Antibiotic Guidelines for Critically Ill Patients in Nigeria.

BACKGROUND: It is well documented that inappropriate use of antimicrobials is the major driver of antimicrobial resistance. To combat this, antibiotic stewardship has been demonstrated to reduce antibiotic usage, decrease the prevalence of resistance, lead to significant economic gains and better patients' outcomes. In Nigeria, antimicrobial guidelines for critically ill patients in intensive care units (ICUs), with infections are scarce. We set out to develop antimicrobial guidelines for this category of patients. METHODS: A committee of 12 experts, consisting of Clinical Microbiologists, Intensivists, Infectious Disease Physicians, Surgeons, and Anesthesiologists, collaborated to develop guidelines for managing infections in critically ill patients in Nigerian ICUs. The guidelines were based on evidence from published data and local prospective antibiograms from three ICUs in Lagos, Nigeria. The committee considered the availability of appropriate antimicrobial drugs in hospital formularies. Proposed recommendations were approved by consensus agreement among committee members. RESULTS: Candida albicans and Pseudomonas aeruginosa were the most common microorganisms isolated from the 3 ICUs, followed by Klebsiella pneumoniae, Acinetobacter baumannii, and Escherichia coli. Targeted therapy is recognized as the best approach in patient management. Based on various antibiograms and publications from different hospitals across the country, amikacin is recommended as the most effective empiric antibiotic against Enterobacterales and A. baumannii, while colistin and polymixin B showed high efficacy against all bacteria. Amoxicillin-clavulanate or ceftriaxone was recommended as the first-choice drug for community-acquired (CA) CA-pneumonia while piperacillin-tazobactam + amikacin was recommended as first choice for the treatment of healthcare-associated (HA) HA-pneumonia. For ventilatorassociated pneumonia (VAP), the consensus for the drug of first choice was agreed as meropenem. Amoxycillin-clavulanate +clindamycin was the consensus choice for CAskin and soft tissue infection (SSIS) and piperacillin-tazobactam + metronidazole ±vancomycin for HA-SSIS. Ceftriaxone-tazobactam or piperacillin-tazobactam + gentamicin was consensus for CA-blood stream infections (BSI) with first choice+regimen for HA-BSI being meropenem/piperacillin-tazobactam +amikacin +fluconazole. For community-acquired urinary tract infection (UTI), first choice antibiotic was ciprofloxacin or ceftriaxone with a catheter-associated UTI (CAUTI) regimen of first choice being meropenem + fluconazole. CONCLUSION: Data from a multicenter three ICU surveillance and antibiograms and publications from different hospitals in the country was used to produce this evidence-based Nigerian-specific antimicrobial treatment guidelines of critically ill patients in ICUs by a group of experts from different specialties in Nigeria. The implementation of this guideline will facilitate learning, continuous improvement of stewardship activities and provide a baseline for updating of guidelines to reflect evolving antibiotic needs.

CONTEXTE: Il est bien établi que l'utilisation inappropriée des antimicrobiens est le principal moteur de la résistance aux antimicrobiens. Pour lutter contre ce phénomène, il a été démontré que la bonne gestion des antibiotiques permettait de réduire l'utilisation des antibiotiques, de diminuer la prévalence de la résistance, de réaliser des gains économiques significatifs et d'améliorer les résultats pour les patients. Au Nigéria, les directives antimicrobiennes pour les patients gravement malades dans les unités de soins intensifs (USI), souffrant d'infections, sont rares. Nous avons entrepris d'élaborer des lignes directrices sur les antimicrobiens pour cette catégorie de patients. MÉTHODES UTILISÉES: Un comité de 12 experts, composé de microbiologistes cliniques, d'intensivistes, de médecins spécialistes des maladies infectieuses, de chirurgiens et d'anesthésistes, a collaboré à l'élaboration de lignes directrices pour la prise en charge des infections chez les patients gravement malades dans les unités de soins intensifs nigérianes. Les lignes directrices sont basées sur des données publiées et des antibiogrammes prospectifs locaux provenant de trois unités de soins intensifs de Lagos, au Nigeria. Le comité a pris en compte la disponibilité des médicaments antimicrobiens appropriés dans les formulaires des hôpitaux. Les recommandations proposées ont été approuvées par consensus entre les membres du comité. RÉSULTATS: Candida albicans et Pseudomonas aeruginosa étaient les microorganismes les plus fréquemment isolés dans les trois unités de soins intensifs, suivis par Klebsiella pneumoniae, Acinetobacter baumannii et Escherichia coli. La thérapie ciblée est reconnue comme la meilleure approche pour la prise en charge des patients. Sur la base de divers antibiogrammes et publications provenant de différents hôpitaux du pays, l'amikacine est recommandée comme l'antibiotique empirique le plus efficace contre les entérobactéries et A. baumannii, tandis que la colistine et la polymixine B se sont révélées très efficaces contre toutes les bactéries. L'amoxicilline-clavulanate ou la ceftriaxone ont été recommandées comme médicaments de premier choix pour les pneumonies communautaires, tandis que la pipéracilline-tazobactam + amikacine ont été recommandées comme médicaments de premier choix pour le traitement des pneumonies associées aux soins. Pour les pneumonies acquises sous ventilation mécanique (PAV), le consensus sur le médicament de premier choix est le méropénem. L'amoxycilline-clavulanate +clindamycine était le choix consensuel pour les infections de la peau et des tissus mous et la pipéracilline-tazobactam + métronidazole ±vancomycine pour les infections de la peau et des tissus mous. HA-SSIS. Ceftriaxone-tazobactam ou pipéracilline-tazobactam + gentamicine a fait l'objet d'un consensus pour les infections de la circulation sanguine de l'AC (BSI), le premier choix de régime pour les HA-BSI étant le méropénem/pipéracilline-tazobactam +amikacine +fluconazole. Pour les infections urinaires communautaires, l'antibiotique de premier choix était la ciprofloxacine ou la ceftriaxone, le régime de premier choix pour les infections urinaires associées à un cathéter étant le meropenem +fluconazole. CONCLUSION: Les données issues d'une surveillance multicentrique de trois unités de soins intensifs, d'antibiogrammes et de publications de différents hôpitaux du pays ont été utilisées par un groupe d'experts de différentes spécialités nigérianes pour élaborer ces lignes directrices sur le traitement antimicrobien des patients gravement malades dans les unités de soins intensifs, fondées sur des données probantes et spécifiques au Nigeria. La mise en œuvre de ces lignes directrices facilitera l'apprentissage, l'amélioration continue des activités de gestion et fournira une base de référence pour la mise à jour des lignes directrices afin de refléter l'évolution des besoins en antibiotiques. Mots clés: Antimicrobiens, Résistance aux antimicrobiens, Gestion des antibiotiques, Lignes directrices, Soins intensifs, Unité de soins intensifs, Infections associées aux soins de santé.

Epidemiology of pulmonary tuberculosis in University of Benin Teaching Hospital and Central Hospital, Benin City.

BACKGROUND: Poverty, overcrowding, homelessness, malnutrition and the AIDS pandemic has worsen the problem of tuberculosis in the developing countries, Nigeria inclusive with Nigeria being the fifth among the twenty-two high tuberculosis burden countries. OBJECTIVE: To identify the epidemiological factors associated with the distribution of tuberculosis in Benin City, Nigeria. METHODS: This study was a cross-sectional and descriptive one and carried out in two major public hospitals in Benin City, Nigeria, namely University of Benin Teaching Hospital (a tertiary hospital) and the Central Hospital (a secondary hospital) within one year period. RESULTS: The results of study revealed more males were affected than females (1.7:1). The mean age was 39.9 +/- 16.7 years with the largest number of patients (71.5%) being in the age groups 21 - 30 years. The major defaulters to anti-tuberculosis drugs were those with primary education and no formal education, which together constituted 80%. CONCLUSION: Tuberculosis was seen to be more common in males than females and the age group mostly affected was between 21 and 30 years. It still remains a disease of the low socio-economic status and those living in overcrowded environment. Compliance was poor amongst the uneducated and the poor.

The electrical axis of the heart in nigerian patients with chronic obstructive lung disease in Benin City.

BACKGROUND: Of the electrocardiographic changes in chronic obstructive lung disease (COLD) patients, a shift of the P wave axis greater than 900 which is highly characteristic, is said to be due to hyperinflation and does not occur in interstitial lung disease. OBJECTIVE: To describe the electrocardiographic changes in chronic obstructive lung disease patients. METHODS: The electrical axis of the various waves of the ECG using the hexiaxial reference system in 92 Nigerian patients with COLD were examined, 39 of whom had associated cor pulmonale. P wave axis greater than 900 was present in 2(19.1%) of 17 patients with COLD alone and 15(41.7%) out of 36 with development of corpulmonale (p<0.001). The mean P wave axis was 64.7 ± 10.6 0 in those without cor pulmonale while it was significantly shifted to the right (83.90) in those with cor pulmonale. The mean QRS axis was 53.50 ± 21.20 and 89.0 ±12.40 in those without and with cor pulmonale respectively (p=0.7716). The QRS axis was normal in all but one of those without cor pulmonale while there was a right axis deviation in 51.7% of those with it. ST and T wave changes were mainly present in those with associated cor pulmonale. CONCLUSION: The study shows that a shift of the electrical axis of the heart occurs in COLD patients mainly with the development of right ventricular hypertrophy (cor pulmonale), rather than the hyperinflation.

Contact tracing/pre-employment screening for pulmonary tuberculosis: should positive Mantoux test necessitates routine chest X-ray?

BACKGROUND: Pulmonary tuberculosis (PTB) remains a scourge in most developing countries. Mantoux skin test and more commonly chest radiography are some of the methods of diagnosing the disease, especially with regard to contact tracing and pre-employment screening. Regular use of radiography has both safety and cost implications. This study aimed at establishing if any justification exists in requesting for chest radiographs in asymptomatic subjects with a positive Mantoux skin test reaction. METHODS: 174 adults comprising PTB contacts and newly employed/admitted university staff/students were recruited into the study. They were 89 males (51.1%) and 85 females (48.9%). All subjects had Mantoux test (using purified protein derivative, PPD). Patients who had positive Mantoux reaction subsequently were subjected to posteroanterior chest radiographic examination. Mantoux test and chest radiographic findings were then correlated with each other. RESULTS: 102 subjects (59.2%) had positive Mantoux reactions, while 27 subjects (31.1%) had abnormal chest radiographs. There was no significant correlation between Mantoux readings and chest radiographic findings (P=0.106). CONCLUSION: It is concluded that other ancillary tests like sputum examination and/or, where available, Interferon and ESAT tests should be carried out before chest radiograph is requested in subjects with positive Mantoux reaction.

The prevalence, management and burden of asthma - a Nigerian study.

Inadequate attention given to the management of asthma and ways of improving treatment could be a significant factor for the increase morbidity and mortality from asthma despite major advances in our understanding of the pathophysiology of the disease. There seems to be paucity of data concerning the management pattern and burden of asthma in Africa. This study was under taken to determine the prevalence, management pattern and the burden of asthma. This study was a cross sectional design involving clinical and lung function assessment. The diagnosis of asthma was made using the clinical features of asthma and lung function parameters (Forced expiratory volume in one second, Peak expiratory flow rate, Reversibility tests). Totally, 120 asthma patients participated in this study. All subjects completed the clinical asthma control questionnaires. All items were rated with the calculation of their mean and percentages. Student t-test was used to calculate the difference between the mean of the lung function tests for subjects and control. The prevalence of asthma among respiratory unit patients was 6.6% and higher in the first three decades of life with female preponderance (F:M=1.5-1).There is a strong family history of asthma(81.7%). Associated allergies include rhinitis (75%), pharyngitis (54%), conjunctivitis (54%) and dermatitis (30%). Percentage of asthma patients treated with bronchodilators alone (70%), combined inhaled bronchodilators and steroid (28.3%). Impaired daily activities include sports (84%), Job career (60%), Physical activity (55%), Social activity (54%), Household chores (61%), Disturbed sleep (53%), Daytime symptoms (51%), Hospitalized(50%). Subjects had significant low lung function values when compared with control (P < 0.05). The burden of asthma is very high despite the advanced knowledge of the pathophysiology and management of asthma.

Prevalence of human immunodeficiency virus in ophthalmic surgical patients.

AIM: The aim of this study was to determine the incidence of human immunodeficiency virus in one hundred and sixteen (116) ophthalmic patients who had surgery over a two year period (July 2003 to June 2005) in the Department ofOphthalmology of the University ofBenin Teaching Hospital, Benin City. MATERIALS AND METHODS: A two year prospective study was carried out on 116 ophthalmic patients who had surgery between July 2003 and June 2005, A total of 116 patients were screened for HIV 1 & 2. An informed consent was obtained from all the patients. Patients who did not give their consent were excluded from the study. RESULTS: The total number of patients screened was one hundred and sixteen (116).There were 61 males and 55 females The age range was lyear to 78years with a mean age of 46 +/- 22.2 years (SD). The highest number of patients, 25 was found in the age group 61-70 years, comprising 21.6 of the total number of patients, followed by 24 patients in the 51 60 years age group. Three (3) patients comprising 2.6% were HIV positive. There were 2 females aged 25 and 50 years and a male aged 42years. The 25 year old female presented with squamous cell carcinoma of the conjunctiva, while the 57 year old woman had panophthalmitis. The male patient had herpes zoster ophthalmicus. He developed corneal opacities as complications of herpes zoster and had a peripheral iridectomy done to improve his vision. CONCLUSION: Although the HIV seropositivity rate of 2.6% is low, there is a need to do routine testing for HIV seropositivity in ophthalmic surgical patients who are billed for surgery as it gives them an opportunity to know their HIV status, thus enabling them to take appropriate preventive or treatment measures where necessary. HIV screening should be mandatory for high risk patients such as those with panophthalmitis, herpes zoster and squamous cell carcinoma of the conjunctiva that are markers for HIV.

A 20-Year Clinicopathological Analysis of Tuberculous Mastitis in Nigerians

Background: Tuberculosis is a global problem with high incidence in endemic areas such as Nigeria. A resurgence of tuberculosis attributed to an increase in the incidence of AIDS was observed in many countries in the last decade. A corresponding increase in the incidence of extrapulmonary tuberculosis including tuberculous mastitis was also documented in tuberculous endemic areas Aim: To present the experience of tuberculous mastitis from the Department of Pathology; University of Benin Teaching Hospital; Benin City; Nigeria. 1987 to 2006. Methods: A retrospective study of cases of tuberculosis of the breast from 1987 to 2006 as found in the records of the Pathology Department was done. Results: Twenty-four cases of tuberculosis of breast were seen during the 20 year period of study. All patients were females. They presented with a lump; mostly in the right breast (70.8). All cases were histologically confirmed. Five (20.8) patients were lactating at the time of presentation. Only 3 (12.5) of the 24 cases were suspected clinically as tuberculous mastitis. There was co-existing fibrocystic disease; fibroadenoma and carcinoma in 3 (12.5); 2 (8.3); and 1 (4.2) patient respectively. All patients had satisfactory results on antituberculosis treatment. Co-existing fibroadenoma and carcinoma were treated by excision biopsy and simple mastectomy respectively. Conclusion: Although the incidence of the tuberculous mastitis is low; it is often misdiagnosed. There is need for a high index of suspicion in making the diagnosis in young women with breast lumps in whom malignancy has been excluded

Ocular disorders in adult patients with tuberculosis in a tertiary care hospital in Nigeria.

OBJECTIVES: To determine the ocular disorders in adult tuberculosis (TB) patients in Benin City, Nigeria. METHODS: A prospective study of adult TB patients presenting at the University of Benin Teaching Hospital, Benin City, Nigeria, between March 2006 and October 2006 was undertaken. The patients were interviewed and examined by the authors and the ocular findings recorded. RESULTS: There were 92 patients (45 males and 47 females) with mean age 37.9 years (SD±15.6). Only one (1.1 percent) was HIV positive. Among the ocular findings in patients with TB, 8 patients had monocular blindness that included cataracts in 3 (37.5 percent), glaucoma in 2 (25 percent), optic atrophy, retinal vasculitis and maculopathy accounting for one case each (12.5 percent). Ocular disorders due to TB occurred in 9 patients (9.8 percent). These include cataract in 2 cases (2.2 percent), phlyctenular conjunctivitis in 2 cases (2.2 percent), glaucoma, anterior uveitis, chorioretinitis, retinal vasculitis, maculopathy, and optic atrophy each occurring in 1 case (1.1 percent). CONCLUSION: Tuberculosis is a cause of ocular morbidity, visual impairment and blindness. Prevention, early diagnosis and early treatment of TB may prevent avoidable visual loss.

Anthropometric predictors of elevated prostate specific antigen among rural and urban Nigerians: a population-based study.

BACKGROUND: Obesity has been associated with incidence and mortality of carcinoma of the prostate (CaP), but the relationship of BMI to CaP risk remains controversial across populations. OBJECTIVE: To describe the anthropometric correlates of elevated prostate specific antigen in Nigeria, a low-incidence region for CaP that currently reports rising incidence. SUBJECTS AND METHODS: Weight, height and skin fold thickness were measured for men, aged 40 years and older. Waist-to-hip ratio (WHR) and body mass index (BMI) were computed. Prostate specific antigen (PSA) status and prostate size were determined. Mean anthropometric indices were compared across groups using Student's t-test, association between anthropometry and PSA was by Spearman's correlation, and mean PSA was tested for linearity across tertiles of anthropometry. Prediction of elevated PSA was determined by multivariate logistic regression controlling for age and prostate size. RESULTS: Of 350 consecutive men contacted, 281(80.3%) completed the survey, mean age 56.9(13.5) years, and elevated PSA prevalence 31(11.0 %). WHR was 0.92 for rural and urban men, BMI (22.9 vs 24.7, p<0.002, and skin fold thickness was lower for rural men. PSA correlated directly with age, r=0.360, p<0.0001 and negatively with height, r=-0.136, p<0.023. WHR remained a significant predictor of elevated PSA,[OR 3.04 (95% CI 1.13 - 8.15)], after adjusting for age and enlarged prostate. CONCLUSION: Central adiposity may be a more important predictor of elevated PSA than BMI in this population. There is need to investigate the role of hormonal, metabolic, and genetic correlates of central adiposity in carcinoma of the prostate risk in this population.

Pneumomediastinum and subcutaneous emphysema associated with asthma exacerbation.

The case of a nineteen year old male student who presented with marked dyspnoea, dysphagia and horseness of voice is presented. Chest examination revealed bilateral polyphonic rhonchi and the chest radiograph showed the presence of subcutaneous emphysema and pneumomediastinum. A diagnosis of acute severe asthma complicated with subcutaneous emphysema and pneumomediastinum was made and the patient was managed conservatively on nebulized salbutamol, steroids, oxygen and chest physiotheraphy. He made a remarkable improvement and has remained in a stable clinical condition.

Peripheral lymphadenopathy in Nigerian children.

AIM: Peripheral lymphadenopathy remains an extremely common clinical problem in Paediatrics. To define the causes of lymph node enlargement in children in this environment. MATERIAL AND METHODS: A 20 year (1984-2003) retrospective study was conducted on all lymph node biopsies received from children (0-14 years) at the Department of Pathology, University of Benin Teaching Hospital, Benin City, Nigeria. Information derived from this study should serve as a diagnostic guide to clinicians. RESULTS: A total of 126 lymph node biopsies were received from children constituting 22.8% of all lymph nodes biopsies received during the period of study. The mean age was 8.3 years (SD +/- 3.1 years). Most (66.7%) cases were males. Regional adenopathy was observed in 90.5% of cases. Overall, the cervical group of lymph nodes was most commonly affected comprising 64 (50.8%) cases. Tuberculosis was the predominant cause of peripheral lymphadenopathy constituting 61 cases (48.4%) and also the commonest cause of cervical lymphadenopathy (62.5%). Non-specific reactive changes, non Hodgkin's lymphoma, Hodgkin's lymphoma and metastatic carcinoma were seen in 32 (25.4%), 22 (17.4%), 7 (5.6%), and 2 (1.6%) cases respectively. Kaposi sarcoma and sarcoidosis constituted one case each. CONCLUSION: In conclusion, the pattern of disease is similar to that of other developing countries. The triad of symptoms including fever, fatigue and weight loss, were recurrent in tuberculous and lymphoma patients. It is thus, imperative to commence antituberculous therapy only after histological diagnosis.

Effects of breast cancer and mastectomy on fibrinolytic activity in African women.

Reduced blood fibrinolytic activity (FA) has been postulated in cancer. It is good to know if this is also the case in Africans with breast cancer. Africans are known to possess enhanced fibrinolysis. This study was designed to assess the effect o breast cancer on fibrinolytic activity and the effect of mastectomy on fibrinolysis in African women. Sixty histo-patholically proven breast cancer patients aged 25 - 45 years were compared with 50 healthy age-matched controls. Plasma fibrinogen levels and euglobulin lysis time (ELT) were estimated in breast cancer patients and th controls. Patients with breast cancer had significantly increased fibrinogen levels euglobulin lysis time (P < 0.001) compare with controls. There was significant mean difference between pre and post-mastectomy fibrinogen and euglobulin lysis time values (p < 0.05). Progressive significant decrease in fibrinogen levels and euglobulin lysis time values (P < 0.05) were observed over the weeks studied respectively. African women with breast cancer have defective fibrin clearing which could predispose them to thrombotic diathesis and early mastectomy may be beneficial. We suggest that fibrinolytic components may be a prognostic marker for breast cancer.

Comparison of the efficacy and safety of budesonide turbuhaler administered once daily with twice the dose of beclomethasone dipropionate using pressurised metered dose inhaler in patients with mild to moderate asthma.

BACKGROUND: Current treatment guidelines have clearly defined the central place and benefits of inhaled glucocorticoids in the management of bronchial asthma. However, compliance with therapy is often poor due to complexity of treatment regimens. Therefore, a single once daily regimen with a simple device, the turbuhaler might be expected to result in improved compliance and better efficiency. STUDY DESIGN: This was a prospective open randomized trial with parallel groups conducted in five tertiary medical institutions. Asthmatic patients who met the enrolment criteria were randomized to receive either budesonide 400 microg daily or beclomethasone dipropionate 400 microg twice daily for eight weeks. RESULT: At the end of the study, both drugs were found to be effective in reducing the symptoms of asthma, reduction of beta2 agonist usage and improvement in lung function tests. However Budesonide Turbuhaler provided better effects in all parameters (p < 0.05). Both drugs were well tolerated. CONCLUSION: It is therefore concluded that Budesonide Turbuhaler administered once daily at a dose of 400 microg is more efficacious than Beclomethasone dipropionate 400 microg twice daily administered via pressurized metered dose inhaler.

Adenosine monophosphate and histamine induced bronchoconstriction: repeatability and protection by terbutaline.

BACKGROUND: Inhaled adenosine monophosphate (AMP) is thought to cause bronchoconstriction in asthmatic patients indirectly through mast cell mediator release. It may therefore be a more sensitive marker of airway inflammation in asthma and hence more specific for epidemiological surveys of asthma than challenges that act directly on airway smooth muscle such as histamine. There is some uncertainty as to how repeatable the measurement is and this is important if it is to be used for epidemiological studies. METHODS: The response to histamine and AMP challenges and the protection afforded by terbutaline (500 micrograms) against these two challenges was measured on two occasions two weeks apart in 20 subjects with asthma (19 completed the study). The response to histamine and AMP was measured as the provocative dose causing a 20% fall in forced expiratory volume in one second (PD20) and the protection afforded by terbutaline in doubling doses (DD). Repeatability was assessed as the limits of agreement. RESULTS: Although terbutaline had a slightly greater protective effect against AMP than histamine on both the first (delta PD20 = 2.66 versus 2.11 DD) and second occasion (2.56 and 2.15 DD), the differences were not statistically significant. The limits of agreement for the two histamine and two AMP challenges after placebo were from 3.06 to -3.5 and from 3.78 to -4.54 DD respectively, and these values did not differ significantly. The agreement limits between the first PD20 histamine and PD20 AMP values after placebo were similar, being from 3.73 to -3.72 DD after allowing for the 17.8-fold higher PD20 values for AMP compared with histamine. CONCLUSIONS: Terbutaline caused a slightly greater inhibition of the bronchoconstrictor response to AMP than histamine but the differences were small and non-significant. Any differences in repeatability between AMP and histamine challenges are small and in this study were not significant. The fact that the agreement between histamine and AMP PD20 values was similar to the agreement between repeat histamine or repeat AMP PD20 values suggests that, within an asthmatic population, PD20 AMP may not be providing different information from that provided by PD20 histamine.

Blood pressure reactivity to stress varies by hypertensive status and sex in Nigerians.

Previous studies among American and European populations have demonstrated larger blood pressure responses to behavioral challenges among men and hypertensive individuals. This is the first report of cardiovascular responses to behavioral challenges in a West African population. Blood pressure and heart rate changes in mirror image tracing and speech making tasks were recorded for 787 Nigerian civil servants participating in a comprehensive blood pressure survey conducted in Benin City, Nigeria, during 1992. Similar to findings in other populations, greater task-induced increases in systolic blood pressure (SBP) and diastolic blood pressure (DBP) were present among men than women (mean values of SBP = 22.1 vs. 18.3 mmHg, p < 0.001; and DBP means = 13.3 vs. 11.2 mmHg, p < 0.0001) and among hypertensives than normotensives (SBP means = 27.6 vs. 19.2, p < 0.0001; and DBP means = 14.1 vs. 12.1 mmHg, p < 0.05). An elevated prevalence of hypertension among men of higher staff status has been found in this population; however, higher staff status was not consistently related to cardiovascular reactivity, independent of hypertensive status. Additionally, hypertensive men who had speech-induced increases of SBP > 40 mmHg had significantly greater left ventricular mass index than did those hypertensive men with smaller SBP increases (p < 0.04). This study demonstrates that measures of cardiovascular reactivity to behavioral challenges have cross-cultural application, suggesting the need for further investigations of the interrelation of hypertension, cardiovascular reactivity, and left ventricular mass.

Body fat distribution and other anthropometric blood pressure correlates in a Nigerian urban elderly population.

Blood pressure (BP) has been reported to be more consistently correlated with body mass index (BMI) than with waist-hip ratio (WHR) in Blacks. We present the correlates of BP in a systematic sample of 152 (65.7 pc response rate) elderly urban Nigerians, with a mean age of 72.7 yrs. +/- 12.1 for males and 73.2 yrs, +/- 11.9 for females. There were 12.3 pc and 22.3 pc obesity rates in the males and females respectively, with an equivalent mean BMI of 22.8 kg/m2 and 23.4 kg/m2 and WHR of 0.97 and 0.94. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) correlated with BMI, r = 0.26; p < 0.01 and r = 0.42; p < 0.001, only in females. WHR did not correlate with BP in either sex, but waist and hip measurements correlated significantly with BP in both sexes. The most important predictor of BP is BMI for females and waist measurement for men. Although smoking and alcohol were not related to BP in either sex, the data suggests that alcohol enhanced, while tobacco inhibited weight gain significantly in males, who on the whole indulged more than the females. Fasting or two hour whole blood glucose were not related to BP. The findings are in support of the adverse effects of weight on BP in the elderly. There is need to study attitudes to adult weight gain as expressed in body shape, and to use the findings in the development of weight control programmes as part of blood pressure control in the elderly.