Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the REMEDY study).

AIMS: Rheumatic heart disease (RHD) accounts for over a million premature deaths annually; however, there is little contemporary information on presentation, complications, and treatment. METHODS AND RESULTS: This prospective registry enrolled 3343 patients (median age 28 years, 66.2% female) presenting with RHD at 25 hospitals in 12 African countries, India, and Yemen between January 2010 and November 2012. The majority (63.9%) had moderate-to-severe multivalvular disease complicated by congestive heart failure (33.4%), pulmonary hypertension (28.8%), atrial fibrillation (AF) (21.8%), stroke (7.1%), infective endocarditis (4%), and major bleeding (2.7%). One-quarter of adults and 5.3% of children had decreased left ventricular (LV) systolic function; 23% of adults and 14.1% of children had dilated LVs. Fifty-five percent (n = 1761) of patients were on secondary antibiotic prophylaxis. Oral anti-coagulants were prescribed in 69.5% (n = 946) of patients with mechanical valves (n = 501), AF (n = 397), and high-risk mitral stenosis in sinus rhythm (n = 48). However, only 28.3% (n = 269) had a therapeutic international normalized ratio. Among 1825 women of childbearing age (12-51 years), only 3.6% (n = 65) were on contraception. The utilization of valvuloplasty and valve surgery was higher in upper-middle compared with lower-income countries. CONCLUSION: Rheumatic heart disease patients were young, predominantly female, and had high prevalence of major cardiovascular complications. There is suboptimal utilization of secondary antibiotic prophylaxis, oral anti-coagulation, and contraception, and variations in the use of percutaneous and surgical interventions by country income level.

Arterial hypertension in women: Menopause as a risk window.

OBJECTIVES: Cardiovascular diseases (CVD) exert a heavy toll on health of women, mainly due to hypertension said to cluster around the period of transition to menopause. This makes this period a good window to target for prevention and control. We therefore sought to determine if this period really heralds arterial hypertension and CVD in women in our environment. STUDY DESIGN: We secondarily analysed our population data on CVD risk factors in free living rural residents. MAIN OUTCOME VARIABLES: The data considered were blood pressure, anthropometric and biochemical variables in women stratified based on menstruation status. RESULTS: There were 488 females, with 218 still menstruating. They were younger (p = .000), had lower systolic and diastolic blood pressures (p = .000), lower anthropometric indices attaining significance only with waist circumference (p = .001) and lower total cholesterol (p = .001). Controlling for age, statistically significant differences remained for systolic and diastolic blood pressures, body mass index, waist and hip circumferences, and total cholesterol. CONCLUSION: The menopause transition comes with a worse CVD profile. Blood pressure rises and so are the anthropometric variables and some biochemical parameters that fuel CVD. This could be ascribed to age which is higher with those post-menopausal. Controlling for age in this cohort still showed that transiting from pre- to post-menopause still came with CVD burden. Clinicians should take the opportunity presented by menopause transition to screen for CVD risk factors and initiate either preventive or control measures to mitigate morbi-mortality consequences.

Association of Novel Locus With Rheumatic Heart Disease in Black African Individuals: Findings From the RHDGen Study.

Importance: Rheumatic heart disease (RHD), a sequela of rheumatic fever characterized by permanent heart valve damage, is the leading cause of cardiac surgery in Africa. However, its pathophysiologic characteristics and genetics are poorly understood. Understanding genetic susceptibility may aid in prevention, control, and interventions to eliminate RHD. Objective: To identify common genetic loci associated with RHD susceptibility in Black African individuals. Design, Setting, and Participants: This multicenter case-control genome-wide association study (GWAS), the Genetics of Rheumatic Heart Disease, examined more than 7 million genotyped and imputed single-nucleotide variations. The 4809 GWAS participants and 116 independent trio families were enrolled from 8 African countries between December 31, 2012, and March 31, 2018. All GWAS participants and trio probands were screened by use of echocardiography. Data analyses took place from May 15, 2017, until March 14, 2021. Main Outcomes and Measures: Genetic associations with RHD. Results: This study included 4809 African participants (2548 RHD cases and 2261 controls; 3301 women [69%]; mean [SD] age, 36.5 [16.3] years). The GWAS identified a single RHD risk locus, 11q24.1 (rs1219406 [odds ratio, 1.65; 95% CI, 1.48-1.82; P = 4.36 × 10-8]), which reached genome-wide significance in Black African individuals. Our meta-analysis of Black (n = 3179) and admixed (n = 1055) African individuals revealed several suggestive loci. The study also replicated a previously reported association in Pacific Islander individuals (rs11846409) at the immunoglobulin heavy chain locus, in the meta-analysis of Black and admixed African individuals (odds ratio, 1.16; 95% CI, 1.06-1.27; P = 1.19 × 10-3). The HLA (rs9272622) associations reported in Aboriginal Australian individuals could not be replicated. In support of the known polygenic architecture for RHD, overtransmission of a polygenic risk score from unaffected parents to affected probands was observed (polygenic transmission disequilibrium testing mean [SE], 0.27 [0.16] SDs; P = .04996), and the chip-based heritability was estimated to be high at 0.49 (SE = 0.12; P = 3.28 × 10-5) in Black African individuals. Conclusions and Relevance: This study revealed a novel candidate susceptibility locus exclusive to Black African individuals and an important heritable component to RHD susceptibility in African individuals.

Heart Failure with Recovered Ejection Fraction: Report of a Case in Jos, Nigeria.

Some patients in heart failure (HF) are able to withstand treatment, recover ejection fraction (EF) enough to require little or no further treatment. They belong to the distinct entity now called HF with recovered EF where patients start as HF with reduced EF and with treatment end up as HF with mid-range EF or even HF with preserved EF. This case report is on one such patient who presented in HF with features of dilated cardiomyopathy. With treatment, he promptly came out of HF, and myocardium remodeled toward recovery of function, which also reflected on electrocardiographic voltages. He remained out of failure despite deescalation of anti-failure regimen. Characterizing this group well will permit a paradigm shift in the management of HF; with the understanding that the myocardium can recover function or go into remission depending on underlying pathology.

Ultrasound assessed peri-renal fat: an index of sub-clinical atherosclerosis.

OBJECTIVE: Overweight/obesity has predicted cardiovascular disease (CVD) risk for long with its standard measure of body mass index (BMI), which later was found to mis-classify risk oftentimes. This is because it does not differentiate between fat and whole body mass. The finding that fat especially visceral fat was more culpable shifted attention to ectopic fat as a more precise measure of CVD risk. Peri-renal fat (PRF) is one such ectopic foci, which is hardly used despite the relative ease of assessment. We assessed PRF to correlate it with carotid intima media thickness (CIMT) to see if there was any significance in order to obviate need for heavy equipment in CVD risk assessment. METHODS: This is secondary analysis of data generated in the course of studying sub-clinical atherosclerosis in apparently normal individuals. Subjects underwent routine anthropometry to determine BMI. They then underwent abdominal ultrasound studies wherein PRF was measured as the size of the echogenic strip between the posterior part of the liver and the right kidney. The CIMT was measured using the same equipment but a different transducer, as the distance between the intima and medial layers of the right common carotid artery 1 cm proximal to the carotid bulb. RESULTS: The 221 subjects (82 M, 139 F) had mean ages of 37.01±10.97 and 36.86±11.62 years respectively. PRF correlated significantly with CIMT, age and all anthropometric measures. A PRF level of 0.26 cm turned out to be a significant value that determined presence of sub-clinical atherosclerosis deriving from the receiver operating characteristic curve analysis. CONCLUSION: PRF has shown to be correlated significantly with indices that predict atherosclerosis. Being an ectopic fat focus, its local and systemic effects on the kidney increase systemic vascular resistance and CVD. Since it can easily be measured on abdominal ultrasound, a test readily available and requiring lower level skills it should be used to advantage. Levels above 0.26 cm should prompt initiation of curative or preventive action to control CVD in the population.

Cardiovascular Anthropometry: What Is Best Suited for Large-Scale Population Screening in Sub-Saharan Africa?

Background : Body mass index (BMI) measures overweight/obesity. It, however, especially in sub-Saharan Africa (SSA), misclassifies cardiometabolic risk. Central obesity measures are superior. We therefore sought to compare BMI, waist-to-hip ratio (WHR) and abdominal height (AH) in predicting cardiovascular disease risk in sub-Saharan Africa. Methods : Subjects had blood pressures, BMI, and WHR determined. Blood pressure was taken, weight and height measured to generate BMI, and AH measured with a new locally fabricated abdominometer. The ability of the anthropometric indices in identifying abnormal individuals needing intervention was assessed with sensitivity, specificity, and area under the receiver operator characteristic curve. Results : Adults totaling 1,508 (728 M/780 F) adults were studied. For BMI, 985 (65.3%) were normal, while 375 (24.9%), consisting of 233 males and 142 females, had normal WHR. Blood pressure was normal in 525 (34.8%) and 317 (21.0%) for systolic and diastolic blood pressures, respectively. Using BMI as gold standard, sensitivity, specificity, positive, and negative predictive values for WHR in males were 80.7, 37.5, 62.5, and 19.3%, respectively. For females and in the same order, they were 62.0, 34.3, 65.7, and 38.0%. For AH, it was equal in both genders at 82.6, 39.2, 60.8, and 17.4%. By receiver operating curves comparing AH, WHR, and BMI against blood pressure detection, the area under the curve was 0.745, 0.604, and 0.554 for AH, BMI, and WHR, respectively. Conclusion : Abdominometer-derived AH has a better sensitivity and greater area under the receiver operator curve compared with BMI and WHR in this sub-Sahara African population; implying superiority as a cardiovascular anthropometric index.

Risk factors for heart failure in adult Nigerians.

OBJECTIVES: Heart failure (HF) is a lethal disorder most common in blacks. Available treatment options have little impact on prognosis, making primary prevention a priority. We aimed to describe the spectrum of established HF risk factors and clinical features in Nigerian adults. METHODS: We recruited consecutive adults with HF diagnosed using the Framingham criteria in a Teaching Hospital, and recorded clinical findings with a structured form. Blood was drawn for haematocrit, erythrocyte sedimentation rate (ESR) and serum cholesterol. RESULTS: 102 subjects were studied. Common HF risk factors were hypertension 45 (44%), obesity 26 (25%), alcohol intake 25 (24%) and hypercholesterolaemia 22 (21%). Both tachycardia (OR 5.5, 95%CI 1.7-14.9) and S3 gallop (OR 4.05, 95%CI 1.53-10.76) were significantly related with NYHA class IV HF. BMI was strongly related with total serum cholesterol (r = 0.70, P < 0.001). Low ESR (< 5 mm/h) was protective of NYHA class IV HF (OR 0.40, 95%CI 0.16-0.88). CONCLUSION: Hypertension, obesity, alcohol intake and hypercholesterolaemia were common in blacks with HF. Both S3 gallop and high ESR indicated more severe HF.

Double orifice mitral valve: a report of two cases.

BACKGROUND: Double orifice mitral valve is rarely reported; and no report of it was encountered in medical literature from Nigeria. OBJECTIVE: To document the existence of double orifice mitral valve co-existing with situs in versus in our environment. METHODS: Two young men who were initially diagnosed as cases of rheumatic mitral incompetence presented for echocardiography. The investigation was for the purpose of confirming the clinical diagnosis, and to determine the functional states. They both underwent 2D and M mode echocardiographic assessment. RESULTS: At echocardiography, both cases turned out to have double orifice mitral valves. There were two orifices between the left atria and ventricles on gross appearance at 2 D echo; with multiple M shaped mitral valve tracings on M mode echo. The second case in addition, had situs in versus discovered on Chest X-ray and confirmed on abdominal ultrasonography. CONCLUSION: Rare as it seems, double orifice mitral valve also occurs in our environment. It can also co-exist with situs in versus as a congenital abnormality. Since it is surgically remediable, all children with cardiac murmurs should be availed of echocardiography for diagnosis and early treatment to avert cardiac dysfunction.

Multidrug intolerance in the treatment of hypertension: result from an audit of a specialized hypertension service.

BACKGROUND: Hypertension as a cardiovascular disease risk factor continues to take a heavy toll on the population despite efforts with containment. Poor control, even among those on treatment, is part of the challenge and results from patient, physician and health system factors. When the problem resides at patient level, adherence is largely responsible. An entity defined as multidrug intolerance (MDI) is hardly considered. A situation when a patient is willing to adhere but is compelled otherwise could frustrate both patient and physician. Encountering a few such cases prompted the author to audit his specialized hypertension service in order to evaluate the burden of MDI and its associations. METHODS: Between 7 May and 30 July 2016 (to cover a 12-week cycle which ensured all attendees were captured), all patients attending follow up for blood pressure control had their records evaluated for intolerance to three or more different classes of anti-hypertensives, which defines MDI. Their ages, sex, control state and co-morbidities were extracted from the records. RESULTS: A total of 489 patients with hypertension were seen over the period; 271 (55.4%) of whom were women and 248 (50.7%) were uncontrolled. Overall 15 (3.1%) satisfied the definition of MDI; 10 women and 5 men. All the men with MDI were uncontrolled while 7 out of the 10 women were uncontrolled; with two having premenstrual syndrome as co-morbidity. A total of four patients (three men, one woman) had history suggesting allergy and two (one man, one woman) were on treatment for anxio-depressive illness. CONCLUSION: MDI does occur in sub-Sahara African patients with hypertension and should be considered before describing hypertension as resistant or considering alternative treatments including device therapy. Staggering doses or trying different formulations could be of benefit.

Economic benefit of back titration in the treatment of hypertension in Jos, Nigeria.

PURPOSE: Treatment of hypertension is expensive and cost is one of the reasons for inadequate blood pressure control. Where there are no social cost cushions, the burden is borne by patients. With pervasive poverty and inadequate control, complications are unchecked. Back titration in appropriate circumstances should, therefore, translate to economic benefit. This is an attempt to compute, in economic terms, the benefit of back titration. PATIENTS AND METHODS: Thirty-nine patients who entered an antihypertensive back titration program for 12 months and who had been earlier reported on, form the subject of this study. A survey of the cost of antihypertensives in pharmacy outlets in Jos, Nigeria was undertaken. Regimens of antihypertensives that patients were on at the onset and end of the 12 months of back titration were costed in Nigerian currency and compared. RESULTS: Back titration translated to economic benefit in all patients with a cost reduction varying from 2.3% to 100%. This reflected in reduction in mean daily cost of treatment of N107.09-N54.61. CONCLUSION: The benefit of antihypertensive back titration apart from psychological relief of lower pill burden and side effect profile is in pharmacoeconomics. This permits greater adherence and prevents morbi-mortality consequences of hypertension. In this study, back titration over 12 months translated to average cost reduction of >50%, making treatment more affordable. In appropriate circumstances, back titration of antihypertensives results in economic relief for patients. This should improve adherence, reduce morbi-mortality and is recommended for wider application.

Sexual dysfunction in female hypertensives.

PURPOSE: Hypertension and its treatment are known to produce sexual dysfunction in males. In our culture, women are not free to discuss issues of sexuality with their doctors. Hence, this phenomenon has not been explored in them. Notwithstanding this, cases occur in practice where noncompliance with dire consequences result from sexual dysfunction. This study was done to determine if any dysfunction existed among women as is commonly reported in males. METHODOLOGY: As part of a larger study on serum uric acid and lipid profile of adult Nigerian hypertensives, we sought information on sexual function in females. One group was newly diagnosed and treatment naïve, while the other was made up of known hypertensives on thiazides. The third group consisted of normotensive age-matched controls. FINDINGS: Six out of 44 (13.6%) in the first group, five out of 29 (17.2%) in the second group and two out of 43 (4.7%) in the control group reported sexual dysfunction. The commonest aspect encountered was reduced desire for intercourse. CONCLUSION: There was a tendency for hypertensive women to have more sexual dysfunction even before treatment than did controls. Larger studies should be undertaken and clinicians should probe this subject if poor compliance is suspected.

The Cold Dusty Harmattan: A Season of Anguish for Cardiologists and Patients.

Human health and disease often demonstrate seasonal patterns. Knowledge of these aspects aids anticipation and planning. Numerous studies have shown that hypertension and cardiovascular diseases demonstrate a seasonal pattern. The Harmattan, the cold dusty season in Sub-Saharan Africa, is the season of greatest concern in this regard. In this commentary, the author draws on his and other researchers' studies to explain the grounds for onset and worsening of existing cardiovascular diseases. As implied in the title, it is a season that puts great strain on the cardiologist and the health system, as well as greater disease burden on the patient. This should be taken into consideration in planning and pooling of resources for effective patient management and mitigation of impact of disease.

Obstetric predictors of hypertension: A cross-sectional study of women attending the postnatal clinic of Jos University Teaching Hospital.

BACKGROUND: Hypertensive disease in pregnancy (HDP) accounts for high mother and child morbi-mortality and predict future cardiometabolic diseases. This study aimed to identify obstetric predictors of HDP needing preventive action to reduce its consequences; when women present to antenatal clinic (ANC). MATERIALS AND METHODS: Cross-sectional descriptive this was an Interviewer-administered semi-structured questionnaire-based study of the anthropometric, and blood pressure measurementsin attendees at the postnatal clinic (PNC) of Jos University with ANC records. SETTING: Six weeks postnatal clinic (PNC) of Jos University Teaching Hospital (JUTH). RESULTS: The following indices proved predictive of HDP and subsequent hypertension: weight (P = 0.009), hip circumference (P = 0.018), parity (P = 0.043), waist circumference (P = 0.00), abdominal height (P = 0.040), waist/height (P = 0.020), history of developing hypertension in previous pregnancy (P = 0.000), birth weight of baby (P = 0.02), and mode of delivery (P = 0.05). CONCLUSION: To initiate preventive action on ANC registration in mitigating effects of or outrightly preventing HDP, careful check on anthropometry as well as history of hypertension or operative/preterm delivery in a previous pregnancy is necessary.

QTc interval prolongation in patients with HIV and AIDS.

A higher prevalence of QT prolongation has been reported among HIV/AIDS patients, possibly related to drugs prescribed for them or to an acquired form of long QT syndrome. A prolonged QTc is a predictor of cardiovascular mortality. We set out to study this interval in a group of AIDS patients. One-hundred consecutive AIDS patients admitted into the Jos University Teaching Hospital and who satisfied the inclusion criteria were recruited. All were evaluated for symptomatology of cardiovascular disease and had a 12-lead surface electrocardiogram recording. QT interval, taken from the onset of the QRS complex to the end of the T wave, was corrected for heart rate. Eighty HIV-negative, healthy persons and 78 HIV-positive, asymptomatic subjects were used as controls. Forty-five percent of the AIDS patients had prolonged QTc interval. Prolonged QTc was present in 28% of HIV-positive controls and 10% of HIV-negative controls. The mean QTc interval differs significantly between the AIDS patients and the two control groups. From our study, Nigerian HIV-positive asymptomatic subjects have higher prevalence of QTc prolongation compared to HIV-negative subjects and, as they move to AIDS, the prevalence of QTc prolongation increases. This makes for increased cardiovascular mortality.

Human immunodeficiency virus (HIV) related heart disease: a review.

Recent advances in the knowledge of human immunodeficiency virus (HIV) replication and transmission as well as the emergence of effective antiretroviral therapies are leading to longer survival times for HIV-infected individuals. As a result, organ related manifestations of late stage HIV infection, including HIV-related heart diseases have emerged. It is now clear that cardiac involvement in HIV seropositive patients is relatively common and is associated with increased morbidity and mortality. Cardiac involvement in HIV infection is multifactorial. The epidemiology has changed dramatically since the introduction of highly active antiretroviral therapy (HAART), but studies carried out before the introduction of HAART remain relevant because of limited access to this treatment in many areas of the world. A variety of cardiac lesions have been reported in HIV infection and AIDS, including pericardial disease with effusion and tamponade, nonspecific or infectious myocarditis, dilated cardiomyopathy with global left ventricular dysfunction, endocardial valvular disease due to marantic or infective endocarditis, arrhythmias, pulmonary hypertension and neoplastic invasion. In the post HAART-era, coronary artery disease and dyslipidaemia, drug related cardiotoxicity and cardiac autonomic dysfunction are becoming increasingly prevalent. In this review, we highlight the importance of cardiac complications in HIV disease and discuss measures that can be taken to improve survival.

Reversal of statin-induced memory dysfunction by co-enzyme Q10: a case report.

Statins are useful in the armamentarium of the clinician dealing with dyslipidemia, which increases cardiovascular morbi-mortality in hypertensive and diabetic patients among others. Dyslipidemia commonly exists as a comorbidity factor in the development of atherosclerotic cardiovascular disease. Use of statins is however associated with side effects which at times are so disabling as to interfere with activities of daily living. There are various ways of dealing with this, including use of more water-soluble varieties, intermittent dosing, or use of statin alternatives. Of late, use of co-enzyme Q10 has become acceptable for the muscle side effects. Only one report of any benefit on the rarely reported memory side effect was encountered by the author in the search of English medical literature. This is a report of a documented case of a Nigerian woman with history of statin intolerance in this case, memory dysfunction despite persisting dyslipidemia comorbidity. Her memory dysfunction side effect which interfered with activities of daily living and background muscle pain cleared when coenzyme Q10 was administered alongside low dose statin. Her lipid profile normalized and has remained normal. It is being recommended for use when statin side effects (muscle- and memory-related) impair quality of life and leave patient at dyslipidemia-induced cardiovascular morbi-mortality.

Relationship of blood pressure with some cardiovascular disease risk factors in a rural population of Plateau State, North Central Nigeria.

BACKGROUND: Hypertension is associated with certain cardiovascular disease (CVD) risk factors which vary from one place to the other depending on community sophistication. We decided to obtain the situation as it affects this rural Nigerian community to be in an evidence-based position to initiate individual and group prevention strategies. DESIGN: Cross-sectional population survey. MATERIALS AND METHODS: We surveyed for CVD risk factors among subjects 15 years and above in this rural community using a questionnaire requesting personal, medical and anthropometric information. One in three of them were randomly assigned to laboratory investigations. RESULTS: Of the 840 subjects studied, 25% were males. The population mean age was 45.5 (18.2) standard deviation (SD), with 1.8% smokers and 4.1% using alcohol. Systolic blood pressure (SBP) correlated with age, body mass index (BMI), total cholesterol (TC) and uric acid (UA); while diastolic blood pressure (DBP) correlated with age, BMI, TC, UA and atherogenic index (AI). SBP and DBP improved with exercise but not salt intake. The local seasonings used in cooking had no impact on blood pressure. CONCLUSION: To reduce cardiovascular morbidity in this and probably other rural sub-Saharan African communities, BMI, TC, UA and salt intake in diet should be targeted for reduction. Physical activity should be encouraged. Interestingly, these fall into the sphere of healthy lifestyle which should be encouraged and re-inforced.

Refractory hypertension in women controlled after identifying and addressing premenstrual syndrome.

Control of high blood pressure is usually difficult when there is an unidentified cause or there exist certain factors that blunt the effect of appropriate therapy. Premenstrual syndrome (PMS) is neither a known cause of hypertension nor is it listed as one of the factors that blunt effect of antihypertensives. PMS defines a constellation of symptoms confined to the luteal phase of the menstrual cycle interfering with individual function but clears after menstruation in the follicular phase. Though there is no consensus yet on its etiopathogenesis, the various models, inconsistent as they are, can initiate or sustain hypertension. The two patients presented had been frustrated by the attitude of their attending physicians who branded them neurotics and the fact that various drug combinations would not control their blood pressure. The classical recurring nature of their symptoms in relation to the menstrual cycle led to the suspicion of and treatment of PMS. With this, it became easy to control their erstwhile "refractory" hypertension. It is, therefore, recommended that history of PMS be sought and attended to, when premenopausal women without evidence of secondary hypertension have high blood pressures that proove difficult to control.

Electrocardiographic changes among Nigerian Norplant users.

OBJECTIVE: To determine any cardiovascular morbidity in the short term with Norplant use by electrocardiography. DESIGN: Prospective observational study of consecutive volunteers. SELLING: Jos Univesity Teaching Hospital, Nigeria. METHODS: Twenty-one Nigerian women seeking long-term reversible contraception were recruited for this study during a Norplant training programme in our centre in August 1997. The clients had baseline (Pre-insertion) blood pressure checks and electrocardiographic (ECG) tracings. These were repeated at the 3,6 and 12 months follow-up visits and the results were analysed. MAIN OUTCOME MEASURES: Heart rate, mean QRS electrical axis, PR and QRS intervals, rhthm assessment, chamber enlargement/hypertrophy. RESULTS: The mean age of subjects was 32.4 +/- 3.98 years (range 25-38 years). The mean weight at pre-insertion and at the 3, 6 and 12 months follow-up visits were 63.63 +/- 10.43, 60.59 +/- 10.07, 64.08 +/- 12.15 and 62.29 +/- 12.25 kilograms respectively. The differences were not significant. The systolic and diastolic blood pressures did not show any significant changes throughout the period of study. The heart rate and cardiac axis measurements did not show any significant changes during the study period. There was no chamber enlargement or hypertrophy. Rhythm remained generally normal. The PR and QRS intervals remained within normal limits throughout the study period. However, they seemed to be significantly prolonged--mean PR interval (seconds) pre-insertion 0.153 +/- 0.003, and at 12 months 0.173 +/- 0.006 (P = 0.019), mean QRS interval (seconds) pre-insertion 0.056 +/- 0.003 and at 12 months 0.74 +/- 0.002 (P = 0.005) CONCLUSION: There is a tendency to significant prolongation of ECG intervals in Norplant users. This requires longer observation.