. Antral mucosal erosions were the commonest cause of UGIB (49%), followed by peptic ulcer disease (25.4%), varices (11.9%) and gastric mass (1.5%). No cause for UGIB was found in 8 cases (11.9%). Endoscopy diagnostic accuracy was greater within the first 24 hours of the bleeding onset compared to those who had it done later (p<0.003). Three patients died giving a mortality rate of 4.5%. These deaths were recorded from among the variceal bleeding group giving a mortality rate of 42.9% in this group of patients. CONCLUSION : Antral mucosal erosions were the commonest cause of UGIB in our environment. NSAIDS intake was very high among the populace, especially in mucosal erosion group leading to high morbidity, absent from work and huge financial cost. It is recommended that serious awareness campaigns be mounted to educate the populace of the dangers inherent in indiscriminate use of NSAIDS in our society. As endoscopy diagnostic accuracy was greater within the first 24 hours of the bleeding onset, it is equally recommended that early endoscopy should be performed within 24 h of the onset of bleeding.

Bilateral Blindness: Prevalence and Their Utilization of Existing Eye Care Facilities in a Nigerian Rural Community

Background: Blindness, which is potentially avoidable, is a serious public health problem globally. Thi s study was carried out to determine prevalence of bilateral blindness and the utilization of existing eye care facilities by the bilaterally blind. Methods: A randomi ze d cross sectional community-based study. Participants were community members aged 5years and above who were selected from 30 enumeration areas determined with EPI INFO V6 statistical software in line with standard practice. They had detailed ocular examinations and data were analyzed with SPSS. Results: Eligible participants were 1,236 (Male: Female = 1:2). Age ranged 5-103 years (median age, 55years). Prevalence of blindness was 4% (49/1236) for which Cataract (42.9%); Glaucoma (24.5%), Couching (10.2%) and Cornea opacity (8.2%) were the common causes. Most of those that were blind (57.1%) had never utilized eye care services available in the study area and lack of awareness was the reason in majority of them. Conclusions: Blindness as a result of avoidable causes is high in this community. Despite this, the level of utilization of available eye care facilities is low and this is mainly as a result of lack of awareness. Eye health promotion campaign at the rural level is recommended.

Coexistence of Cor triatriatum sinistrum and a prominent Eustachian valve mimicking a Cor triatriatum dextrum

Cor triatriatum is among the rarest of all congenital cardiac abnormalities accounting for 0.1-0.4% of all congenital heart disease. Its coexistence with a very prominent Eustachian valve which mimics a Cor triatriatum dextrum is an exceptionally rare finding in an asymptomatic adult. We report the case of a 44 year old male who presented to our department on observing a pulse rate of 44 beats per minute during a home blood pressure check with his digital sphygmomanometer. Clinical examinationwas however, unremarkable and resting electrocardiography showed sinus rhythm with atrial premature complexes. The diagnosis was made on a two dimensional transthoracic echocardiography. Isolated atrial premature complexes and bradycardia may be a clinical presentation of Cor triatriatum in adult population. Although extremely rare, its coexistence with a prominent Eustachian valve may remain asymptomatic into adult life.

Pattern of Abnormal Serum Lipids and Lipoprotein Ratios in Nigerian Hypertensive Patients Seen in Clinical Practice

Background: Hypertension is a major health problem worldwide. Its role, and other well - known coronary risk factors, especially dyslipidemia, in atherogenesis have informed estimation of cardiovascular risk. Hi therto, low density lipoprotein (LDL - C) and high density lipoprotein (HDL - C) are prominent in guidelines but attempts are being made to include the use of lipoprotein ratios to optimize the predictive capacity of lipid profile in risk evaluation. This stud y aimed to describe pattern of lipids abnormalities, including the common lipid ratios used in clinical practice and to understand if they differ more with abdominal obesity which compared with peripheral obesity in subjects with systemic hypertension. Mat erials and Methods: Two hundred and eleven new adult hypertensive patients were studied in a hospital - based cross - sectional study. Serum lipids were measured and lipoprotein ratios calculated. SPSS IBM 20 was used to analyze data.

Respiratory-Related Medical Admissions in a Tertiary Institution in South-Western Nigeria

Background: Globally, respiratory diseases are common causes of medical admissions. Our objective was to determine the causes and outcome of respiratory diseases in our facility for health planning, policy formulation and allocation of resources.Method: A retrospective study of all respiratory-related admissions between January 2011 and December 2015. Classification of diseases was based on the ICD-10 coding system.Results: Respiratory-related admissions accounted for 460 (12%) of all medical cases with a slight male preponderance of 1.4 to 1. Mean age of patients was 50.4 ± 20.8 years. The majority 342 (74.3%) of these admissions were due to communicable respiratory diseases. Pulmonary tuberculosis (44.1%) and pneumonia (28.9%) accounted for the highest admissions which were closely followed by COPD (11.1%) and asthma (7.2%). The commonest co-morbidity was HIV/AIDS (12.3%) which also coexisted with other diseases in most cases of mortality. The median hospital-stay was 7 days. Most diseases had peak presentations during the dry season except bronchial asthma with rainy and dry peak seasons. The overall mortality was 17.6% and the highest mortalities were recorded in patients who had pulmonary tuberculosis (55.5%), pneumonia (20.9%) and COPD (8.6%).Conclusion: Communicable respiratory diseases are the leading causes of morbidity and mortality. Scaling up on coverage of the control programmes as well as the methodical integration of non-communicable diseases into already existing control programmes will further strengthen the health-care systems in resource-limited settings.