ABSTRACT
BACKGROUND: Increased QT dispersion (QTd) has been implicated as a marker of arrhythmogenesis and cardiac death. Paucity of literature on QTd in Nigeria necessitated an inquiry into QTd in adult hypertensive population. This study sought to: (i) compare the QTd values of adult hypertensive subjects with age and sex matched normotensive subjects and (ii)examine the relationship between QTd and left ventricular hypertrophy (LVH). STUDY DESIGN: One hundred and fifty-one hypertensive patients and 101 age and sex-matched controls were recruited into this study. A resting 12- lead ECG was obtained from all subjects for determination of QTd and ECG LVH using Sokolow Lyon (SL) and Araoye's codes. Echocardiographic LVH was determined for 60 hypertensive subjects and 60 age/sex matched controls. RESULTS: Hypertensive subjects had higher mean QTd than the controls (65.6 ± 28.1 ms vs 38.7 ± 11.3 ms, p< 0.0001). QTd of hypertensives with ECG LVH was significantly higher than those without ECG LVH (Araoye: 71.5 ± 22.0 ms vs 62.2 ± 24.1 ms, p = 0.02, SL; 72.0 ± 24.4 ms vs 61.6 ± 23.1 ms p = 0.009). Similarly the QTd of hypertensives with echocardiographic LVH (72.6 ± 21.3 ms) was higher than those without (60.1 ± 22.2 ms) but did not achieve statistical significance (p = 0.085). CONCLUSIONS: Hypertension with or without ECG LVH is associated with significantly increased QTd. Echo-cardiographic LVH is associated with a non significant increase in QTd in hypertensive subjects.
Subject(s)
Electrocardiography , Hypertension/complications , Hypertension/physiopathology , Hypertrophy, Left Ventricular/complications , Adult , Aged , Case-Control Studies , Echocardiography , Female , Humans , Hypertrophy, Left Ventricular/diagnostic imaging , Male , Middle Aged , Nigeria , Risk FactorsABSTRACT
INTRODUCTION: Hypertension is associated with increased morbidity and mortality. Paradigm shift and novel drugs that go beyond blood pressure control have debuted in the last decade globally and in Nigeria. The study therefore proposed to investigate the effect of the above if any on hypertension related acute deaths in patients admitted to the emergency room of the Lagos University Teaching Hospital. METHOD: Autopsy reports for bodies deposited from the medical emergency room (ER) were reviewed. Details of the time of admission, time of death and blood pressure status prior to the event were obtained. Subjects were batched into two groups 1982 1991 and 1992 2001 based on periods of paradigm shift in hypertension diagnosis and management. RESULT: There were 297 hypertension related deaths but 252 were analyzed. There were 168 (66.7%) males and 84 (33.3%) females (M:F 2:1) and mean age was 47.33 +/- 12.18 years (14-85 yr). Two thirds of the subjects (65.5%) were = 50 yrs of age. The mean duration of admission was 5.88 +/- 6.41 hours. One third (35.3%) died within an hour of admission. The commonest causes of death were stroke (52.8%) and heart failure 103 (40.9%). Intra-cerebral hemorrhage was the commonest type of stroke seen, 69 (52.3%). There were fewer cases of acute deaths in the second decade under review 95 (37.7%) vs. 157 (62.3%), p = 0.02 and strokes during this period, 47 (49.47) Vs 86 (54.78), p = 0.06. CONCLUSION: There is a trend towards reduction of hypertension related acute deaths. However stroke remains a major cause of acute hypertensive death and the patients are still dying young.
Subject(s)
Emergency Service, Hospital , Hypertension/mortality , Hypertension/therapy , Adult , Aged , Autopsy , Cause of Death , Cohort Studies , Female , Hospital Mortality , Humans , Hypertension/diagnosis , Male , Middle Aged , Nigeria , Retrospective StudiesABSTRACT
BACKGROUND: Prehypertension has been associated with target-organ damage. This study sought to determine the impact of prehypertension (PHT) on QT dispersion and left ventricular hypertrophy (LVH) in adult black Nigerians. METHODS: One hundred and one subjects with office blood pressure (BP) < 140/90 mmHg were categorised according to their office BP into normotensive (normal BP < 120/80 mmHg, n = 57) and prehypertensive (prehypertensive BP 120-139/80-89 mmHg, n = 44) groups. Echocardiography and electrocardiography (ECG) were performed on the subjects. RESULTS: Thirty-four males aged 53.65 ± 16.33 years and 67 females aged 52.42 ± 12.00 years were studied. The mean QT interval dispersion (QT(d)) of the normotensive (38.96 ± 11.06 ms) and prehypertensive (38.41 ± 11.81 ms) groups were similar (p = 0.81). Prehypertensive subjects had higher left ventricular mass (LVM) (165.75 ± 33.21 vs 144.54 ± 35.55 g, p = 0.024), left ventricular mass index 1 (LVMI-1) (91.65 ± 16.84 vs 80.45 ± 18.65 g/m(2), p = 0.021) and left ventricular mass index 2 (LVMI-2) (54.96 ± 10.84 vs 47.51 ± 12.00 g/m(2.7), p = 0.017). QT(d) was independent of echocardiographic and electrocardiographic LVH (p > 0.05). CONCLUSIONS: Compared with normotension, prehypertension is associated with higher LVM but similar QT(d). This suggests that structural remodelling precedes electrical remodelling in prehypertension.
Subject(s)
Blood Pressure/physiology , Hypertrophy, Left Ventricular/etiology , Prehypertension/complications , Adult , Aged , Aged, 80 and over , Blood Pressure Determination/methods , Echocardiography/methods , Electrocardiography/methods , Female , Humans , Male , Middle Aged , Nigeria , Prehypertension/physiopathologyABSTRACT
BACKGROUND: Increase in QT dispersion (QTd) is associated with an increased risk of cardiovascular morbidity and mortality. OBJECTIVES: This study sought to (i) determine the mean QTd and (ii) characterise QTd in a healthy Nigerian population. METHODS: One hundred healthy Nigerian adults were studied. Healthy status of the subjects was determined by history and physical examination. A resting 12- lead ECG was obtained from all subjects for determination of QTc, QTd and ECG left ventricular hypertrophy (LVH) using Sokolow Lyon (SL) and Araoye's codes. Echocardiography was used to determine LV systolic function, LVM and LVMI for 60 subjects. RESULTS: The QTd ranged from 15-70ms with a mean value of 38.5 ± 11.2ms. QTd was independent of age (p = 0.86), sex (p = 0.97), heart rate (p = 0.22), blood pressure (p > 0.05), BMI (p = 0.81), QTc (p = 0.41), LVH (ECG and echo) and LV systolic function (p > 0.05). CONCLUSION: QT dispersion is independent of demographic parameters, LV systolic function and LV hypertrophy in healthy adult Nigerians.
Subject(s)
Hypertrophy, Left Ventricular/physiopathology , Adult , Echocardiography , Electrocardiography , Female , Humans , Hypertrophy, Left Ventricular/diagnosis , Hypertrophy, Left Ventricular/epidemiology , Male , Middle Aged , Nigeria/epidemiology , Risk FactorsABSTRACT
Una de cada seis visitas al primer nivel son motivadas por un problema musculoesqueletico. Se analizo la Artritis Reumatoidea (AR) por su prevalencia. La relacion mujer/ varon es de 3/1; entre 30 y 60 años. Produce incapacidad laboral con alto impacto socioeconomico. La terapeutica adecuada se basa en el diagnostico, seguimiento y tratamiento oportuno. Objetivos: caracterizacion epidemiologica de la poblacion con dolor articular (DA) y sospecha de AR. Analizar el tratamiento segun la calidad de atencion. Material y metodos: investigacion descriptiva de corte transversal. La poblacion pertenece a nueve zonas rurales de Tucuman. Se encuestaron personas con DA mayores de 18 años. Se excluyeron personas con enfermedad neurologica y oncologica. Resultados: 342/2807 presentaron DA. Con sospecha de AR 2,2 por ciento, 84 por ciento fue poliarticular, el 70 por ciento consulto menos de 3 veces, 40 por ciento toma DAINES, 14 por ciento drogas de segunda linea y ninguno tratamiento no farmacologico. Conclusion: la prevalencia de DA y AR es considerable. La escasa respuesta de los servicios se evidencia por: bajo numero de consultas, tratamiento farmacologico sintomatico y ausencia de tratamiento no farmacologico; agravandose el pronostico con deterioro de la calidad de vida. La reumatologia debe plantearse estrategias poblacionales para no consentir un desarrollo cientifico limitado a unos pocos