Anticoagulation During the Cold Harmattan Season:Need for Extra Caution.

With increasing availability of valve surgery, a pool of patients requiring chronic anticoagulation is emerging in our environment. The lower blood coagulability with low temperatures, though rare, can occur, putting patients at risk of bleeding. Recently, the author lost two patients with prosthetic valves on anticoagulation at the peak of the cold harmattan season. Before their death, despite dose reduction, the International Normalised Ratio (INR) kept increasing and they were reported to have died suddenly at home. This triggered the need to draw attention of clinicians especially in the tropics to this difficulty, so as to anticipate and confront it when necessary. Case 1 was a 42-year-old male hypertensive on life-style measures with Moduretic once daily and weekly 20 mg Propranolol to control his blood pressure. He had surgery in India for aortic aneurysm with placement of prosthetic valve in 2013, and was placed on an oral anticoagulant - Acitrom. In 2015 while on 3 mg daily dose, he had an INR of 2.8. By October, INR rose to 3.95 prompting a dose reduction to 2 mg daily. Early in January 2016 (peak of cold harmattan season), the INR went higher to 4.19. He was asked to skip doses on Saturday and Sunday. After a forthnight he was reported to have died suddenly at home and no autopsy was done. Case 2 was a 40-year-old female with mitral stenosis. She had mitral valve surgery with prosthetic valve placement in India in 2010 where she was put on warfarin. In 2015, she had episode of ecchymosis and INR returned 2.07. With dose reduction, the INR dipped to 1.21 prompting a dose increase to 6 mg. The INR increased to 2.73. By October of 2015, her INR rose to 3.72, prompting de-escalation to 5 mg daily. While on this, she presented in a peripheral centre with haemoptysis where her Warfarin was further de-escalated and Co-trimoxazole prescribed. Again, within a fortnight she was reported to have died suddenly; and no autopsy was done The curious similarity here is the increasing INR despite anticoagulant de-escalation in the cold harmattan season. This experience has not been reported locally to the knowledge of the author. Some workers have reported that clotting times are longer with cold; clotting times being 3 times longer at 27 degrees Centigrade than 37 degrees.1 The phenomenon of decreasing temperature progressively delaying thrombus initiation began at 30 degrees Centigrade, progressing rapidly below that; and reaching statistical significance at 24 degrees.2 However, significant inter-individual variability in this response has been observed and explains conflicting result of studies on this subject.3 One could understand, therefore, why such observation may be made in Jos where harmattan temperatures can drop to single digits.

Paragonimiasis: Neglected, Re-Emerging or Expanding Frontiers. Lessons from a Case Presenting in Jos, Plateau State.

BACKGROUND AND OBJECTIVES: Paragonimiasis is endemic in Eastern Nigeria. An upsurge was recorded after the Nigeria/Biafra war as protein lack in Biafra forced people to eat fresh water crabs. Its protean manifestations create confusion with several diseases. Elimination was assumed after a while and suspicion index fell. The interest in reporting this case follows its presentation outside the traditional endemic zone. RESULTS: The patient, though living in Eastern Nigeria and manifesting several pointers of Paragonimiasis, was treated as tuberculosis despite negative sputum AFB; without improving. He then presented up-country in Jos where history led to suspicion and confirmation of Paragonimiasis. By this time he had severe cor-pulmonale and died despite treatment. CONCLUSION: In this current economic downturn in Nigeria which may drive people to cheaper protein sources, a high index of suspicion should be raised for paragonimiasis when a patient presents with chronic cough productive of AFB-negative sputum and haemoptysis.

A Rare Case of Rheumatic Heart Disease with Stenosis and Incompetence of Three Valves in a Nigerian Woman.

BACKGROUND: Though valve disease resulting from rheumatic heart disease is common, triple valve involvement is uncommon; with a bleak survival outlook Objective: To report a 38-year-old patient with both stenosis and incompetence of 3 valves, who lived till adulthood and went into heart failure after child-birth. No such report has come from Nigeria Methods: Case report of a Nigerian woman who lived with multiple valve disease up to adulthood when after delivery she developed hypertension and went into heart failure. Recurrent atrial fibrillation kept her in and out of heart failure. Three of her valves: mitral, aortic and tricuspid were both stenosed and incompetent. The consequent pulmonary hypertension and later development of arterial hypertension and atrial fibrillation worsened her morbidity till surgical intervention. CONCLUSION: Mixed triple valve disease of rheumatic origin tough rare, can occur; and is amenable to specialist surgical intervention.

Target organ damage among subjects with high­normal blood pressure in a Nigerian tertiary health institution

Background: There is paucity of data on the relationship between high ­ normal blood pressure (BP) and target organ damage (TOD) in sub-Saharan Africa including Nigeria. This study therefore, aimed to assess target organ damage (TOD) among subjects with high ­ normal BP in comparison with hypertensives and subjects with optimal BP. Materials and Methods: The study was crosssectional and comparative conducted at Aminu Kano Teaching Hospital, Kano on eligible subjects aged 18 years and above. Three groups comprising of randomly selected subjects (high -normal (group 1), hypertension (group 2) and optimal BP (group 3)), with each group having 100 in number were studied. Funduscopy and relevant investigations including transthoracic echocardiography were carried out. High ­ normal BP was defined as systolic BP of 130 -139mmHg and/or diastolic BP of 80-89mmHg. Results: The mean age of subjects in group 1 was 27.32 ± 8.20 years and 60% were female, 34.04±6.25 years for group 2 and 53% were female, and 52.81 ± 13.3 years for group 3 and 56% were female (P = < 0.001). The most prevalent TOD was left ventricular hypertrophy,present in 62% of hypertensives, 14% of those with high-normal BP and 2% of those with optimal BP(P = <0.001). Micro albuminuria and slight increase in creatinine were found in 12.9% and 6% of subjects with high-normal BP; 25.7% and 25% of hypertensives and 4.1% and 3% of subjects with optimal BP. The study found a significant progressive increase in both cardiovascular disease risk factors and target organ damage (TOD) as BP increased across the blood pressure categories from optimal BP to high ­ normal BP and to hypertension (P = <0.05). Conclusion: Subjects with high-normal BP had significantly higher prevalence of both TOD and cardiovascular disease risk factors than those with optimal BP but lower than hypertensives, suggesting that efforts to control BP should start early to reduce the complications of high BP

Knowledge and utilization of electrocardiogram among resident doctors in family medicine in Nigeria.

BACKGROUND: Electrocardiogram (ECG) is a simple, readily affordable, and noninvasive tool for the evaluation of cardiac disorders. There is a dearth of information on the utility of ECG in general practice in Nigeria. We assessed the knowledge and utilization of ECG among family medicine residents in Nigeria. MATERIALS AND METHODS: A cross-sectional evaluation was conducted between November 2011 and May 2012 in four family medicine training centers in Nigeria. A self-administered questionnaire was used to obtain information from the resident doctors regarding their ECG requests, preferred source of interpretation, most common ECG diagnosis, and update of ECG knowledge. RESULTS: Only 61 out of 120 questionnaires (50.8%) were returned. The respondents were mostly between 31 and 40 years (54.7%) and were predominantly males (73.8%) and senior residents (65.6%). Fifty-four (88.3%) respondents made <5 ECG requests/week, and the most common indication was hypertension (50%). ECG interpretation was either self-reported (41%), by a cardiologist (26.5%), or automated reports (21.3%). Self-reporting of ECG was more common among senior residents (P < 0.01). Left ventricular hypertrophy was the most common ECG diagnosis (55.8%). About 69% of respondents did not update their knowledge of ECG. Most respondents (50%) reported basic interpretation as the aspect of ECG for which further learning was desired. Teaching ECG to resident doctors in the update courses of the postgraduate medical colleges and continuing medical education (CME) activities was adjudged the best way to improve knowledge/utility (61.1%). CONCLUSION: The attitude to and utility of ECG among family medicine residents in Nigeria is poor. Improved knowledge, attitude, and utilization of ECG through curriculum revision, hands-on tutorials, and CMEs are highly recommended.

Carotid Intima Media Thickness in Nondiabetic Hypertensive Nigerians: Role of Fasting and Postprandial Blood Glucose.

Background/Aims. Carotid intima media thickness (CIMT) tracks atherosclerotic vascular disease. Hypertension and diabetes chiefly contribute to atherosclerosis with 75% of symptomatic cardiovascular disease cases having dysglycaemia even in normal cases. Hypothesising that postprandial hyperglycaemia contributes to cardiovascular morbidity, we sought to determine if any relationship existed between glycaemic profile in nondiabetic hypertensives and atherosclerosis. Methods. In a study of CIMT in nondiabetic, statin-naïve hypertensives, we evaluated fasting blood glucose (FBG) and 2-hour postprandial sugar (2hPPBG) in the patients and compared them with the CIMT. CIMT was measured on both sides, 1 cm proximal to the carotid bulb using a 7.5 mHz transducer of ALOKA SSD-3500 ultrasound machine. Results. The subjects with complete data were 86 (63 F). The mean (SD) of CIMT was 0.89 (0.15) mm, FBG 4.8 (0.097) mmol/L, and 2hPPBG 6.5 (1.81) mmol/L. There was no significant correlation between FBG and 2hPPBG with CIMT. Blood pressure had no bearing on this. When blood glucose data were divided into quartiles and post hoc multiple comparison was done, there was significant difference in CIMT for the different ranges. This was not so for 2hPPBG. Conclusion. Though expected from other studies, we did not show any significant correlation between FBG and 2hPPBG status and CIMT. This may be our pattern as the degree of excursion of 2hPPBG was low. There may be a threshold level above which PPBG starts to impact CIMT.

Influence of gender on heart failure among hospitalised Nigerian patients.

BACKGROUND: Heart failure is a global phenomenon with poor morbi-mortality statistics. Though data abound in the developed nations, they are just becoming available here. There is a perceived neglect of heart failure epidemiology as it affects women; which is getting some attention in the advanced nations. This work attempts to see how gender impacts on heart failure in our environment and to provide insight on how any peculiarities could be approached. METHOD: As part of a larger study on relationship between 6 minute walk test and left ventricular systolic function in heart failure patients in our centre (July 2012 to June 2013), we dichotomized the cases along the line of gender. This was to see what differences may be related to the genders. All patients had history, physical examination and investigations including echocardiography which formed the bases for comparison. RESULTS: There were 140 patients, 85 (60.7%) of whom were females. Mean age was 48.2 (14.5) years; but males were significantly older [53.8 (12.6) Vs 44.6 (14.6)]. Heart failure under 45 years affected women more. More males drank and smoked. While diabetes was more common in males, more females had hypertension and rheumatic heart disease as aetiologies. Females tended to be more symptomatic but the difference did not attain statistical significance. Renal function tended to be worse in males. CONCLUSION: Women tend to go into heart failure earlier than men in our environment and had more hypertension and rheumatic heart disease as causes. Renal function was worse in males given a greater constellation of cardiovascular disease risk factors namely alcohol use, smoking and diabetes. More effort should go into preventing rheumatic heart disease and hypertension which result in heart failure in women. Obstetric encounters for cerebrovascular disease evaluation should be taken more seriously since these conditions are likely to result in failure related to pregnancy and child-birth.

Relationship between Six-Minute Walk Test and Left Ventricular Systolic Function in Nigerian Patients with Heart Failure.

BACKGROUND: Heart failure (HF) is a major public health problem. The six-minute walk test (6MWT) is a submaximal exercise test performed even by HF patients not tolerating maximal exercise testing. The left ventricular ejection fraction is one of the strongest indicators of mortality in HF. Literature reports that relationship between 6MWT and (Left Ventricular Systolic Function (LVSF) were not homogenous, hence the need for this study. METHODS: One hundred and forty consenting HF patients in NYHA II and III were consecutively recruited after obtaining ethical clearance. The patients were made to walk on a level ground at their own convenient pace while attempting to cover as much ground as possible in six minutes. Echocardiography was also performed on all the patients. RESULTS: Eighty-five (60.7%) were women. The population mean age was 48.2 ± 14.5 years. The average distance walked was 272.2 ± 114.0 meters and the mean ejection fraction (EF) was 36.73 ± 15.04. Patients in NYHA II significantly walked longer than those in NYHA III (334.81 ± 98.80m vs 204.05 ± 87.66m; p<0.001). There was no correlation between the distance walked and LVSF; EF(r = -0.402, P = 0.534), SF (r = -0.128, P = 0.878).The independent predictors of distance walked were sex (p=0.021) and NYHA stage(p<0.0001). CONCLUSION: NYHA stage and sex independently predicted the distance walked in our HF patients. There was an inverse relationship between 6MWT and NYHA, with no correlation between 6MWT and LVSF. 6MWT therefore, appears not to be a good measure of LVSF as assessed by M-mode derived EF, in our HF patients.

Rare intracardiac aneurysms seen in Jos, Nigeria: a report of two cases.

BACKGROUND: Some congenital heart diseases are compatible with early life presenting their peculiar challenges in adulthood. Some of them are particularly rare, and are misdiagnosed in the absence of modern imaging facilities. Intra - cardiac aneurysms fall into this group. OBJECTIVE: The clinical presentation of the cases up to point of sudden death were documented and echocardiography done. RESULTS: Two such cases which were never encountered in over 20 years of echocardiography in our unit are reported. One was a ruptured sinus of Valsalva aneurysm dissecting the interventricular septum and the other ventricular septal defect aneurysm involving the tricuspid valve. CONCLUSION: Some congenital heart diseases present late. Increased availability of echocardiography and skilled personnel should lead to early diagnosis preventing fatality that follows late diagnosis as occurred here.

Low rate of proteinuria in hypertensives resident in a rural area of Plateau State, Nigeria.

BACKGROUND: Hypertensives are screened for proteinuria largely to detect kidney involvement. In most reports from urban areas, the burden is considerable. We decided to see the scenario in a rural setting with the opportunity presented by our cardiovascular disease (CVD) survey of a rural area in North Central Nigeria. METHODOLOGY: In 2008 we surveyed a rural population in Mangu Local Government area of Plateau State for CVD risk factors using the protocol of the National survey of 1991; slightly modified. One in three subjects was sequentially randomized to have blood and urine examination. Blood tests included glucose, creatinine, uric acid, total and high density lipoprotein cholesterol. Blood pressures were also taken. RESULTS: Blood and urine tests were done on 282 subjects. Eight of them (2.84%) had proteinuria. Ninety-nine of the 282 (35.11%) were hypertensive. Seven out of the 99 hypertensives (7.07%) had proteinuria. Between those hypertensives (positive or negative for proteinuria), the following indices: glucose, HDL cholesterol, SBP and DBP differed significantly (p = 0.000, p = 0.015, p = 0.000, p = 0.000 respectively). CONCLUSION: Compared with rates in urban centres of Nigeria, our population recorded low proteinuria rates both for the whole population and the hypertensive segment. It therefore appears that proteinuria in hypertension is not only a reflection of severity and burden of hypertension, but has some relation with residence. Rural areas have lower constellation of CVD risk factor (due to different life style) and lower incidence of hypertension. Consequently, their proteinuria rates are low.

Cardiovascular epidemiological transition in a rural habitat of Nigeria: the case of mangu local government area.

BACKGROUND: Epidemiological transition is at various stages in different places. The true situation in sub-Saharan Africa (SSA) is largely unknown. Having studied this rural habitat 17 years ago, we returned there to study several cardiovascular disease (CVD) risk factors to see if any change had occurred. METHODS: The communities studied in 1991 as part of the national CVD survey were returned to in 2008 and re-studied descriptively in a cross-sectional manner. All adults 15 years and above, apart from demographic and personal data had blood pressure (BP) and some blood indices determined. RESULTS: Over the period, some changes occurred. The mean (SD) age increased from 34.1(16.9) to 45.5(18.2) years suggesting an ageing population. More people in 2008 than 1991 lived most of their last 5 years in the urban areas suggesting some influence of urbanisation. Significantly fewer people smoked and drank after 17 years. However mean (SD) of Body Mass Index rose [20.7(2.8) to 23.7(4.5) kg/m²], as well as SBP and DBP. Prevalence of hypertension rose from 7.4% to 20.9%. Both total and HDL cholesterol rose, although atherogenic index dropped. Mean (SD) blood sugar interestingly dropped from 5.0(2.9) to 4.6(1.0) mmol/l. CONCLUSION: Epidemiological transition is evident in this rural SSA habitat, and proactive steps to stem the tide and curb the consequences of CVD should be instituted.

Valsartan, an angiotensin receptor blocker treats sexual dysfunction in a female hypertensive: a case report.

INTRODUCTION: Hypertension and its treatment cause sexual dysfunction (SD), impairing quality of life; and adversely affecting compliance and blood pressure control. SD is reported more often by men than women in most cultures especially ours. This has tended to affect the attitude of clinicians towards SD in female hypertensives. METHODS: A woman who for over 15 years of hypertension and its treatment faced difficulties in all domains of sexual function is hereby reported. On reporting this, the beta blocker in her regimen was replaced by an angiotensin receptor blocker (ARB). RESULTS: Gradually she regained libido and began to enjoy intercourse once again. This change obviated the need for a 5 phosphodiesterase inhibitor which would have added to cost of treatment. DISCUSSION/CONCLUSION: SD occurs in female hypertensives and should be sought. When found, ARB use can reverse the problem with all its attendant benefit on quality of life and blood pressure control.

Impact of hypertension on sexual function in women.

BACKGROUND: the effect of hypertension and its treatment on female sexual function is largely unexplored especially in Africa. However in practice, cases abound where consequent sexual dysfunction leads to poor or non-adherence with catastrophic results. Believing that like in males, hypertension and its treatment should affect female sexual function; we set out using a structured questionnaire to study the subject as it affects women. OBJECTIVE: to examine the relationship between hypertension and female sexual functions of arousal, lubrication and orgasm. METHODS: five hundred questionnaires were distributed to consenting Nigerian women after ethical clearance was obtained. Information sought included demographics, menstrual history, medical treatment and sexual function. RESULTS: a total of 454 returned questionnaires were analysable. Out of this, 109(24%) admitted to being hypertensive, 89 of whom were on treatment. Hypertension was related to difficulty with sustaining sexual excitement (p=0.03), decreased sexual thoughts (p=0.003), poor rating of marriages (p=0.03), difficulty being excited by fantasies (p=0.0001), increased vaginal dryness in the preceding one year (p=0.02), reduced frequency of sexual contact in the last one year (p=0.04) and rejection of partner sexual advance (p=0.05). The proportion of women in regular sexual relationship was less among the hypertensive group (p=0.02). Use of drugs produced significant sexual unpleasantness (p=0.03). CONCLUSION: hypertension and its treatment may produce female sexual dysfunction, and should be considered in managing the female hypertensive. By so doing, quality of life can be maintained; and compliance improved upon. The cumulative effect would be improvement in blood pressure control, with its attendant reduction in morbidity and mortality from hypertension.

Impact of income on the profile of cardiovascular risk factors among hypertensives in a Nigerian tertiary health centre: a cross-sectional study.

BACKGROUND: In most developed countries, risk factors for cardiovascular diseases (CVD) are more prevalent in low socioeconomic classes. However, the pattern in developing countries appears to be different. This study sought to evaluate and compare risk factors for CVD as well as absolute CVD risk in hypertensive subjects grouped by income in Kano, Nigeria. METHODS: The study was cross-sectional in design and carried out in Aminu Kano Teaching Hospital, Kano, Nigeria. Seventy treatment-naïve hypertensives and an equal number of hypertensives on treatment were recruited by balloting from the outpatient clinics, and then regrouped into low- and high-income earners. These two groups were then compared in terms of their profile of CVD risk factors and absolute CVD risk. All the assessed CVD risk factors are recognised in standard guidelines for the management of persons with systemic hypertension. RESULTS: The low-income group comprised 45 patients (32.1%) while the remaining 95 (67.9%) had a high income. The most prevalent CVD risk factor was dyslipidaemia, found in 77.8 and 71.6% of low- and high-income earners, respectively (p = 0.437). The prevalence of proteinuria was significantly higher among low-income earners (42.2%) compared with high-income earners (15.8%) (p = 0.001). Mean serum creatinine was also higher among low-income earners but the difference did not reach statistical significance (p = 0.154). Very high CVD risk was found in 75.6 and 70.5% of low- and high income earners, respectively (p = 0.535). CONCLUSION: Dyslipidaemia and very high CVD risk were found in over 71% of the patients regardless of their level of income. Low-income earners had a higher prevalence of indices of renal damage. These findings pose a great challenge to the present and future management of all subjects, particularly those in the low-income group, given that in Nigeria, healthcare is largely paid for directly out of their pockets.

Impact of Income on the Profile of Cardiovascular Risk Factors among Hypertensives in a Nigerian Tertiary Health Centre: a Cross-Sectional Study : Cardiovascular Topics

Background: In most developed countries; risk factors for cardiovascular diseases (CVD) are more prevalent in low socioeconomic classes. However; the pattern in developing countries appears to be different. This study sought to evaluate and compare risk factors for CVD as well as absolute CVD risk in hypertensive subjects grouped by income in Kano; Nigeria. Methods: The study was cross-sectional in design and carried out in Aminu Kano Teaching Hospital; Kano; Nigeria. Seventy treatment-naIve hypertensives and an equal number of hypertensives on treatment were recruited by balloting from the outpatient clinics; and then regrouped into low- and high-income earners. These two groups were then compared in terms of their profile of CVD risk factors and absolute CVD risk. All the assessed CVD risk factors are recognised in standard guidelines for the management of persons with systemic hypertension. Results: The low-income group comprised 45 patients (32.1) while the remaining 95 (67.9) had a high income. The most prevalent CVD risk factor was dyslipidaemia; found in 77.8 and 71.6of low- and high-income earners; spectively (p = 0.437). The prevalence of proteinuria was significantly higher among low-income earners (42.2) compared with high-income earners (15.8) (p = 0.001). Mean serum creatinine was also higher among low-income earners but the difference did not reach statistical significance (p = 0.154). Very high CVD risk was found in 75.6 and 70.5of low- and high-income earners; respectively (p = 0.535). Conclusion: Dyslipidaemia and very high CVD risk were found in over 71of the patients regardless of their level of income. Low-income earners had a higher prevalence of indices of renal damage. These findings pose a great challenge to the present and future management of all subjects; particularly those in the low-income group; given that in Nigeria; healthcare is largely paid for directly out of their pockets

Hypoglycaemia as a possible cause of transient ischaemic attack in a patient with multiple vascular risk factors.

An elderly, fibrillating, diabetic hypertensive patient in heart failure is at risk of stroke from all her cardiovascular morbidities. When such a patient presents with stroke, it is usually difficult to squarely incriminate one. Consequently, precious time is lost while care givers conduct expensive investigations to make a definitive diagnosis. This case report is on one such patient, in whom hypoglycaemia was a plausible cause. Treatment resulted in dramatic recovery. Had neurological complication of drug induced hypoglycaemia not been suspected, the hemiplegia might have become permanent; and any of her risk factors given as a rational explanation. Therefore when a diabetic on treatment presents with stroke, care givers should perform immediate blood glucose test to exclude hypoglycaemia; not withstanding the existence of other risk factors.

Evaluation of cardiovascular morbidity in Nigerian women after 3 years of Norplant contraception.

This study was conducted to determine any cardiovascular morbidity with Norplant use by electrocardiography. Thirty Nigerian women seeking long-term reversible contraception were recruited. The clients had baseline blood pressure checks and electrocardiography (ECG) tracings. These were repeated at the 12, 24 and 36 months follow-up visits and the results were analysed. The mean age of subjects was 32.4 +/- 3.98 years. The mean weight at pre-insertion and at the 12, 24 and 36 months follow-up visits showed a statistically significant rise after 2 years (p < 0.01). The blood pressures did not show any significant changes throughout the period of study. There was statistically significant prolongation of the PR and QRS intervals at the 12 month visit; 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 0.074 +/- 0.002 (P = 0.005). After 3 years of Norplant use, prolongation of the mean QRS interval remained evident (p = 0.011) while mean PR interval had returned to pre-insertion levels. There is a tendency to prolongation of PR and QRS (ECG) intervals in Norplant users; accordingly, it may be prudent for clients with cardiac conditions showing longer ECG intervals, to consider alternative methods of contraception.

Prevalence of premenstrual syndrome and its relationship with blood pressure in young adult females.

Premenstrual syndrome is a collection of symptoms which women experience 1 to 2 weeks before menstruation which clear with onset of menstrual flow and capable of interfering with life functions. An association between Premenstrual syndrome and hypertension has been suggested leading to the suspicion that it may be one precussor trait of hypertension in the normal population. Since people who develop hypertension later in life start from the higher range of normal earlier on, we sought to find if premenstrual syndrome had any bearing on hypertension. Consenting female subjects in three institutions in Jos, Nigeria were studied. Self-administered questionnaires designed to diagnose premenstrual syndrome and anxio-depressive status were used. Medical, family and menstrual history, as well as height, weight, pulse and blood pressures were documented; and data analysed. Four hundred and fourty seven subjects aged between 17 and 38 years with a mean of 23.6 + 3.9 were studied. Sixty one percent of them satisfied the criteria for diagnosis of premenstrual syndrome. When the data for those in luteal phase was split into the early (1st) and late (2nd) parts, there was a statistically significant rise in systolic and diastolic blood pressure from 1st to 2nd parts only for those with premenstrual syndrome (SBP 107.3 + 11.05 to 111.39 + 13.48 mm Hg. p=0.05 and DBP 65.06 + 10.38 to 70.69 + 10.03. p=0.004). Those with premenstrual syndrome also had higher anxiety and depression scores (chi-square 47.9 and 28.4 respectively). The symptoms of premenstrual syndrome peak in the 2nd part of the luteal phase. They are associated with a lot of stress. Since blood pressure elevation with this change was significantly higher among subjects with premenstrual syndrome, it is felt that premenstrual syndrome may predict future hypertension among currently normotensive females.

Cardiovascular risk factors in Nigerians with systemic hypertension.

BACKGROUND: Hypertension is the commonest risk factor for cardiovascular disease, and it frequently coexists together with other risk factors, thereby increasing the absolute cardiovascular risk. This study is primarily aimed at assessing cardiovascular risk factors in patients with hypertension in comparison with controls. It is also aimed at assessing target organ damage and absolute cardiovascular risk among the hypertensives. STUDY DESIGN: The study was case-control in design, conducted at the General outpatient and Cardiology Clinics of Aminu Kano Teaching Hospital, Kano, Nigeria. Three groups of patients (treated hypertensives, untreated hypertensives and controls), each 70 in number, were matched for age and sex. Patients were selected by balloting, using simple random sampling method. RESULTS: The most prevalent cardiovascular risk factor was Increased Body Mass Index, which was significantly more prevalent among treated (70%) than untreated (45.7%) hypertensives and controls (44.3%). Left Ventricular Hypertrophy was the most prevalent Target Organ Damage, found in 54.3% of treated and 42.9% of untreated hypertensives, and 0% of controls. Very high cardiovascular risk was detected in 75.6% of treated and 68.5% of untreated hypertensives. CONCLUSION: Even before the commencement of treatment, hypertenisves had high prevalence of cardiovascular risk factors and evidence of target organ damage. These were more pronounced in treated hypertensives. The basis and prognosis are discussed.

Erectile dysfunction in Nigerian hypertensives.

Erectile dysfunction (ED) is associated with hypertension and its treatment. It is known to impair and quality of life and compliance to treatment. This study excluded diseases which co-exist with hypertension as well as impair erectile function in their own right. This was to see how much of this problem could be ascribed solely to hypertension or its treatment. Thirty six untreated, newly diagnosed hypertensive males, 21 hypertensive males on thiazides and 37 non hypertensive controls were studied. Co-morbidities which on their own could cause ED were excluded. Erectile function, smoking and alcohol habits were documented. Patient groups were matched for age. Smoking rates were low. There was no significant difference in alcohol use among cases. Both hypertensive groups significantly had more ED than controls. Hypertensives on thiazides tended to have more ED than the untreated newly diagnosed group. ED is common in hypertensives even before treatment and tended to rise with thiazide use. Since it affects intimacy between couples adversely, impacting negatively on treatment outcome; it should be sought in all cases before treatment. Where present, appropriate management steps should be instituted to maintain quality of life and ensure compliance.