Hypertensive Nigerians Research Articles

Abstract P108: Correlations of attended and unattended office blood pressure measurements with Left Ventricular Mass in untreated hypertensives.

Introduction: Unattended (UA) office blood pressure (BP) measurements have been proposed as better substitutes for attended (AT) BP readings for the diagnosis and monitoring of patients with hypertension (HTN). A superior correlation of UA over AT BP measurements with Left Ventricular Hypertrophy (LVH), an early marker of hypertensive organ damage has not been conclusively demonstrated. We hypothesized that in a group with untreated HTN, UA BP would correlate more strongly with left ventricular hypertrophy than AT BP. Methods: Newly diagnosed untreated patients with HTN presenting newly to an outpatient clinic in Nigeria were consented as part of a larger study. Three sets of AT and UA seated BP readings were carried out using a validated device followed by same-day echocardiographic assessment of their Left Ventricular Mass Indexed to Body surface area (LVMI). Pearson’s coefficient (r) was determined and a 2-tailed significance was defined by a two-tailed P value (P) less than 0.05. Coefficients were compared using Fisher r to z transformation. Results: A total of 49 participants (female=25) were recruited with a mean age of 46.2 +/- 9 years. The mean of the AT BP in the cohort (mAT) was 157.1 +/- 13.5mmHg, while the mean of the UA BP was 151.9 +/- 15.7 with no significant difference in both (P=0.085). The mean LVMI of the cohort was 102.3 +/- 28.7 mg/m2. Both the mAT BP (r= 0.304, P= 0.034) and the mUA BP (r=0.354, P=0.013) positively correlated with LVMI, with no significant difference in the strength of both correlations with r to z transformation (z=0.27, P=0.394 ). Conclusion: In a small cohort of newly diagnosed Nigerian hypertensives, both attended and unattended systolic office blood pressure readings correlated positively with left ventricular mass indexed to body surface area, with no significant difference in the strength of their correlation. Having failed to demonstrate a superior correlation of unattended blood pressure readings with LVH, our findings support the continued use of attended office blood pressure readings for clinical monitoring in busy time-constrained office settings where unattended office blood pressure monitoring may not be feasible. Larger studies are however required to confirm these findings.

Electrocardiographic Abnormalities in Nigerian Hypertensives With Echocardiographic Left Ventricular Hypertrophy.

Introduction To enhance the diagnosis of anatomic left ventricular hypertrophy (LVH) using electrocardiography (ECG), we aimed to identify common ECG amplitude and non-amplitude abnormalities in Nigerian patients with hypertensive echocardiographic LVH. Method The study included 1,765 patients with essential hypertension aged 18 years and older from the Federal Medical Centre Abuja Hypertension Registry (FMCAHR). Participants underwent echocardiography and ECG following the American College of Cardiology and the American Society of Echocardiography guidelines. Results The prevalence of overall ECG LVH amplitude criteria (43.8%) and individual criteria of Cornell voltage (27.1%), Sokolow-Lyon voltage (23.2%), and Gubner-Ungerleider (13.9%) werehigher than non-amplitude ECG abnormalities among patients with echocardiographic LVH. The sensitivity and specificity of LVH criteria were 43.8% and 79.5% for overall ECG LVH, 23.2% and 87.2% for Sokolow-Lyon voltage, 27.1% and 93.3% for Cornell voltage, and 13.9% and 95.4% for Gubner-Ungerleider criteria, respectively. After multivariable adjustment, non-amplitude ECG changes, including prolonged corrected QT (QTc) (odds ratio (OR): 1.68, 95% confidence interval (CI): 1.06-2.66), left ventricular (LV) strain pattern (OR: 1.83, CI: 1.23-2.72), left axis deviation(OR: 1.56, CI: 1.09-2.24), poor R wave progression (OR: 2.36, CI: 1.40-3.97), premature ventricular contractions(OR: 1.80, CI: 1.10-2.91), premature atrial contractions(OR: 2.06, CI: 1.10-3.87), atrial fibrillation(OR: 2.40, CI: 1.20-4.82), and left atrial abnormality (OR: 8.43, CI: 2.95-24.05), were associated with echocardiographic LVH (p < 0.05). Conclusion In our cohort of hypertensive patients, ECG LVH amplitude criteria were the most frequently observed abnormalities associated with echocardiographic LVH. Our findings suggest that despite the low sensitivity, ECG LVH amplitude criteria may remain valuable in diagnosing echocardiographic LVH.

Family History of Hypertension and Echocardiographic Left Ventricular Hypertrophy in Hypertensive Nigerians.

Studies on the relationship between a family history of hypertension and left ventricular hypertrophy are sparse. We evaluated this relationship in patients with essential hypertension. A total of 1668 patients with essential hypertension were consecutively enrolled in the prospective Federal Medical Centre Abuja Hypertension Registry. First-degree family history was defined by the presence of a known history of hypertension in any or both parents, siblings, and children. Echocardiographic left ventricular hypertrophy was diagnosed using the criteria of the American Society of Echocardiography and the European Association of Cardiovascular Imaging. The prevalence of a family history of hypertension, echocardiographic, and electrocardiographic left ventricular hypertrophy were 61.7%, 46.8%, and 30.8%, respectively. After multivariable adjustment, paternal history of hypertension [OR: 1.56, CI: 1.20-2.05, p=0.001] was associated with an increased risk of echocardiographic left ventricular hypertrophy, while maternal history of hypertension [OR: 0.72, CI 0.58-0.91, p=0.006] was associated with a reduced risk. Age ≥50 years (p=0.026), duration of hypertension ≥1 year (p=0.047), and heart failure (p < 0.001) were associated with an increased risk of left ventricular hypertrophy, while male sex (p < 0.001) was associated with a reduced risk. Our study showed that a paternal history of hypertension is associated with an increased left ventricular hypertrophy risk among patients with essential hypertension, while maternal history is protective.

Atherogenicity, Oxidative Stress, Heavy Metals and Bioelements Status in Hypertensive Nigerians in an Urban Population

Objectives: This study investigated levels of measured parameters; bio-elements (zinc, copper, selenium, chromium, and manganese), heavy metals (cadmium and lead), oxidative stress biomarkers (vitamin C, Vitamin E, reduced Glutathione-GSH and malondialdehyde-MDA) and lipid profile (cholesterol-CHOL, triglyceride- TG, high-density lipoprotein- HDL, low-density lipoprotein- LDL and VLDL) in primary hypertensive individuals.&#x0D; Materials and Methods: A total of 74 confirmed hypertensive individuals (30 males, 44 females) of 30-55 years (test subjects) and 46 (22males, 24 females) age-matched apparently healthy normotensive individuals (control) were involved in this study. Atomic absorption spectrophotometer was used to determine the concentrations of bio-elements and toxic metals while spectrophotometric methods were used for the concentrations of oxidative stress biomarkers and lipid fractions.&#x0D; Results: Comparative analysis between test and control subjects showed significantly reduced concentrations of vitamins C and E, GSH, the bio-elements, HDL and Zinc/Copper ratio. Significantly elevated concentrations of the toxic metals, MDA, CHOL, TG, LDL, and VLDL, the atherogenic indices- LDL/HDL, TC/HDL, and TG/HDL as well as Cadmium/ Zinc ratio. There was indirect association between the bio-elements and atherogenic lipid fractions but a direct correlation with HDL. Also, negative correlations were observed between the heavy metals and the antioxidants biomolecules.&#x0D; Conclusion: The concentrations of the measured bio-elements, vitamins C and E, GSH and HDL were significantly lower in hypertensive individuals while the levels of heavy metals, cholesterol, TG, LDL and MDA were significantly higher.

Prevalence, patterns and predictors of metabolic abnormalities in Nigerian hypertensives with hypertriglyceridemic waist phenotype: A cross sectional study.

Simultaneous presence of elevated waist circumference and hypertriglyceridemia (HTGW) is a simple and low-cost measure of visceral obesity, and it is associated with a plethora of cardio-metabolic abnormalities that can increase the risk of cardiovascular diseases and incident Type 2 diabetes mellitus. We decided to study the prevalence, patterns, and predictors of metabolic abnormalities in Nigerian hypertensives with the HTGW phenotype. The medical records of 582 hypertensives with complete data of interest were retrieved and analyzed for the study. Their socio-demographic data, anthropometric data, and booking blood pressure values were retrieved. The results of their fasting plasma glucose, lipid profile, uric acid and serum creatinine were also retrieved for analysis. The mean age of the study population was 56.2 ±13.6, with 53.1% being males. The prevalence of smoking and use of alcohol was 4.3% and 26.5% respectively. The prevalence of the HTGW phenotype was 23.4% and were predominantly males (61%). Subjects with the HTGW phenotype were more obese assessed by waist circumference (WC) and body mass index (BMI). Mean serum total cholesterol, triglyceride, very low-density lipoprotein, uric acid, and creatinine were significantly higher in the HTGW phenotype (p = 0.003; <0.001; <0.001; 0.002 and <0.001 respectively). The prevalence of newly diagnosed Type 2 diabetes was 28.7%. There was also a preponderance of cardio-metabolic abnormalities (obesity, dyslipidaemia, hyperuricemia) in the HTGW phenotype. In both males and females, the HGTW phenotype was significantly associated with elevated Tc, TG, VLDL, hyperuricemia and atherogenic index of plasma. The HTGW phenotype is common amongst Nigerian hypertensives, and it is associated with metabolic abnormalities.

Prevalence of echocardiographic left atrial enlargement among hypertensive Nigerian subjects.

Left atrial enlargement (LAE) predispose to arrhythmias, atrial thrombogenesis and cardioembolic stroke. Whether LAE constitute a major risk among African hypertensive subjects is not well described. This study was aimed to describe the epidemiologic pattern of LAE among hypertensive subjects and determine their correlates. Clinical and demographic details of 414 hypertensive subjects used were taken. Echocardiography was done. LAE was defined as Left atrial dimension (LAD)>3.7 cm. Statistical analysis was done using SPSS 17.0. 414 subjects including 258 (62.3%) males were recruited. The mean age was 56.8±16.8 years. LAE was present in 57.73% of hypertensive subjects. Those with LAE were likely to be older (58.23±14.5 vs. 54.8 ±19.7 years, p<0.05), had a higher waist circumference (88.1 ±26.8 ±75.8 ±28.4 cm, p<0.05), left ventricular mass index (79.2 ± 12.4 vs. 48.7 ±15.5g/m2.7, p<0.05) and a higher frequency of left ventricular hypertrophy (LVH) (65.3% vs. 40.0 %, p<0.05) respectively than those without LAE. LAD was significantly higher among those with LVH than those without LVH (41.4 ±8.4 vs. 35.6 ±5.9 mm respectively, p<0.05). LAE is common among Nigerian hypertensive subjects. Age, waist circumference, left ventricular wall dimension and mass index are the important correlates of LAE in hypertensive Nigerians.

Gingival overgrowth and associated factors in a population of Nigerian hypertensives

Background: Gingival overgrowth may be idiopathic or secondary. Drug Induced Gingival Overgrowth (DIGO) occurs within 3 months of treatment and is more prevalent in younger age group with predilection for the anterior gingival tissue and usually not associated with attachment loss or tooth mobility unless there is an existing periodontal disease. Methodology: 170 hypertensive patients were recruited for the study; 85 calcium channel blocker (CCB) and 85 non-CCB users. Interviewer-administered questionnaires was used to obtain socio-demographic information as well as medical and drug history. GO was assessed using New Clinical Index for DIGO and data was analyzed with SPSS version 21 (Armonk, NY: IBM Corp). Continuous and nominal variables were described with means, standard deviations and frequencies. Statistical significance was set at P &lt; 0.05. Results: Amlodipine was the most commonly used CCB. The prevalence of DIGO in CCB and non-CCB was the same (49.5%). Gingival enlargement was found equally among both sexes in the CCB and non-CCB groups. A third of the participants with GO were 70 years and above while those without were majorly in the fifth and sixth decade of life. Two-third of those with DIGO had fair oral hygiene status, two-fifth had gingival bleeding and three-fifth had mild gingival inflammation. Those without DIGO in both groups had a slight female predominance and majorly good oral hygiene. Associated factors with DIGO were female sex, 60-69 age group, 10mg drug dosage, been on medication less than 10 years, mild gingival inflammation and generalized gingivitis. Conclusion: There was no difference in the prevalence of DIGO between BBC and non-BBC users. However, there was mild gingival inflammation in all participants with DIGO and amlodipine users were three times more at risk of developing DIGO than nifedipine users. Thus, it is imperative to advise the hypertensives on the importance of maintaining adequate oral hygiene measures and incorporate periodontal care in their management so as to ameliorate the side effects of their medication.

Gingival overgrowth and associated factors in a population of Nigerian hypertensives

Gingival overgrowth and associated factors in a population of Nigerian hypertensives

Relationship between P-wave dispersion, left ventricular mass index and function in Nigerian hypertensive patients.

Hypertension is the most prevalent cardiovascular disorder in the world. It is associated with target-organ damage in various organs and ECG changes. P-wave dispersion (PWD), which represents inhomogeneous atrial conduction and discontinuation of impulses, has been observed, when prolonged, to predict atrial fibrillation, particularly in the setting of hypertension. This study of PWD in 150 hypertensive patients and controls sought to determine the prevalence of PWD in Nigerian hypertensives and its relationship to left ventricular mass index and left ventricular function. Mean PWD in normal subjects was 32.14 ± 4.72 ms and was significantly shorter than that in hypertensive patients at 38.29 ± 8.02 ms. In the total population, 51.3% had prolonged PWD ( > 33.46 ms); 70% in the hypertensives and 32.7% of controls. The only significant difference in hypertensives with prolonged and normal PWD was the waist circumference. There was a negative correlation between PWD and ejection fraction (r = -0.17, p = 0.03), but not with diastolic function.

Influence of Gender on Total Serum Creatine Kinase and Creatine Kinase-Mb Levels of Nigerian Hypertensives

Introduction: Hypertension is a long-term medical condition which when not detected and managed properly and on time often results to complications leading to disabilities and mortality. Gender has been known to affect the interpretation of some variables necessitating the need for gender-specific ranges.&#x0D; Objectives:This study evaluated total creatine kinase (CK) and creatine kinase-MB (CK-MB) isoenzyme activities of hypertensive subjects in Calabar, Nigeria and to assess if gender has influence on the activities of these enzymes.&#x0D; Methodology:One hundred and two participants were consecutively enrolled in this case control study. Serum total serum CK and CK-MB activity were evaluated in fifty one hypertensive and 51 normotensive subjects. The total CK levels were assessed using a spectrophotometric method while immunoinhibition method was used to determine the activity of CK-MB. Data was analyzed using Student’s t-test and Pearson’s correlation. Statistical significance was set at p&lt;0.05.&#x0D; Results:The total creatine kinase activities of the hypertensives did not differ significantly from those of the normotensive controls (p = 0.428) while the serum CK-MB activities of the hypertensive subjects were significantly higher than those of the normotensive controls (p=0.000). The body mass index of the hypertensives was significantly higher than those of the normotensive subjects (p=0.030). Gender had no effect on the blood pressure, body mass index and levels of CK and CK-MB (p&gt;0.05). There was also no significant correlation (p&gt;0.05) between blood pressure, body mass index and the levels of CK and CK-MB.&#x0D; Conclusion:CK-MB activities were significantly higher in hypertensive subjects compared to normotensive controls. There were no gender specific differences in the CK-MB levels of male and female hypertensives. This cardiac marker should be included in the routine assessment of hypertensives and gender-specific considerations may not be necessary in the interpretation of the data.

Evaluation of peroxisome proliferator-activated receptor-gamma (Ppar-γ) and metabolic dysfunction among hypertensive nigerians

Background and AimsHypertension is gradually becoming a major health burden in Nigeria; the most populous African nation. Often this starts unnoticed, but later, this disorder leads to complications and death if not properly managed. This study assessed the level of peroxisome proliferator-activated receptor-gamma (PPAR-γ), insulin, glucose and lipid profile components in hypertensive Nigerians. MethodsA total number of four hundred and nineteen volunteers consisting of two hundred and fifteen (215) hypertensive and two hundred and four (204) normotensive participants (of which two hundred and sixty (260) and one hundred and fifty-nine (159) were female and male respectively) participated in this study. Blood pressure of all volunteers was measured and blood samples of the consenting participants were collected in their fasting state and were analyzed for PPAR-γ, insulin, glucose, glycated haemoglobin (HbA1c) and lipid profile using enzyme-linked immunosorbent assay and Cobas C-111 auto-analyzer respectively. Homeostatic model assessment for insulin resistance (HOMA-IR) was calculated. ResultsThe mean body mass index (BMI) and blood pressure of hypertensive volunteers were higher (P<0.05) than the control. The female participants had higher (p<0.05) BMI and systolic blood pressure when compared with male counterpart. The circulating levels of PPAR-γ were not significantly different (P>0.05) between hypertensive and control volunteers as well as between gender studied. The glucose, insulin, total cholesterol (TC), high density lipoprotein cholesterol (HDL-c) and Low density lipoprotein cholesterol (LDL-c) were higher in hypertensive volunteers (P<0.05). Insulin, HOMA-IR, total cholesterol, triglycerides and HDL-c were significantly raised (p<0.05) in female participants when compared with male. Negative association existed between PPAR-γ and HbA1c (P<0.001), and between PPAR-γ and glucose (P>0.05). Positive association existed between HOMA-IR and HbA1c, HOMA-IR and Glucose (P<0.001), HOMA-IR and Cholesterol (P<0.05). ConclusionHypertensive volunteers demonstrated higher BMI, insulin, glucose, HbA1c, HOMA-IR, and LDL-c all these could precipitate metabolic dysfunction.

ASSOCIATION OF SOLUBLE DIPEPTIDYL PEPTIDASE-4 AND PLATELET-LYMPHOCYTE RATIO WITH PULSE PRESSURE IN TREATMENT-NAIVE HYPERTENSIVES

Abstract Objective: Hypertension is a major risk factor for cardiovascular diseases (CVD) and the burden is increasing globally especially in Africans. This is as a result of increasing adult population, rapid urbanization and uptake of western lifestyles. Hypertensive patients with elevated pulse pressure (PP) have increased risk of cardiovascular morbidity and mortality. Soluble dipeptidyl peptidase-4 (sDPP-4) and platelet-lymphocyte ratio (PLR) have been linked to the development and progression of CVD. We hypothesized that sDPP-4 and PLR would be correlated with PP in hypertensive Nigerians. Design and method: A cross-sectional study comparing the anthropometrical, hematological, inflammatory and cardiometabolic disorder markers between normotensives (blood pressure less than or equal to 120/80 mmHg; n = 19) and treatment-naïve hypertensive adults (sustained blood pressure equals to or greater than 140/90 mmHg; n = 48). Results: Our results showed that hypertensive group had significantly higher body weight, neck circumference, hip circumference, mid-arm circumference, LDL-cholesterol, PP, systolic and diastolic blood pressure than the normotensive group. Using multivariate linear regression analysis, results indicated that PP (R2 = 0.22) was correlated with sDPP-4 (Beta = 0.41, p = 0.004) and PLR Beta = 0.31, p = 0.025) in the hypertensive group. A receiver operating characteristic curve analysis also revealed that area under curve (AUC) for sDPP-4 was 0.65 (p = 0.04) and AUC for PLR was 0.74 (p = 0.001) and are efficient predictors of PP in hypertensives. Conclusions: Findings from the present study reveal that circulating sDPP-4 and PLR are strongly correlated with PP in treatment-naive hypertensive individuals.

Hyperhomocysteinemia and its relations to conventional risk factors for cardiovascular diseases in adult Nigerians: the REMAH study

BackgroundEvidence linking homocysteine (Hcy) with cardiovascular diseases (CVD) or its risk factors are limited in a sub-Saharan black population.ObjectiveWe set out to evaluate the association between Hcy and hypertension and other CVD risk factors in a population of adult Nigerians.MethodsData of 156 adults aged 18–70 years was accessed from the North Central study site of the REmoving the MAsk on Hypertension (REMAH) study. Homocysteine, blood glucose and lipid profile in whole blood/serum were measured using standard laboratory methods. Hypertension was diagnosed if average of 5 consecutive blood pressure (BP) measurements obtained using a mercury sphygmomanometer was equal to or higher than 140 systolic and/or 90 mmHg diastolic or the individual is on antihypertensive medication. Hyperhomocysteinemia (HHcy) was defined as Hcy > 10 µmol/L.ResultsOf the 156 participants, 72 (43.5%) were hypertensive, of whom 18 had HHcy. Subjects with HHcy were significantly (p < 0.05) older (41.5 vs. 40.6yrs), had lower HDL-cholesterol (0.6 vs. 0.8 mmol/L) and higher systolic (145.5 vs. 126.0 mmHg) and diastolic BP (92.9 vs. 79.6 mmHg), compared to those without HHcy. Intake of alcohol and a 1 yr increase in age were respectively and significantly (p < 0.05) associated with a 1.54 and 0.10 µmol/L increase in Hcy. In a multivariable model adjusted for age, sex and body mass index, a 1 µmol/L increase in Hcy, was associated with a 1.69 mmHg and 1.34 mmHg increase in systolic and diastolic pressure (p < 0.0001) respectively; and a 0.01 mmol/L decrease in HDL-cholesterol (p < 0.05).ConclusionHHcy occurs among hypertensive Nigerians and it is independently associated with age, HDL-cholesterol, systolic and diastolic BP.

Assessment of Plasma Sodium to Potassium Ratio, Renal Function, Markers of Oxidative Stress, Inflammation, and Endothelial Dysfunction in Nigerian Hypertensive Patients.

Background This study investigated plasma sodium/potassium ratio, markers of oxidative stress, renal function, and endothelial dysfunction in hypertensive Nigerians. Materials and Methods Five hundred forty-nine volunteers consisting of three hundred and twenty-four hypertensive and two hundred twenty-five controls participated in this study. Blood samples were collected from the participants and were analyzed for electrolytes, markers of oxidative stress, endothelial dysfunction, renal function, and inflammation, using ion-selective electrodes, spectrophotometric, and enzyme-linked immunosorbent assay methods, respectively. Results The mean systolic blood pressure, mean diastolic blood pressure, mean arterial blood pressure, and body mass index (BMI) were significantly elevated among the hypertensive group when compared with control (p < 0.001). The mean sodium increased, while potassium and bicarbonate (HCO3−) decreased (p < 0.001) in hypertensive volunteers. The sodium-potassium ratio (Na+/K+) and urea were raised (p < 0.001) in the hypertensive group when compared with the control. Glutathione, superoxide dismutase, nitric oxide (NO), and catalase were significantly reduced (p < 0.001) while malondialdehyde (MDA), high-sensitivity C-reactive protein (hs-CRP), and ferritin were raised significantly (p < 0.001) in hypertensive participants. The odds of hypertension and its complications increased (p < 0.001) with an increase in BMI, Na+/K+, hs-CRP, MDA, and ferritin and a decrease in estimated glomerular filtration rate (eGFR), glutathione, superoxide dismutase, and catalase. Conclusion An increase in Na+/K+, urea, hs-CRP, ferritin, MDA, and BMI and a decrease in eGFR, glutathione, and superoxide dismutase were associated with an increased risk of hypertension complication. Abnormal values of markers of oxidative stress, inflammation, and endothelial function could impact deleterious effects on the cardiovascular system among hypertensive Nigerians. A decreased bicarbonate possibly suggests an occult acid-base imbalance among hypertensive volunteers.

Effect of Adrenomedullin on Cardiovascular Response to Sympathetic Autonomic Stress in Normotensive and Hypertensive Nigerians

Adrenomedullin is a potent vasodilator with established cardio-protective potentials when the body is exposed to stress. Sympathetic autonomic stress can lead to systolic (SBP) and diastolic blood pressure (DBP) reactivity which is a predictor of stroke. This study was to determine the effect of Adrenomedullin on cardiovascular response to sympathetic autonomic stress using the Cold Pressor Test in normotensive (NT) and hypertensive (HT) adults. Cardiovascular response to the CPT was measured among 30 NT and 30 HT participants, via blood pressure and heart rate before and after exposure to the cold pressor test (CPT). Plasma Adrenomedullin (ADM) was also determined by means of ELISA. Data were expressed as mean±S.E.M and statistical significance was accepted at 95% confidence interval. Exposure to CPT led to significant increases in SBP and DBP in both NT and HT participants with greater effect in HT (p&lt;0.0001). Plasma Adrenomedullin was significantly higher among the NT but the difference on effect of response to CPT in both groups of participants was not significant. There was a negative and insignificant correlation between the ADM level and change in SBP and DBP among the NT participants but a positive and insignificant correlation with both SBP and DBP among the HT participants. We conclude that plasma Adrenomedullin may prevent the development of hypertension in black individuals.

Prevalence of hyperhomocysteinaemia, selected determinants and relation to hypertension severity in Northern-Nigerian hypertensives: the ABU homocysteine survey.

This study aimed at evaluating the prevalence of hyperhomocysteinaemia in Northern-Nigerian hypertensives and its association with hypertension severity and some major determinants as data regarding these are lacking in sub-Saharan Africa. A Community-based cross-sectional study done on 120 randomly-selected hypertensive patients who responded to an ABU radio frequency modulated invitation for free health-screening at the Ahmadu Bello University (ABU) Medical Centre from January 2016 to June 2016. The percentage of participants with high homocysteine levels, their anthropometric parameters and blood pressures were determined. Plasma homocysteine (hcy) was classified as normal (5-15), moderate (>15-30), intermediate (31-100) and severe (>100) µmol/L. Kruskal-Wallis test was applied and log-transformed homocysteine (Ln10Homocysteine) was correlated with systolic and diastolic blood pressures as well as age, body mass index, fasting blood glucose, glomerular filtration rate, hypertension duration and Ln10folate in males and females using the Pearson's Correlation analysis. There were 83(69.2%) females and 37(30.8%) males with Median homocysteine of 20.8 µmol/L and 22.0 µmol/L respectively (p=0.003). Hyperhomocysteinaemia was found in 118(98.3%) hypertensives while 2(1.7%) subjects had normo-homocysteinaemia. Moderate hyperhomocysteinaemia (Median, 20.8 µmol/L) was identified in 105(87.5%) and intermediate (Median, 40 µmol/L) in 13(10.8%) (p<0.001). No subject had severe hyperhomocysteinaemia. Homocysteine was higher (p=0.003) in subjects with Stage 2 systolic hypertension. Ln10Homocysteine was significantly (p<0.001) correlated with blood pressure (SBP: r=0.45; DBP: r=0.40) and age (r=0.33). The prevalence of hyperhomocysteinaemia in North-Western Nigerian hypertensives is high as against normal healthy controls. Plasma homocysteine is higher with severe systolic hypertension and positively associated with age. No specific grants but Micro Nova Pharmaceuticals Limited, Nigeria and Emzor Pharmaceutical Industries, Lagos, Nigeria supported with drugs.

Using Multitheory Model to Predict Low-Salt Intake Among Nigerian Adults Living With Hypertension.

One of the public health recommendations for the management of hypertension is the reduction of sodium/salt intake. The purpose of this study was to use the novel multitheory model of health behavior change to predict the initiation and maintenance of low-salt intake among adult Nigerian hypertensives. A quantitative cross-sectional design utilizing a convenience sample of 149 consenting Nigerian adults living with hypertension were self-administered a valid and reliable 39-item instrument. Multivariate regression analysis revealed 40.6% of the variance in initiating the consumption of low-salt diets explained by advantages outweighing disadvantages, behavioral confidence, and changes in physical environment. About 41.8% of the variance to sustain the intake of low-salt diet was explained by emotional transformation, practice for change, and changes in social environment. The results justified the predictive role of multitheory model and adequacy of its utility to build evidence-based health education interventions for hypertension in Nigeria.

Intima-media thickness of femoral arteries and carotids among an adult hypertensive Nigerian population: A case-control study to assess their use as surrogate markers of atherosclerosis.

Background:Increased intima-media thickness (IMT) is an established and important surrogate marker for atherosclerosis. Intima-media thickening in the femoral arteries occur earlier and reflect the true extent of generalized atherosclerosis better than in the carotids. Aims: To study the ultrasound-detected morphological changes in the common femoral versus carotid artery wall.Patients and Methods:A case-control study design was used, with 61 adult hypertensive as cases and 61 age-, sex- and BMI-matched normotensive as controls. Variables were participants' characteristics, cardiovascular risk factors, and ultrasonographically evaluated IMT of the carotid and femoral arteries.Results:A total of 122 participants were studied. The mean femoral IMT in hypertensives and controls on the right and left was 0.63 ± 0.07mm vs. 0.52 ± 0.06mm [P < 0.0001] and 0.69 ± 0.0 mm vs. 0.55 ± 0.05mm [P < 0.0001]. Also, the mean carotid IMT among hypertensives and controls on the right =0.80 ±0.15mm vs. 0.64 ± 0.06mm [P < 0.0001], and 0.91 ± 0.22mm vs. 0.65 ± 0.06mm [P < 0.0001] on the left. Significant correlation was observed between IMT and age (B = 0.006, P < 0.001 and B = 0.003, P < 0.001), hypertension (B = 0.205, P < 0.001 and B = 0.122, p< 0.001), and duration of hypertension (B = 0.02, P < 0.001 and B = 0.006, P = 0.02) the femoral and carotid arteries respectively.Conclusion:The femoral and the carotid artery show similar significantly increased IMT in hypertensive adults. The femoral IMT appears to be a good surrogate marker of atherosclerosis among hypertensive Nigerians.

Lipid and apoprotein markers and carotid intima-media thickness among hypertensive Nigerians

Context: Measurement of lipids and apoproteins are essential components aimed at reducing the global burden of atherosclerotic cardiovascular disease. Carotid intima-media thickness (CIMT) has been widely accepted as an index of subclinical atherosclerosis. A relationship between CIMT and the parameters of the traditional lipid profile has been described.Aim: Evaluation of the diagnostic character of lipid and apoprotein markers, which are cheap and easy to perform, in detecting a significant thickening of the carotid intima media in hypertensive persons.Subjects and Methods: Cross-sectional study of adult male hypertensive persons with fasting measurement of the traditional lipid profile and apoprotein B. CIMT of the common carotid artery was determined by ultrasound in all participants.Results: The mean CIMT was significantly higher among the hypertensive participants than normotensive controls. Age, systolic blood pressure, triglycerides, low-density lipoprotein-cholesterol (LDL-C), and Apo B were all significantly associated with CIMT. Hypertensive persons with CIMT ≥1.00 mm had significantly higher serum concentrations of total cholesterol (TC), LDL-C, and Apo B. The positive predictive value of a result (TC >200 mg/dL, LDL-C >130 mg/dL, and Apo B >100 mg/dL) was <50%, while that for a negative result (TC <200 mg/dL, LDL-C <130 mg/dL, and Apo B <100 mg/dL) approached or was equal to 100%.Conclusions: There is some relationship between dyslipidemia and significant thickness of the carotid intima media. The levels of TC, LDL-C, and Apo B in plasma, which are cheaper and easier to determine, may help in the selection of hypertensive persons to be offered CIMT assessment.

Diastolic Dysfunction and Its Implications to Serum Magnesium Changes in Hypertensives

Overtime, Diastolic dysfunction (DD), which is seen in damping blood, and pressure build up within the ventricles has been associated with different disease states including chronic hypertension, coronary heart disease, aging, aortic stenosis, hypertrophic and restrictive cardiomyopathies. Diagnosis is by echocardiography (ECG) and often cumbersome. Howbeit, in acute stages of hypertension, prolongation of ventricular activation time in an ECG session has been described as potential marker for diagnosing DD. Current study was therefore undertaken to investigate ventricular activation time in essentially hypertensive Nigerians. One hundred and sixty two (162) hypertensives were recruited for the study. Their compliance to antihypertensive medication, blood pressure control, and electrocardiographic changes were determined and measured. Venous blood sample was then drawn and placed in special tubes to determine the serum magnesium concentrations, using a standard Colorimetric assay machine, Using the statistical measure of association (correlation), correlation between serum magnesium and ECG parameters was calculated using the Pearson’s correlation coefficient. One way analysis of variance (ANOVA) was also explored in obtaining differences in mean between variables. From our observations, only a weak correlation was found between serum magnesium levels and ECG findings across the study population. This proved statistically insignificant at p < 0.05. Other factors such as antihypertensive medications, duration of blood pressure and the control of blood pressure did not show any significant relationship.