Normal limits of electrocardiogram in Africans and their consequences on the prevalence of left ventricular hypertrophy in hypertensive individuals: Insights from the TAHES study.

AIMS: To determine normal limits for major ECG variables, and the electrocardiographic impact of hypertension, in a rural sub-Saharan African setting. METHODS: This cross-sectional study included adults aged ≥25 years from Tanvè Health Study (TAHES) cohort. ECG were recorded at rest at 25 mm/s using a standard 12­lead device. Wave amplitudes and durations were measured. Corrected QT interval (QTc) was calculated using Bazett's formula. Sokolow-Lyon, Cornell and Peguero-Lo Presti criteria were determined to assess left ventricular hypertrophy (LVH). RESULTS: ECG was recorded among 997 out of 1407 TAHES participants. After exclusion of subjects with hypertension or diabetes, normal limits, defined as the 2nd and 98th percentiles, were evaluated in 622 healthy participants (median: 37 years; 60.1% women). The following limits were established in men (women): heart rate: 50 to 100 (55 to 102) beats/min, P wave duration: 80 to 120 (80 to 120) ms, PR interval: 120 to 200 (120 to 200) ms, QTc: 315 to 470 (323 to 465) ms, QRS duration: 50 to 120 (50 to 110) ms. Upper limits (in millimeter) for the Sokolow-Lyon, Cornell and Peguero-Lo Presti for men (women) were 47 (38), 30 (22) and 39 (30), respectively, all above current reference limits. The prevalence of LVH in hypertensive subjects according to these criteria were lower than those estimated according to current LVH criteria. CONCLUSION: The normal limits of ECG variables determined in this African population differ from those in Caucasians, indicating that ethnicity must be considered in ECG interpretation.

Description and outcomes of Afro-Caribbean children treated for multisystem inflammatory syndrome in the French West Indies.

Introduction: Several studies have reported a higher frequency and greater morbidity and mortality of multisystem inflammatory syndrome in children (MIS-C) of black African descent. Objectives: We aimed to describe the clinical, laboratory and echocardiographic characteristics as well as outcomes of children with MIS-C requiring admission to a pediatric intensive care unit (PICU) in the French West Indies (FWI), where the majority of the population is Afro-Caribbean. Methods: Ambidirectional observational cohort study between April 1, 2020 and August 31, 2022. Children (age ≤18 years) with MIS-C and organ failure were included. Every patient was monitored and treated following the same protocol, with repeated biological tests, echocardiography, intravenous steroids and polyvalent immunoglobulins. The primary outcomes were clinical, laboratory and echocardiography characteristics. Results: Forty children (median age 7 years, range: 5-11) were included. The majority (77 %) were included prospectively. Thirty-five (87 %) had gastrointestinal symptoms, 30 (75 %) presented initial heart failure (with persisting diastolic dysfunction at day 7) and 18 (45 %) had pericarditis. Sixteen (40 %) were in cardiogenic shock and required inotropic support. Median duration of inotropic support and hospitalization in PICU were respectively 4 and 5 days. The evolution curves of the inflammatory variables matched after treatment. The clinical outcomes were favorable. The Delta variant was associated with the highest incidence of MIS-C. Conclusion: This is the first description of MIS-C course among children of Afro-Caribbean descent. The outcomes were good, without any death or cardiac sequelae. Our work does not support an ethnic susceptibility for severity of MIS-C in Afro-Caribbean population.

Inter-arm difference in systolic blood pressure: Prevalence and associated factors in an African population.

OBJECTIVES: Inter-arm blood pressure difference (IABPD) can lead to underdiagnosis and poor management of hypertension, when not recognized and are associated with increased cardiovascular mortality and morbidity. However, the prevalence and associated risk factors of IABPD in sub-Saharan Africa are unknown. This study aims to determine the prevalence and associated risk factors of IABPD among Tanve Health Study (TAHES) participants, a cohort about cardiovascular diseases in a rural area in Benin. METHODS: The cohort was conducted since 2015 among adults aged 25 years and over in Tanve village. Data were collected from February to March, 2020. Brachial blood pressure were recorded at rest on both arm with an electronic device. Systolic IABPD (sIABPD) was defined as the absolute value of the difference in systolic blood pressure between left and right arms ≥ 10 mmHg. A multivariate logistic regression models identified factors associated with sIABPD. RESULTS: A total of 1,505 participants (women 59%) were included. The mean age was 45.08 ±15.65 years. The prevalence of sIABPD ≥ 10 mmHg was 19% (95%CI: 17-21). It was 19% (95%CI: 16-22) in men and 20% (95%CI: 17-22) in women. In final multivariable model, the probability of sIABPD ≥ 10 mmHg increased significantly with age (adjusted OR (aOR) = 1.1; 95%CI: 1.02-1.20 per 10-years), hypertension (aOR = 2.33; 95%CI: 1.77-3.07) and diabetes (aOR = 1.96; 95%CI: 1.09-3.53). CONCLUSION: Almost quarter of sample have a sIABPD ≥ 10 mmHg, with an increased risk with older age and hypertension and diabetes.

Prevalence and factors associated with hyperglycemia in a rural population of Tanvè and Dékanmey in Benin in 2019.

BACKGROUND: Hyperglycemia leads to serious damage to the body, especially the blood vessels and nerves. This study aimed to determine the prevalence and factors associated with hyperglycemia in a rural population of Tanvè and Dékanmey in Benin in 2019. MATERIALS AND METHODS: This was a cross-sectional, descriptive and analytical study, nested in the Tanvè Health Study (TAHES) cohort. It covered all residents of the villages of Tanvè and Dékanmey, aged 25 years and above, and having given their written consent. Data were collected in the households during the fourth annual monitoring visit in 2019 using the WHO STEPS Wise approach. Hyperglycemia was defined as a fasting capillary blood glucose value ≥ 110 mg/dL. Data were analyzed with R Studio software version 3.5.1. RESULTS: A total of 1331 subjects were included in the study with a 60% female predominance and a sex ratio (male/female) of 0.7. The median age was 40 years (Q1 = 32 years; Q3 = 53 years) with a range of 25 and 98 years. The prevalence of hyperglycemia was 4.6%. In multivariate analysis, advanced age (AOR = 1.03; 95%CI = 1.02-1.73; p = 0.004), male sex (AOR = 2.93; 95%CI = 1.49-5.84; p = 0.023), monthly income> 105,000 FCFA (AOR = 2.63; 95%CI = 1.24-5.63; p = 0.030), abdominal obesity (AOR = 2.80; 95%CI = 1.29-6.16; p = 0.007, and obesity (AOR = 1.68; 95%CI = 0.75-3.59; p = 0.004) were statistically associated with hyperglycemia. CONCLUSION: The prevalence of hyperglycemia is not negligible in rural areas in Benin. Our study found that older age, male gender, high income, abdominal obesity, and obesity are determining factors in its occurrence.

Trends in benzodiazepine anxiolytics and z-hypnotics use among French drivers involved in road traffic crashes from 2005 to 2015: a responsibility case-control study.

BACKGROUND: In France, benzodiazepine anxiolytics and z-hypnotics (zolpidem and zopiclone) account for the largest share of road traffic crash risk attributable to exposure to prescription drugs. The aim of this study was to monitor the evolution of the use of these prescription drugs and their association with crash risk over a period that began before the implementation of a color-graded pictogram system printed on prescription drug boxes. METHODS: Data from three French national databases were extracted and linked: the national health care insurance database, police reports, and the national police database of injurious crashes. Drivers involved in an injurious crash in France, from July 2005 to December 2015, and identified by their national identifier were included. The association with crash risk was estimated using a responsibility analysis comparing the use of benzodiazepines and z-hypnotics among drivers responsible or not for the crash. RESULTS: A total of 97,936 responsible and 103,522 non-responsible drivers involved in an injurious crash were included. The proportion of drivers exposed to benzodiazepine anxiolytics or z-hypnotics remained stable among responsible and non-responsible drivers. Among controls from the general population, the proportion of exposed individuals tended to increase. The association with crash risk remained almost constant over the study period. The odds-ratio for benzodiazepines ranged between 1.42 [1.24-1.62] at the beginning of the study period and 1.27 [1.09-1.47] at the end. CONCLUSION: Given the increase in exposure in the control group from the general population, the stability of exposure for responsible and non-responsible drivers can be interpreted as a relative effectiveness of the pictogram on driver exposure levels. On the other hand, while the intrinsic effect of a prescription drug cannot be modified, a decrease in risk could have been expected if drivers adapted their behavior as promoted by the pictogram. Our results therefore suggest that no significant change occurred in driving behaviors or consumption patterns.