Abstract
Background: Although hypertension is highly prevalent in Nigeria, coronary artery disease (CAD) remains relatively uncommon. This may well change due to epidemiological transition. To ascertain the future role of CAD in Nigeria, we risk stratified every consecutive hypertensive subject referred to the Cardiology unit of the University of Abuja Teaching Hospital over 7 years. Hypothesis: A significant proportion of the study population will fall within the intermediate or high risk category. Methods: It is a prospective, observational study. 1571 hypertensive subjects were risk stratified according to the Framingham 10-year Risk Score. Results: 834(53.1%) of the subjects were female while 737(46.9%) were male. The mean age, mean body mass index and mean arterial pressure of the subjects were 50.9 ± 11.4 years, 28.1 ± 9.4 kg/m2 and 116.23 ± 13.1 mmHg respectively. According to Framingham criteria, 1263(80.4%) of the study population were low risk individuals, 286(18.2%) were medium risk, 22(1.4%) were high risk individuals. When the age of the subjects was hypothetically increased by an additional 10 years, the high risk group increased from 1.3% to 21.3%. Conclusions: According to the Framingham risk score, the majority of subjects with hypertension presenting to a large teaching hospital in Nigeria have a low risk of developing CAD in the near future, which contrasts with the risk profile seen in hypertensive subjects in Europe and North America. Nonetheless, approximately one in four subjects were classified as intermediate or high risk emphasizing the importance of lifestyle modification and the need to consider absolute risk stratification to guide management in countries undergoing epidemiological transition.
Highlights
IntroductionDespite a relatively high prevalence of hypertension in Nigeria (estimated to affect 25-27% of the population) [1], and the high burden of hypertensive left ventricular hypertrophy [2,3,4,5,6], hypertensive heart failure [7,8,9,10], chronic kidney disease [11,12,13,14,15,16] and strokes [17,18] due to uncontrolled hypertension, the prevalence of coronary artery disease (CAD) is still relatively low [19,20].This represents a paradox given that each 20 mmHg increase in SBP over the range of 115-185 mmHg doubles coronary heart disease and stroke mortality [21]
According to the Framingham risk score, the majority of subjects with hypertension presenting to a large teaching hospital in Nigeria have a low risk of developing coronary artery disease (CAD) in the near future, which contrasts with the risk profile seen in hypertensive subjects in Europe and North America
Approximately one in four subjects were classified as intermediate or high risk emphasizing the importance of lifestyle modification and the need to consider absolute risk stratification to guide management in countries undergoing epidemiological transition
Summary
Despite a relatively high prevalence of hypertension in Nigeria (estimated to affect 25-27% of the population) [1], and the high burden of hypertensive left ventricular hypertrophy [2,3,4,5,6], hypertensive heart failure [7,8,9,10], chronic kidney disease [11,12,13,14,15,16] and strokes [17,18] due to uncontrolled hypertension, the prevalence of coronary artery disease (CAD) is still relatively low [19,20].This represents a paradox given that each 20 mmHg increase in SBP over the range of 115-185 mmHg doubles coronary heart disease and stroke mortality [21]. A 10 to 12 mmHg reduction in systolic blood pressure and a 5 to 6 mmHg reduction in diastolic blood pressure has been shown to reduce the risk of coronary artery disease (CAD) by 16% [21] It has been projected that with the epidemiological transition in disease pattern being experienced in many parts of sub-Saharan Africa [23], CAD is likely to play a more significant role in the burden of disease in Nigeria in the future. To ascertain the future role of CAD in Nigeria, we risk stratified every consecutive hypertensive subject referred to the Cardiology unit of the University of Abuja Teaching Hospital over 7 years.
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