Sylvie Ndongo Amougou

Prevalence, Awareness, and Control of Hypertension in Health Workers of Two Teaching Hospitals of Yaounde-Cameroon: The Hypertension Awareness Initiative (THAI) Pilot Survey

Introduction: High blood pressure is a public problem worldwide because of its high morbidity and mortality. The greatest burden is in low-income set-tings. The burden of disease has not been studied in health workers in our setting. Methods: Between December 2016 and June 2017, we carried out a cross-sectional descriptive and analytic study in two teaching hospitals in Yaounde, using the WHO STEP wise approach. Participants were consenting Physicians, Nurses, Midwives, and Nursing assistants of both sex, aged ≥ 21 years. Results: A total of 266 health workers were screened—31 Physicians, 144 Nurses, 80 Nursing assistants, and 11 Midwives. Their mean age was 41.1 ± 7.6 years (25 to 66 years), and 84.6% were females. The prevalence of Hypertension was 13.9%, of which 54.1% were newly diagnosed—Awareness rate of 45.9%. The control rate of known cases of hy-pertension was 64.7% (64.3% in those on monotherapy, and 66.7% in those on bitherapy). Age > 40 years, and adiposity were significantly associated with hypertension. Conclusion: Compared to the general population, the prevalence of hypertension amongst health workers was low, but with a high rate of un-awareness.

Vascular hyperreactivity in black Cameroonian hypertensive and normotensive patients: a comparative study

Introduction Vascular hyperreactivity is a risk factor and a factor predicting hypertension (high blood pressure). Unlike other continents where several studies were carried out, it has rarely been studied in black Africa in general and in Cameroon in particular. Methods Vascular reactivity was measured by the cold test. Vascular hyperreactivity was defined as an increase in blood pressure > 20 mmHg for systolic and/or > 15 mmHg for diastolic. Khi2, Man-Withney, Wilcoxons signed ranks and logistic regression tests were used for statistical analysis. Results A total of 31 hypertensive and 31 normotensive patients matched by age and sex participated in this study. Vascular hyperreactivity was present in 77.4% hypertensive patients and 51.6% normotensive patients. There was a significant association between vascular hyperreactivity and hypertension [OR = 3.2 (1.07 - 9.63), p = 0.034]. The median arterial pressure was higher in responders compared to non-responders in the normotensive group. Age > 45 years, female sex, obesity and family history of hypertension appeared to be associated with vascular hyperreactivity, but only in normotensive patients. Conclusion Vascular hyperreactivity appears to be a risk factor for high blood pressure in black Cameroonians. It appeared to be associated with low blood pressure, age, sex, obesity and family history of hypertension but this was only in the normotensive.

Office versus ambulatory blood pressure measurements in diagnosing diurnal hypertension in sub-Saharan Africans: a comparative cross-sectional study in Cameroon

Background: Hypertension is the most frequent cardiovascular risk factor worldwide, with the greatest burden in low-income settings. We sought to know if the serial blood pressure (BP) readings measured in a single encounter, alongside other cardiovascular risk factors could reliably make the diagnosis of hypertension in a group of sub-Saharan Africans. Methods: Between October and November 2016, we carried-out a cross-sectional descriptive and analytic study in Yaounde, Cameroon. Adults of both sexes, aged ≥18 years were screened for cardiovascular risk factors using the WHO STEPwise approach. Participants with de novo elevated office BP underwent an ambulatory blood pressure measurement (ABPM) to ascertain hypertension. We then studied the determinants of ABPM diagnosed hypertension. Results: Of the 26 participants who had an ABPM, 23 (88.5%) had hypertension, and 3 (11.5%) had white coat hypertension (WCH). Of those with hypertension (n=22), 6 (27.3%) were dippers, 2 (9.1%) were extreme dippers, 9 (40.9%) were non-dippers, and 5 (22.7%) were reverse dippers. The three participants with White coat effect were non-dippers. The determinants of de novo hypertension on ABPM were: Age >50 years (OR: 4.1, P=0.001), adiposity (OR: 6.2, P=0.002), pulse pressure >65 mmHg (OR: 21.4, P de novo diurnal hypertension on ABPM. Conclusions: In people with de novo raised office BP, 9-in-10 will have hypertension on ABPM especially when they are aged >50 years, have abdominal obesity, high pulse pressure, and hyperuricemia. Those with white coat effect appeared to have a blunted BP dipping pattern.

Aetiologies and correlates of secondary mitral regurgitation in patients with dilated cardiopathy in Cameroon: a cross-sectional study

Background: Dilated cardiopathy is a heterogeneous group of heart disease in which there is progressive ventricular remodeling, with or without secondary functional mitral regurgitation (MR). MR has prognostic implications, and has not been studied in our setting. This work aimed at studying the occurrence, aetiologies and correlates of secondary MR in a group of patients with dilated cardiopathy in a resource limited setting in sub-Saharan Africa. Methods: We carried out a cross-sectional study in the echocardiography laboratories of three tertiary hospitals in the city of Yaounde, Cameroon. Participants were consecutively recruited over an eight month period, after results of echocardiograms. The severity of MR was assessed from the size of the regurgitant orifice and the mechanism of MR assessed with the Carpentier classification. Results: A total of 25 participants (13 males) with an echocardiographic dilated left ventricle were included in the study. Their mean age was 53.2 years (range: 22 to 84 years). All patients had MR, of whom 6 (24%) had severe MR (grade IV). Type I MR was seen in 14 (46%), type III in 10 (40%), and type I and III in 1 (4%) of patients. The baseline heart disease were primary 4 (16%), ischemic 10 (40%), hypertensive 10 (40%), and peri-partum cardiomyopathy. The left atrium was dilated in 22 (88%), raised filling pressure in 19 (76%), and raised pulmonary pressure in 15 (60%). The severity of MR significantly correlated with age (r=0.5, P=0.011), left ventricle end diastolic diameter (r=0.41, P=0.04), low ejection fraction (r=−0.378, P=0.031), and left atrial size (r=0.431, P=0.022). Conclusions: Secondary MR is almost always present in patients with dilated cardiopathy. The severity of MR correlated with age, low ejection fraction, left ventricular end diastolic diameter, and left atrial size.

Prevalence and correlates of chronic kidney disease in a group of patients with hypertension in the Savanah zone of Cameroon: a cross-sectional study in Sub-Saharan Africa

Background The prevalence of chronic kidney disease (CKD) is increasing worldwide due to an increase in the risk factors such as hypertension. The greatest burden is in low-income settings, coupled with late diagnosis and limited management resources. This work aimed at studying the prevalence and risk factors of CKD in a group of patients with hypertension in the Savanah zone in Sub-Saharan Africa (SSA). Methods We carried out a cross-sectional study between January and May 2016 in the regional Hospital of Garoua-Cameroon. Participants were adults ≥18 years of both sexes, who had a diagnosis of hypertension. Patients underwent a comprehensive clinical, biological, and electrocardiographic evaluation. Results A total of 400 patients with hypertension were included, of whom 132 (33%; 95% CI: 28.6-37.8%) were males. Their mean age was 54.16±11.17 years. Hypertension was controlled in 122 (30.5%; 95% CI: 26.2-35.2%) participants. Twelve percent had a positive urine dipstick for proteins. The mean glomerular filtration rate (GFR) was 75.27±24.87 mL/min/1.73m2. The prevalence of CKD was seen in 129 (32.3%; 95% CI: 27.9-36.98) participants. Stage 3A was the most frequent (62.01%). The main comorbidities were anemia (44.5%), obesity (39.75%), diabetes (32%), consumption of traditional medicines (15.75%), and hyperuricemia (10.75%). After multivariate analysis, age >50 years (aOR: 1.75; 95% CI: 1.06-2.89; P=0.027), female sex (aOR: 2.21; 95% CI: 1.29-3.78; P=0.0035), obesity (aOR: 1.58, 95% CI: 1.01-2.44; P=0.026) and the hyperuricemia (aOR: 3.67; 95% CI: 1.78-7.58; P<0.001) were independently associated with CKD. Conclusions The prevalence of CKD in adults with hypertension was high. This was associated with age greater than 50 years, female sex, obesity and the hyperuricemia.