[Severe high blood pressure recently diagnosed in an urban milieu from Subsahelian Africa: Epidemiologic, clinical, therapeutic and evolutionary aspects]. / Hypertension artérielle sévère nouvellement diagnostiquée dans un pays en Afrique sub-saharienne : aspects épidemio-cliniques, thérapeutique et évolutifs.

OBJECTIVES: High Blood Pressure (HBP) is a worldwide public health problem. It can be particularly severe in the Black race. Recent studies in Cameroon, showed an alarming prevalence, leading us to want to study the epidemiological, clinical, therapeutic and evaluative aspects of severe, (BP op to 180/110mmHg), recently diagnosed HBP in Yaounde. Our objective was to determine its clinical presentation and evolution. METHODS: We conducted nine months prospective cohort study, from January to September 2016. We recruited from the active population participants who voluntarily accepted blood pressure screening offered in various localities in Yaounde, and were aged from 18 years and above. RESULTS: Of a total of 6519 people who participated in the screening, 1875 (28.8%.), presented a HBP and 363 (5.6%) had severe HBP. Our cohort comprised 153 (42.1%) of these individuals with sustained severe hypertension, not on medication, who accepted the invitation to participate in the study. The range of 45-54 years and 55-64 years were the most represented; the sex ratio was 0.9. The cardiovascular risk factors number range from 5 to 8 with a median of 6. Systolic BP ranged from 184 to 225mmHg with a median of 200mmHg; while the diastolic BP ranged between 111-132.5mmHg with a median of 119mmHg. Kidney injury (77.8%) was the main complications. We identified 3 clinical forms: hypertensive emergencies 121 (79.1%) cases and hypertensive crises 32 (20.9%) cases. In these two groups, 33 (21.6%) patients presented with "super HBP" (a blood pressure>250/150mmHg). The average rate of BP control over 6 month was 39%. The main cause of poor BP control was lack of therapeutic compliance. We registered one death at the 3rd month of follow up due to acute kidney injury. CONCLUSION: Severe HBP prevalence in Yaounde is high in the active fraction of the population insidiously affected. Particularly, unsuspected renal impairment appears to be the major complication. The bad blood pressure control is linked to poor therapeutic observance and persistence.

[Cardiac surgery in Cameroon. Results at one year of the pilot phase]. / Chirurgie cardiaque au Cameroun. Résultats à un an de la phase pilote.

In the framework of implementation of his national program for control and prevention of cardiovascular diseases, Cameroonian government has set up a cardiac surgery project. We report in this manuscript results of one year follow up of the patients operated during the pilot phase. From September 22 till 26, 2008, 11 patients have been operated in Cameroun. Surgical procedures were 5 mitral mechanic valve replacement, 2 aortic mechanic valve replacement, 1 atrial septal defect closure, 2 pace maker implantation. No intrahospital death was observed. One patient died at 11th month after the operation due to mitral valve thrombosis and attributed to lack of compliance. One patient presented low cardiac output, pneumonia and a pleural effusion. 2 patients presented 2 minor complications consisting of pericarditis and superficial wound infection. The results of the pilot phase of cardiac surgery in Cameroon are effective. However, the sustainability of the program require human, material capacity building, and funding mechanism as well.

Risk factors and complications of hypertension in Yaounde, Cameroon.

AIM: To determine the risk factors and complications of hypertension, isolated systolic hypertension (ISH) and isolated diastolic hypertension (IDH) in Yaounde. METHODS AND RESULTS: Between January and September 1998 we examined 813 consecutive adult patients (46.5% men) in the Yaounde University Teaching Hospital, with special focus on risk factors of hypertension and clinical findings in the cardiovascular system. We measured systolic blood pressure, diastolic blood pressure, body mass index and plasma glucose, and recorded chest X-ray, electrocardiogram and echocardiogram. Hypertension, ISH and IDH were defined using the WHO-ISH 1999 criteria. After controlling for the confounding effects of age and sex, hypertension was significantly associated with obesity, family history of hypertension, alcohol intake, heart failure, stroke and left ventricular hypertrophy (p < 0.01); smoking was significantly associated with ISH (p = 0.04), and no factor was independently associated with IDH. CONCLUSIONS: A prevention strategy for hypertension and its resultant complications in Cameroon should include measures aimed at obesity and alcohol consumption, as well as early diagnosis with the institution of effective and affordable therapy.

Medicine: alternative, complementary or competitive? Some thoughts on other ways of doing things.

Alternative medicine depends on which side of the fence one is sitting. In an African setting 'modern medicine' is often treated as competitive or complementary to traditional medicine. Differences in views as to what is health, and what causes disease can result in altered treatment objectives. Health needs to be seen in a wider context, and management with patient participation, rather than 'imposed treatment', is called for. Although we need to be open to new ideas, these need to be critically assessed if we are to do no harm to our patients. For patients to take part in the decision-making process they need adequate information. We need to improve our communication skills, and to understand that a pathophysiological explanation of illness does not answer the basic question which we all ask when ill--'Why me?' In this respect we can do well to learn from traditional healers who try to treat the whole patient and not just the disease.