Efficacy of newer versus older antihypertensive drugs in black patients living in sub-Saharan Africa.

To address the epidemic of hypertension in blacks born and living in sub-Saharan Africa, we compared in a randomised clinical trial (NCT01030458) single-pill combinations of old and new antihypertensive drugs in patients (30-69 years) with uncomplicated hypertension (140-179/90-109 mm Hg). After ≥4 weeks off treatment, 183 of 294 screened patients were assigned to once daily bisoprolol/hydrochlorothiazide 5/6.25 mg (n=89; R) or amlodipine/valsartan 5/160 mg (n=94; E) and followed up for 6 months. To control blood pressure (<140/<90 mm Hg), bisoprolol and amlodipine could be doubled (10 mg per day) and α-methyldopa (0.5-2 g per day) added. Sitting blood pressure fell by 19.5/12.0 mm Hg in R patients and by 24.8/13.2 mm Hg in E patients and heart rate decreased by 9.7 beats per minute in R patients with no change in E patients (-0.2 beats per minute). The between-group differences (R minus E) were 5.2 mm Hg (P<0.0001) systolic, 1.3 mm Hg (P=0.12) diastolic, and 9.6 beats per minute (P<0.0001). In 57 R and 67 E patients with data available at all visits, these estimates were 5.5 mm Hg (P<0.0001) systolic, 1.8 mm Hg (P=0.07) diastolic and 9.8 beats per minute (P<0.0001). In R compared with E patients, 45 vs 37% (P=0.13) proceeded to the higher dose of randomised treatment and 33 vs 9% (P<0.0001) had α-methyldopa added. There were no between-group differences in symptoms except for ankle oedema in E patients (P=0.012). In conclusion, new compared with old drugs lowered systolic blood pressure more and therefore controlled hypertension better in native African black patients.

[Family form of isolated left ventricular noncompaction; case of a mother and her son observed in Gabon]. / Forme familiale de la non compaction isolée du ventricule gauche ; cas d'une mère et de son fils observés au Gabon.

We describe a case report of a young Gabonese lady who presented an acute pulmonary oedema and we suspected a paripartum cardiomyopathy. Subsequent investigations showed isolated left ventricular noncompaction. A few months later, the same disease was disclosed at her 9 year-old son who presented a cardiac insufficiency. Therefore, we suspect a family form of left ventricular noncompaction. And it is the first description in subsaharan Africa. The hereditary character of this new form of cardiomyopathy linked to a genetic mutation on the X chromosome is well known. This disease is associated with heart failure, high incidence of systemic thromboembolism complications or ventricular arrhythmia. The echocardiography and the cardiac magnetic resonance imaging has been reported to be tools for diagnosis. In Africa, access to these techniques remains a privilege. So the discovery of illness is often late and the family screening are special. In our area, the therapeutic management is the medical treatment of heart failure. Implatable cardioverter defibrillator or heart transplantation are not available. So long-term prognosis of our patients with congestive heart failure stays poor. With best equipment in our hospitals and good training of African cardiologists, we should improve the management of our patients.

[Purple extremities in black-skinned patients: blue toe syndrome as presenting sign of antiphospholipid antibody syndrome]. / Extrémités violettes sur peau noire: orteils pourpres révélateurs d'un syndrome des antiphospholipides.

Although acral ischemia can involve several underlying mechanisms, suspicion of lupus warrants testing for antiphospholipid antibodies in patients with blue toe syndrome.

[Association myositis and hepatocellular carcinoma: one case and review of literature]. / Association myopathie inflammatoire et hépatocarcinome : à propos d'une observation et revue de la littérature.

Association inflammatory myopathies and tumors are not fortuitous but association with hepatocellular carcinoma is rarely reported in literature. We described a case of association polymyositis hepatocellular carcinoma in 37-year-old black African patient, with fatal issue.

[Elevated C reactive protein rate in 23 black African patients with systemic lupus erythematosus and without opportunistic infectious disease]. / Valeur prédictive de l'augmentation de la protéine C réactive dans le lupus systémique en l'absence d'infection intercurrente chez le patient noir africain à travers une série de 23 lupus systémiques.

INTRODUCTION: CRP rarely increases during systemic lupus exacerbations. MATERIALS AND METHODS: This retrospective study of patients with systemic lupus diagnosed according to ACR criteria examined all patients with no intercurrent infectious disease and responding to corticosteroid treatment and compared the patients with normal and with significantly elevated (> or = 30 mg/l) CRP. RESULTS: 23 black patients (22 women, 1 man) were selected and classified in two groups: group I with CRP > 30 mg/l (n = 12) and the controls, group II, with normal CRP (n =11). In group I, mean CRP was 279 mg/l. Four patients had isolated pericarditis, and one pericarditis associated with pleurisy. Nine patients had no cardiovascular risk factors or abnormal liver function enzymes. Antinuclear antibodies were specific for anti-DNA (n= 8), anti-Sm (n = 2), anti-RNP (n = 1), and anti-SSA (n = 1). In group II, seven patients had pericarditis, and nine had no cardiovascular risk factors or liver function results. Antinuclear antibodies were specific for anti-DNA (n = 9), anti-Sm (n = 1) and unknown (n = 1). DISCUSSION: The paucity of data about black Africans in the literature makes it difficult to interpret these results in terms of their specificity for this population or as a typical profile of elevated CRP without infectious disease. CONCLUSION: In absence of a specific profile for patients with elevated CRP without intercurrent infectious disease, we consider the possibility of a subgroup of the black population that may be particularly vulnerable and express CRP more easily.

[Two cases of probable immune restoration syndrome under antiretroviral treatment in patients treated for tuberculosis in Gabon]. / Probables syndromes de restauration immunitaire lors de la mise sous traitement antirétroviral chez des patients traités pour tuberculose: à propos de deux observations au Gabon.

Tuberculosis can be reactivated under specific treatment, as immune reconstitution inflammatory syndrome (IRIS), in HIV patients under antiretroviral treatment. We report two observations of tuberculosis exacerbation with extension to other territories (lymph node and pericarditis) occurring 3 weeks and 4 months after administration of tuberculosis treatment, with a favourable development, in absence of rehabilitation or addition of complementary therapy These observations show the necessity of increased surveillance on the short, medium and long term in patients with both treatment for tuberculosis and antiretroviral treatment.

Significance of dobutamine-induced changes in QT dispersion early after acute myocardial infarction.

This study sought to examine the effects of graded dobutamine infusion on QT dispersion early after acute myocardial infarction (AMI) and to investigate the relation of dobutamine-induced changes in QT dispersion to wall motion responses. Seventy-eight patients with a first AMI underwent dobutamine-atropine stress echocardiography 5 +/- 2 days after admission. Contractile reserve was identified in 45 patients and ischemic myocardium in 40. Sixteen patients had persistent akinesia. The best cut-off value of QT dispersion on the baseline electrocardiogram for predicting myocardial viability was 65 ms (sensitivity and specificity of 68%). Dobutamine infusion increased QT dispersion only in patients with viable myocardium (61 +/- 18 to 83 +/- 19 ms, p = 0.003) and/or ischemia (72 +/- 16 to 112 +/- 25 ms, p < 0.0001). No change was observed in patients with persistent akinesia (84 +/- 10 to 87 +/- 15 ms, p = NS). QT dispersion increased by 22 +/- 12 ms with administration of low-dose dobutamine in patients who had viable myocardium and by 47 +/- 21 ms with administration of low- to high-dose dobutamine in patients with ischemic myocardium. An increase in QT dispersion of > or = 20 ms from at rest to low-dose dobutamine infusion was associated with myocardial viability with a sensitivity of 78% and a specificity of 79%, whereas an increase in QT dispersion of > or = 10 ms from low- to high-dose dobutamine infusion predicted ischemic myocardium with a sensitivity of 85% and a specificity of 82%. In conclusion, (1) low QT dispersion on the baseline electrocardiogram is determined by the presence of viable myocardium, (2) a dobutamine-induced increase in QT dispersion is associated with viable and jeopardized myocardium, and (3) unchanged QT dispersion during dobutamine stress is a simple marker of extensive necrosis.