Prevalence and Predictors of Peripheral Vascular Disease Amongst Predialysis Hypertensive Chronic Kidney Disease Patients in Southern Nigeria.

BACKGROUND: Peripheral vascular disease (PVD) is an atherosclerotic disease associated with increased morbidity and mortality among chronic kidney disease (CKD) patients. However, despite the substantial burden of PVD in CKD, local data are lacking. OBJECTIVE: To determine the prevalence and predictors of PVD in predialysis CKD patients. METHOD AND MATERIALS: The study was cross-sectional. One hundred fifty hypertensive CKD patients and age- and sex-matched hypertensive non-CKD subjects were consecutively enrolled at the renal unit of Delta State University Teaching Hospital (DELSUTH), Oghara. Structured questionnaires were used to obtain information on participants' demographic data and health status. PVD was defined by an ankle-brachial index of < 0.9 or > 1.4 in either lower extremity. eGFR was calculated from serum creatinine using the MDRD equation. RESULTS: The mean ages of the study and control groups were 48±14 and 51±15years, respectively. The sex ratio was 3:2 in favour of males for both the study and control groups. The majority of the study group was in CKD stage 4 (44%). The prevalence of PVD was higher among the CKD group compared with controls (24.0% vs. 14.7%). Of the CKD patients with PVD, 11.1% were symptomatic. Predictors of PVD in the study group were eGFR (B=0.010, 95%CI: 0.007-0.013), diastolic BP (B=-0.005, 95%CI: -0.007- -0.002), MAP (B=-0.018, 95%CI: -0.027- -0.008), urinary ACR (B=-0.0036, 95%CI: -0.040- -0.024) and smoking history (p<0.001, OR=14.71). CONCLUSION AND RECOMMENDATION: PVD is common and largely asymptomatic in CKD patients. The predictors of PVD in this study were eGFR, diastolic BP, mean arterial pressure (MAP), urinary albumin to creatinine ratio (ACR), and smoking. A proactive assessment of PVD and early intervention in CKD patients is needed.

Risk Assessment of Pre-dialysis Chronic Kidney Disease (CKD) Patients for Cardiovascular Disease (CVD) in a Tertiary Hospital in Nigeria: A Case-Controlled Cross-Sectional Study.

INTRODUCTION: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the chronic kidney disease (CKD) population. CKD patients are more likely to die from CVD before ever reaching end-stage renal disease (ESRD). The study, therefore, seeks to identify the prevalence of risk factors of CVD in CKD patients such as systemic hypertension, anemia, dyslipidemia, hypoalbuminemia, albuminuria, and abnormal calcium/phosphate products. METHODS: The study was a case-control cross-sectional study where one hundred fifty hypertensive CKD patients and age- and sex-matched hypertensive non-CKD subjects were consecutively enrolled at the renal unit of Delta State University Teaching Hospital (DELSUTH), Oghara. RESULTS: The findings of the study revealed the mean ages of cases and controls to be 48.91±11.93 years and 51.0±15.45 years respectively (p-value 0.182). There was an equal number of males and females among the study group and controls (92 males and 58 females) making a male-to-female ratio of 3:2. The prevalence of CVD risk factors such as diabetes mellitus, hypercholesterolemia, hypertriglyceridemia, elevated low-density lipoprotein, anemia, hypocalcemia, hyperphosphatemia, albuminuria, and hypoalbuminemia was significantly higher among the CKD group compared to controls. Similarly, the prevalence of reduced high-density lipoprotein (HDL) was higher among cases than controls, the difference was however not statistically significant. CONCLUSION: The study has shown that systemic hypertension, diabetes, anemia, dyslipidemia, hypoalbuminemia, albuminuria, and abnormal calcium/phosphate products increases the risk for CVD in the general population but is more expressed and significant in CKD patients.

Echocardiographic Correlates of Left Atrial Function Index Among Hypertensive Heart Failure Patients: A Cross-Sectional Study.

Background Heart failure contributes to the global burden of cardiovascular diseases, with hypertensive heart failure affecting individuals in their productive age group and leading to high economic losses and disability-adjusted life years. The left atrium, on the other hand, contributes significantly to left ventricular filling in heart failure patients, and the left atrial function index is an excellent tool for assessing left atrial function among heart failure patients. The study aimed to evaluate some parameters of systolic and diastolic function as correlates and potential predictors of the left atrial function index among hypertensive heart failure cohorts. Materials and methods The study was conducted at Delta State University Teaching Hospital, Oghara. Eighty (80) patients with hypertensive heart failure who met the inclusion criteria were enrolled in the cardiology outpatient clinics. The left atrial function index was calculated using the following formula: LAFI = (LAEF x LVOT-VTI)/LAESVI. (LAFI = left atrial function index; LAEF = left atrial emptying fraction; LAESVI = left atrial end-systolic volume index; LVOTVTI = outflow tract velocity time integral). The data were analysed using IBM Statistical Product and Service Solution Version 22. Relationships between variables were determined using analysis of variance, Pearson correlation, and multiple linear regressions. Significance was assessed at p<0.05. Result It was discovered that the left atrial function index correlated with ejection fraction (r = 0.616, p = 0.001), fractional shortening (r = 0.462, p = 0.001), and the ratio of early transmitral flow to early myocardial contractility, E/E' (r = -0.522, p = 0.001). However, there was no correlation with stroke volume (r = 0.38, p = 0.11); the ratio of early transmitral flow to late transmitral flow, E/A (r = -0.10, p = 0.11); isovolumetric relaxation time, IVRT (r = -0.171, p = 0.11); and tricuspid annular plane systolic excursion, TAPSE (r = 0.185, p = 0.10). Of the variables that correlated with left atrial function index, left ventricular ejection fraction and the ratio of early transmitral flow to early myocardial contractility (E/E') were found to be independent predictors of left atrial function index. Conclusion Left ventricular ejection fraction and the ratio of early transmitral flow to early myocardial contractility reflect changes in the left atrial function index, and as such, they should be used as surrogates for its assessment, especially in low- and medium-income countries where left atrial function index estimation is not routinely done.

Association Between Electrocardiographic Left Atrial Enlargement and Echocardiographic Left Atrial Indices Among Hypertensive Subjects in a Tertiary Hospital in South South Nigeria.

INTRODUCTION: Left atrial (LA) enlargement poses a clinically significant risk of adverse cardiovascular outcomes for patients. To maximize the utility of LA size in diagnosis, its accurate measurement using electrocardiogram (ECG) and echocardiogram (ECHO) to assess LA linear diameter and LA volumes is expedient. The LA volumes correlate better than LA linear diameter with diastolic function variables. It is therefore expedient to use LA volumes routinely in assessing LA size as they may detect early and subtle changes in LA size and function. METHODS: A descriptive cross-sectional study was conducted on 200 adult hypertensive patients attending the outpatient cardiology clinic at Delta State University Teaching Hospital, Oghara, Nigeria, irrespective of blood pressure control and duration of hypertension whether on antihypertensive medications or not. The SPSS version 22 (IBM Corp., Armonk, NY, USA) was used for data management and analysis. RESULT: There was a significant association between electrocardiographic left atrial (ECG-LA) enlargement and echocardiographic left atrial (ECHO-LA) size (LA linear diameter and LA maximum volume) in the study. Logistic regression analysis showed a significant odds ratio for all associations. With LA linear diameter as standard for assessing LA enlargement, the ECG had a sensitivity of 19%, specificity of 92.4%, a positive predictive value of 51%, and a negative predictive value of 73% in detecting LA enlargement. Using ECHO-LA maximum volume as a standard for assessing LA enlargement, the ECG had a sensitivity of 57.3%, a specificity of 67.7%, a positive predictive value of 42.9%, and a negative predictive value of 79% in detecting LA enlargement. The LA maximum volume showed relatively higher sensitivity and negative predictive values while LA linear diameter showed relatively higher specificity and positive predictive values. CONCLUSION: A good association exists between ECG-LA enlargement and ECHO-LA enlargement. However, in ruling out LA enlargement on ECG, it is better to use LA maximum volume as a standard rather than the LA linear diameter.

A Comparative Study of Left Atrial Function Index of Hypertensive Heart Failure Patients Versus Controls in a Teaching Hospital, Sub-Saharan Africa.

BACKGROUND AND AIM: The left atrium contributes significantly to the left ventricular filling as it functions as a reservoir, conduit, and pump. These functions are referred to as the phasic function of the left atrium and they are assessed using left atrial volumes. The left atrial function index on the other hand is a rhythmic independent composite index which is a better marker of left atrial function. The study therefore aimed at comparing left atrial function (using the left atrial function index) among hypertensive heart failure patients, patients with hypertension but not in heart failure, and normotensive patients. METHOD: The study was a cross-sectional analytical study that was carried out at Delta State University Teaching Hospital, Nigeria. A total of 80 hypertensive heart failure patients, 80 hypertensive, and 40 normotensive patients who met the inclusion criteria were recruited from the cardiology clinics using the convenience sampling method. The left atrial function index was determined using the volumetric method. Significance was assessed at p < 0.05. RESULT: The left atrial function index (21.13 ± 8.83 versus 42.28 ± 10.40 versus 50.47 ± 14.37, p = 0.001) of the hypertensive heart failure group was significantly lowest when compared with the hypertensive (p < 0.001) and normotensive (p < 0.001) groups. Although the left atrial function index of the hypertensive group (42.28 ± 10.40) was lower than the normotensive group (50.47 ± 14.37), it was however not found to be significant (p = 0.12). Also, the left atrial function index was significantly (p = 0.001) worse among the patients with heart failure with reduced ejection fraction (13.5 ± 5.94) compared to heart failure with preserved ejection fraction (40.81 ± 12.12). CONCLUSION: Left atrial function index was lowest among hypertensive heart failure patients compared with hypertensive and normotensive cohorts, and it was worse among heart failure with reduced ejection fraction patients. However, there was no significant difference between the left atrial function index of the hypertensive and normotensive groups. As a result, we recommend that the left atrial function index should be incorporated into the routine echocardiographic assessment of patients in our day-to-day clinical practice and large studies should be carried out to determine the cut-off value for the left atrial function.

Disparities in clinical features and outcomes of peripartum cardiomyopathy in high versus low prevalent regions in Nigeria.

AIMS: The prospective, multicentre Peripartum Cardiomyopathy in Nigeria (PEACE) registry originally demonstrated a high prevalence of peripartum cardiomyopathy (PPCM) among patients originating from Kano, North-West Nigeria. In a post hoc analysis, we sought to determine if this phenomenon was characterized by a differential case profile and outcome among PPCM cases originating elsewhere. METHODS AND RESULTS: Overall, 199 (81.6%) of a total 244 PPCM patients were recruited from three sites in Kano, compared with 45 patients (18.4%) from 11 widely dispersed centres across Nigeria. Presence and extent of ventricular myocardial remodelling during follow-up, relative to baseline status, were assessed by echocardiography. During median 17 months follow-up, Kano patients demonstrated significantly better myocardial reverse remodelling than patients from other sites. Overall, 50.6% of patients from Kano versus 28.6% from other regions were asymptomatic (P = 0.029) at study completion, with an accompanying difference in all-cause mortality (17.6% vs. 22.2% respectively, P = 0.523) not reaching statistical significance. Alternatively, 135/191 (84.9%) of Kano patients had selenium deficiency (<70 µg/L), and 46/135 (34.1%) of them received oral selenium supplementation. Critically, those that received selenium supplementation demonstrated better survival (6.5% vs. 21.2%; P = 0.025), but the supplement did not have significant impact on myocardial remodelling. CONCLUSIONS: This study has shown important non-racial regional disparities in the clinical features and outcomes of PPCM patients in Nigeria, that might partly be explained by selenium supplementation.

SARS-CoV 2 Infection (Covid-19) and Cardiovascular Disease in Africa: Health Care and Socio-Economic Implications.

The current pandemic of SARS-COV 2 infection (Covid-19) is challenging health systems and communities worldwide. At the individual level, the main biological system involved in Covid-19 is the respiratory system. Respiratory complications range from mild flu-like illness symptoms to a fatal respiratory distress syndrome or a severe and fulminant pneumonia. Critically, the presence of a pre-existing cardiovascular disease or its risk factors, such as hypertension or type II diabetes mellitus, increases the chance of having severe complications (including death) if infected by the virus. In addition, the infection can worsen an existing cardiovascular disease or precipitate new ones. This paper presents a contemporary review of cardiovascular complications of Covid-19. It also specifically examines the impact of the disease on those already vulnerable and on the poorly resourced health systems of Africa as well as the potential broader consequences on the socio-economic health of this region.

Clinical Features and Outcomes of Peripartum Cardiomyopathy in Nigeria.

BACKGROUND: Nigeria has the highest incidence of peripartum cardiomyopathy (PPCM) in the world. However, data on PPCM-related outcomes are limited. OBJECTIVES: The purpose of this study was to examine the clinical profile, myocardial remodeling, and survival of patients with PPCM in Nigeria. METHODS: This study consecutively recruited 244 PPCM patients (median 7 months postpartum) at 14 sites in Nigeria and applied structured follow-up for a median of 17 months (interquartile range: 14 to 20 months). Left ventricular reverse remodeling (LVRR) was defined as the composite of left ventricular (LV) end-diastolic dimension <33 mm/m2 and absolute increase in left ventricular ejection fraction (LVEF) ≥10%. LV full recovery was defined as LVEF ≥55%. RESULTS: Overall, 45 (18.7%) patients died during follow-up. Maternal age <20 years (hazard ratio [HR]: 2.40; 95% confidence interval (CI): 1.27 to 4.54), hypotension (HR: 1.87; 95% CI: 1.02 to 3.43), tachycardia (HR: 2.38; 95% CI: 1.05 to 5.43), and LVEF <25% at baseline (HR: 2.11; 95% CI: 1.12 to 3.95) independently predicted mortality. Obesity (HR: 0.16; 95% CI: 0.04 to 0.55) and regular use of beta-blockers at 6-month follow-up (HR: 0.20; 95% CI: 0.09 to 0.41) were independently associated with reduced risk for mortality. In total, 48 patients (24.1%) achieved LVRR and 45 (22.6%) achieved LV full recovery. LVEF <25% at baseline (HR: 0.66; 95% CI: 0.47 to 0.92) and regular use of beta-blockers at 6-month follow-up (HR: 1.62; 95% CI: 1.17 to 2.25) independently determined the risk for LV full recovery. Progressive reverse remodeling of all cardiac chambers was observed. In total, 18 patients (7.4%) were hospitalized during the study. CONCLUSIONS: This is the largest study of PPCM in Africa. Consistent with late presentations, the mortality rate was high, whereas frequencies of LVRR and LV full recovery were low. Several variables predicted poor outcomes, and regular use of beta-blockers correlated with late survival and LV functional recovery.

Prevalence and correlates of prehypertension and hypertension among adults in Delta State, Nigeria: a cross-sectional community-based study.

BACKGROUND: There are indications that prehypertension precedes hypertension. Like hypertension, it is associated with increased cardiovascular risk. OBJECTIVE: To determine the prevalence, awareness and correlates of prehypertension and hypertension among adults in Delta State, Nigeria. METHODS: This was a cross-sectional study. We recruited adults aged ≥18 years from two communities in Delta State, Nigeria, using the multi-stage sampling technique. The study instrument was a modified WHO-STEPS questionnaire. Prehypertension and hypertension were defined using the JNC-7 criteria. Ethical approval was obtained before the recruitment of participants. RESULTS: Of the 852 adults studied, the mean (±SD) age was 42.64 (±16.07) years, females (55.9%) and urban dwellers (55.8%). The prevalence of prehypertension and hypertension were 42.5% and 29.3%, respectively; both were higher among urban dwellers. The peak age-group for prehypertension and hypertension were 25-34 and 35-44 years, respectively. Awareness of hypertension was low; 12.0% (102/852). Blood pressure category significantly correlated with age, body mass index, place of residence, level of education, employment status and fruit intake. CONCLUSION: The prevalence of prehypertension and hypertension in this study were high. Based on the premise that prehypertension is a precursor of hypertension and occurred more among youths, the higher prevalence of prehypertension gives an inkling to rising prevalence of hypertension. FUNDING: Nil.