Atorvastatin improves sputum conversion and chest X-ray severity score.

BACKGROUND: We report the results of a phase IIB study investigating the safety and effectiveness of atorvastatin use with standard anti-TB drugs.METHODS: In this multicentre, open-labelled study, we recruited treatment-naÏve patients with uncomplicated pulmonary TB aged at least 18 years. Participants were randomly assigned to standard-of-care or standard-of-care plus oral dose of atorvastatin (40 mg) daily for 2 months. Primary end points were safety measured by the number of participants with severe adverse events and effectiveness measured by the number of participants with negative sputum culture. Secondary endpoint was chest X-ray (CXR) severity score.RESULTS: Of the 185 participants screened, 150 were enrolled and equally assigned to the standard-of-care and atorvastatin groups. Adverse event severity was similar in the two groups. There was increased frequency of muscle pain in the trial group (12/75, 16% vs. 4/75, 5%). For efficacy analysis, respectively 64 (97%) and 57 (85.1%) patients in the trial and control groups had culture-negative results (P = 0.02) and experienced a reduction in CXR severity score of respectively 37% and 22%, with a mean difference of 1.4-4.9%.CONCLUSION: Atorvastatin is safe and associated with improved microbiological and radiological outcomes in TB.

Right ventricular systolic function in hypertensive heart failure.

BACKGROUND: Heart failure (HF) is a major cause of cardiovascular admissions and hypertensive heart failure (HHF) is the most common cause of HF admissions in sub-Saharan Africa, Nigeria inclusive. Right ventricular (RV) dysfunction is being increasingly recognized in HF and found to be an independent predictor of adverse outcomes in HF. This study aimed to determine the prevalence of RV systolic dysfunction in HHF by several echocardiographic parameters. METHODOLOGY: One hundred subjects with HHF were recruited consecutively into the study along with 50 age and sex-matched controls. All study participants gave written informed consent, and had a full physical examination, blood investigations, 12-lead electrocardiogram, and transthoracic echocardiography. RV systolic function was assessed in all subjects using different methods based on the American Society of Echocardiography guidelines for echocardiographic assessment of the right heart in adults. This included tricuspid annular plane systolic excursion (TAPSE), RV myocardial performance index (MPI), and RV systolic excursion velocity by tissue Doppler (S'). RESULTS: RV systolic dysfunction was found in 53% of subjects with HHF by TAPSE, 56% by RV MPI, and 48% by tissue Doppler systolic excursion S'. RV systolic dysfunction increased with reducing left ventricular ejection fraction (LVEF) in subjects with HHF. CONCLUSION: A high proportion of subjects with HHF were found to have RV systolic functional abnormalities using TAPSE, RV MPI, and RV S'. Prevalence of RV systolic dysfunction increased with reducing LVEF.

Echocardiographic Assessment of Cardiac Changes During Normal Pregnancy Among Nigerians.

BACKGROUND: Pregnancy is a physiological process associated with an increased hemodynamic load and cardiac structural remodeling. Limited echocardiographic information exists on cardiac chambers, left ventricular (LV) systolic and diastolic functions, and LV mass during trimesters of normal pregnancy among African women. MATERIALS AND METHODS: Echocardiography was done at the beginning of the second trimester, beginning of the third trimester, and middle of the third trimester for 100 normal pregnant women and at one visit for age-matched 100 nonpregnant women. The data were analyzed using the Statistical Package for Social Sciences (SPSS) version 17 software. Analysis of variance was used to compare within trimesters, and a P value of <0.05 was considered significant. RESULTS: The mean (SD) ages of the patients and controls were 28.20 (±5.91) and 28.35 (±6.06) years, respectively (age range = 19-44 years, P = 0.86). Cardiac chambers, LV systolic function, and LV mass and its index increased significantly during pregnancy. A significant increase in A-wave velocity but slight increase in E-wave velocity and a reduction in tissue e' velocity at the septal margin but a progressive increase in a' velocity were also observed (P < 0.05). CONCLUSION: Cardiac chamber dimensions, LV wall thickness, and mass, most indices of LV systolic and diastolic function, though within normal range, were significantly higher in pregnant than in nonpregnant Nigerian women.

Radiation safety of women of the reproductive age: evaluation of the role of referring physicians.

BACKGROUND: Women between 12 and 50 years are in the reproductive age. The likelihood of or actual presence of pregnancy should be ruled out before they are exposed to medical ionizing radiation. Fetal exposure to ionizing radiation can either induce malformation (teratogenic) or cancer. They should be exposed only when it is safe for the fetus or when the benefit far outweighs the risk in urgent medical conditions. The radiation dose in medical imaging is generally below the threshold to induce malformation (100 mGy) in the fetus, but there is indeed no safe level as the risk of cancer induction later in life can occur at any dose. The referring physician must obtain the last menstrual period (LMP) and sometimes carry out pregnancy test before sending their patients for examinations using ionizing radiation. However, there are circumstances in which these rules are waived. OBJECTIVE: The purpose of the study is to evaluate the role of the referring physician in the radiation protection of the fetus using the LMP. SUBJECTS AND METHODS: This is a prospective study over a 2-month period. All the request forms of menstruating women aged 12-50 years sent for conventional radiography are included in the study. RESULTS: One percent provided the LMP in the request forms. 0.6% (one) of our subjects was sure she is pregnant, but 13.7% (25) had an overdue menstruation. CONCLUSION: The level of compliance of the physicians with the referral guidelines for women of reproductive age is poor.

Normal Limits of Electrocardiogram and Cut-Off Values for Left Ventricular Hypertrophy in Young Adult Nigerians.

This study assessed healthy young adults to determine the normal limits for electrocardiographic variables and cut-off values for left ventricular hypertrophy. It was a cross sectional descriptive study in which the participants were evaluated clinically by standard 12-lead resting electrocardiogram (ECG) at 25 mm/s during quiet respiration. The heart rate, P wave duration, axis and amplitude, PR and QT intervals, QRS duration, axis and amplitude and T wave axis were assessed. Three hundred and twenty four (324) volunteers comprising of 175 males and 149 females aged 20 to 30 years (mean, 23.01 ± 2.88 years) participated in the study. The normal limits for heart rate, P wave duration, amplitude and axis in lead II, QRS duration and axis, T wave axis, PR interval, QT interval and QTc respectively were; 61-93 beats per minute,0.08-0.12s,1.00-2.00 mm,22.00-79.000,78.00-106.00 ms,15.50-81.000, 24.25-69.000,0.12-0.19s, 0.32-0.40s and 0.36-0.44s. The cut-off values for Sokolow-Lyon, Cornell and Araoye criteria for assessment of left ventricular hypertrophy (LVH) were higher than those previously in use in medical practice. Gender difference exists in some cut-off values for LVH. This study defined the normal limits for electrocardiographic variables for young adult Nigerians. Racial factor should be taken into consideration in interpretation of ECG.

Cardiovascular responses to treadmill exercise in Nigerian hypertensives with left ventricular hypertrophy.

BACKGROUND: Left ventricular hypertrophy (LVH) is an independent risk factor for adverse cardiac outcomes in hypertensive patients. OBJECTIVE: This study is designed to assess the cardiovascular responses to treadmill exercise among Nigerian hypertensives with echocardiographically proven LVH. MATERIALS AND METHODS: Fifty hypertensive patients with LVH (27 males and 23 females) between 30 and 65 years of age were studied in Nigeria. 50 hypertensive patients without LVH and 50 normal subjects who were age and sex matched served as controls. All patients and control subjects underwent M-mode, 2-D and Doppler ECHO-studies and the Bruce protocol treadmill exercise test. RESULTS: The study showed that the estimated maximal oxygen consumption (MVO2) in MET reduced progressively from 8.39 ± 1.26 (normotensive control) to 7.62 ± 1.33 (hypertensive without LVH), 6.27 ± 0.99 (hypertensive with LVH) (P<0.0001ANOVA). The duration of exercise (s) was also reduced in that order from 455.4 ± 79.1 to 411.6 ±8 2.3, 315.8 ± 75.6 respectively (P<0.0001). The systolic blood pressure (SBP) and pressure rate product (PRP) during maximal exercise were also increased in hypertensives with LVH and hypertensive without LVH when compared to normotensive controls. The hypertensives with LVH and hypertensives without LVH also showed significant limitation to heart rate increase with exercise compared to normotensive controls (P<0.003). CONCLUSION: This study demonstrated significant impairment of exercise capacity in hypertensives with or without LVH compared to normotensive subjects. Both earlier recognition and improved understanding of LVH may lead to more effective therapeutic strategies for this cardiovascular risk factor.

Left ventricular geometry in Nigerians with type II diabetes mellitus.

BACKGROUND: Left ventricular hypertrophy is independently associated with increased incidence of cardiovascular disease, cardiovascular and all cause mortality. In a relatively healthy hypertensive adult population, type II diabetes is associated with higher left ventricular mass, concentric left ventricular geometry and lower myocardial function independent of age, sex, body size, and arterial blood pressure. OBJECTIVE: The study is to investigate left ventricular geometry in Nigerians with Type II Diabetes mellitus. METHODS: The study design was cross-sectional and it comprised 75 consecutive patients with type II diabetes mellitus with or without hypertension. Using a structured pre-evaluated questionnaire, the demographic and clinical data were obtained. All subjects had two dimensional (2D) and 2D derived M-mode echocardiography using Sonoline G60s Ultrasound imaging system with 4.2 MHZ transducer equipped with simultaneous ECG tracing. RESULTS: A total of 75 consecutive type II diabetic patients with or without hypertension were recruited into the study. There were 18 (24.0%) hypertensive-diabetic and 12 (16.0%) normotensive-diabetic males and Thirty-four (45.3%) hypertensive-diabetic and 11 (14.0%) normotensive-diabetic were females. Hypertensive-diabetic males had significantly higher left ventricular mass compared to normotensive-diabetic counterpart 207.05 +/- 41.5g and 156.00 +/- 27.1g P = 0.001. Similarly, left ventricular mass index was found to be higher in hypertensive-diabetic males than their normotensive-diabetic counterpart 114.50 +/- 29.2g/m2 and 92.28 +/- 20.5g/m2 P = 0.014. Hypertensive-diabetic female significantly had higher LVM compared to the normotensive-diabetics 196.06 +/- 41.5g and 161.54 +/- 31.6g P = 0.016. Left ventricular mass index was also found to be higher in hypertensive-diabetic female than their normotensive counterpart 118.52 +/- 27.8g/m2 and 95.75 +/- 23.0g/m2 P = 0.019. Hypertensive-diabetics had predominantly concentric left ventricular hypertrophy compared to the normotensive-diabetics 36 (69.2. %) and 5 (21.7%) P = 0.001. CONCLUSION: The study reported that hypertensive-diabetics have predominantly concentric left ventricular hypertrophy, higher left ventricular mass and left ventricular mass index compared to normotensive-diabetic. Female hypertensive-diabetic had predominantly concentric left ventricular hypertrophy, while male hypertensive-diabetic and normotensive-diabetic had predominantly concentric left ventricular remodelling.

C-reactive protein in healthy adult Nigerians.

BACKGROUND: C-reactive protein (CRP) is an acute phase reactant produced in the liver in response to tissue injury or systemic inflammation, its release is stimulated by cytokines (interleukin-6 and tumour necrosis factor-alpha). Elevated CRP levels have been linked to an increased risk of later development of diabetes mellitus and systemic hypertension. Baseline level of C-reactive protein in apparently healthy men and women predict long-term risk of a first myocardial infarction. METHOD: The study design was cross-sectional conducted among apparently healthy adult relative of patients and hospital staff of the Obafemi Awolowo University Teaching Hospitals complex (OAUTHC) Ile Ife, Osun State south western Nigeria. Serum lipids and fasting blood glucose were measured, while C-reactive protein measurement was based on the principle of solid phase enzyme-linked immunosorbent assay (ELISA). RESULTS: Atotal of 50 apparently healthy consecutive adult subjects were recruited into the study comprising 19 male and 31 female. There was no significant difference in mean Fasting blood glucose and serum lipids between the male and female study subjects. However, C-reactive protein was found to be higher in female compared to male, but the difference was not statistically significant. CONCLUSION: This study showed that apparently healthy adult female Nigerians have higher level of C-reactive protein compared to male, but with no significant difference.

Prediction of functional capacity during six-minute walk among patients with chronic heart failure.

BACKGROUND: Formulae for predicting functional capacity during 6-minute walk are lacking and the accuracy of the existing formulae has been challenged in deferent populations. AIMS: The purpose of this study was to develop an equation that would be useful in predicting functional capacity in form of maximum oxygen consumption) (V0 2 ) in Chronic Heart Failure Patients (CHF) during exercise. METHODS: Sixty-five subjects were recruited for the study. The procedure required the subjects to walk on a self paced speed on a 20 meter marked level ground for 6 minutes. The distance covered in 6 minutes was measured and the speed calculated. RESULTS: The result showed that the distance covered was highly correlated with the VO2 (0.65, p< 0.01). The regression analysis revealed that a linear equation model developed was a good predictor of V0 2 for the group. CONCLUSION: The study concluded that in situation where sophisticated equipments are lacking, this equation might be useful during exercise supervision for patients with CHF. [VO2 (mlkg-1 min-1) = 0.0105 x distance (m) + 0.0238 age (yr) - 0.03085 weight (kg) + 5.598].

Prediction of functional capacity during six-minute walk among patients with chronic heart failure

Formulae for predicting functional capacity during 6-minue walk are lacking and the accuracy of the existing formulae has been challenged in deferent populations. The purpose of this study was to develop an equation that would be useful in predicting functional capacity in form of maximum oxygen consumption) (V0 ) in Chronic Heart Failure Patients (CHF) during exercise. Sixty-five subjects were recruited for the study. The procedure required the subjects to walk on a self paced speed on a 20 meter marked level ground for 6 minutes. The distance covered in 6 minutes was measured and the speed calculated. The result showed that the distance covered was highly correlated with the VO2 (0.65; p 0.01). The regression analysis revealed that a linear equation model developed was a good predictor ofV0 for the group. The study concluded that in situation where sophisticated equipments are lacking; this equation might be useful during exercise supervision for patients withCHF. [VO2 (ml kg-1 min-1)

Which factors actually influence the development and progression of overt nephropathy in Nigerian diabetics?

OBJECTIVE: To determine the risk factors predisposing Nigerian diabetics to overt nephropathy with a view to developing strategies for its prevention. DESIGN: case control study. SETTING: Tertiary care hospital, a major nephrology referral centre in Nigeria. SUBJECTS: 30 diabetic nephropathy (DN) patients and 32 age and sex-matched diabetic patients without nephropathy. MATERIALS AND METHODS: 30 diabetic nephropathy (DN) patients with chronic renal failure who have been diabetic for a minimum of five years and satisfied the inclusion criteria for the study were compared with 32 age and sex-matched diabetic patients without nephropathy. Their socio-demographic parameters, clinical and laboratory profiles were determined and compared. RESULTS were analysed using the statistical package for social sciences version 10. Chi-square test, logistic regression analysis and Spearman's rank correlation coefficient were used, p-value < 0.05 was considered as significant. MAIN OUTCOME MEASURES: The study sought to compare socio-demographic, clinical and biochemical data between diabetic patients with overt nephropathy and those without. RESULTS: Duration of diabetes, blood pressures and blood sugar levels were significantly higher in DN patients than the controls (p < 0.05). A family history of renal disease, socio-economic status, cigarette smoking, body mass index and total serum cholesterol did not distinguish between DN patients from controls (p > 0.05). Systolic blood pressure positively correlated with serum creatinine (r = 0.057, p < 0.001) and duration of DM (r = 0.284, p = 0.02). There was a constellation of clinical features viz: retinopathy, peripheral neuropathy and left ventricular hypertrophy, which were significantly associated with DN (p < 0.05). CONCLUSIONS: Prolonged duration of diabetes, hypertension, retinopathy, and peripheral neuropathy, left ventricular hypertrophy and poor glycaemic control were the major risk factors for overt nephropathy among Nigerian diabetics. Apreventive strategy should include adequate blood pressure and glycaemic control.

Shifting trends in the pharmacologic treatment of hypertension in a Nigerian tertiary hospital: a real-world evaluation of the efficacy, safety, rationality and pharmaco-economics of old and newer antihypertensive drugs.

The current prescription patterns for essential hypertension and the efficacy, safety, tolerability and cost-effectiveness of the newer antihypertensive drugs were evaluated in Nigerian patients. The findings were compared with that of a previous study conducted in the same tertiary hospital 10 years earlier. A cross-sectional evaluation of blood pressure (BP) control in a hypertension clinic was undertaken among 150 Nigerian patients aged 61 +/- 12 years (55% females), with a duration of treatment on a particular drug class or combination of 9 +/- 3 months. The initial blood pressure was 176 +/- 20/108 +/- 11 mmHg and 22% of the patient had concurrent diabetes mellitus. Thiazide diuretics (D) alone or in combination remained the most commonly prescribed drugs in 56% of all patients. There were significant increases in the prescriptions of calcium channel blockers (CCBs) (51%), P < 0.0001, and ACE-inhibitors (ACEIs) (24%), P < 0.0001, but a slight reduction in the use of methyldopa, and fixed drug combinations (P < 0.01) compared to the previous study. The fall in systolic blood pressure on D (r = 0.65, P < 0.001) or CCB (r = 0.48, P < 0.02) was significantly correlated with the initial systolic blood pressure, but not age. More patients achieved normotension BP < 140/90 mmHg on CCB monotherapy (71%), than D monotherapy (56%). Combination therapy with ACEIs + D or methyldopa+thiazides normalized BP in 63 and 68%, respectively. Pulse pressure, a surrogate marker for cardiovascular complications and mortality in essential hypertension, was significantly reduced (P < 0.01) equally by all treatments, with 95% confidence intervals ranging from -28 to -1 mmHg. However, hypertensive-diabetic (HT-DM) patients (n = 33) exhibited no significant change in pulse pressure in response to treatment. Adverse drug reactions that occurred in 11% were impotence or postural dizziness with D, headache and pitting oedema with CCB, and dry cough with ACEI. Pharmaco-economic comparison of the drug classes revealed that for every US dollar (dollar) spent per month, the percentage of treated patients attaining normotension was 18.6 for D, 4.73 for CCB, 3.5 for ACEI + D and 13.6 for methyldopa + thiazides. A combination of ACEI + CCB or D was the preferred treatment for hypertensive-diabetic Nigerians, but only 24% attained a BP < 130/85 mmHg. These results demonstrate a shift in trend to a more rational and efficacious treatment of hypertension over a 10 year period. This may be associated, at least in part, with the intensive and continuous education of the prescribers in rational drug use and the introduction of a hospital formulary. Methyldopa is still a highly efficacious and cost-effective drug in this population. Black HT-DM Africans still constitute a subgroup who not only require more and costlier antihypertensive drugs, but whose BP control is suboptimal, and exhibit a poor therapeutic response to other risk factors (pulse pressure) that constitute a continuing risk for cardiovascular mortality.

Cardiovascular changes in sickle cell anaemia.

Sickle cell anaemia (SCA) is the commonest inherited haemoglobinopathy in Nigeria and is associated with high morbidity and mortality, particularly in early childhood in most of the affected population. The cardiac manifestations of SCA are a significant feature of the disease but there is a paucity of information on the cardiovascular involvement in SCA in Nigeria and Africa. The size of the sickle cell problem in the country is growing rapidly and there should therefore be a greater awareness of the cardiac problems associated with SCA. This review highlights the clinical features, changes in cardiac structure and function at rest and on exercise, cardiac pathology and associated heart diseases in SCA as well as the recent global progress made in the understanding of the cardiovascular changes in the disease. Emphasis is laid on data derived from Nigerian studies.

The clinical, electrocardiographic and self-paced walking exercise features of Nigerians with sickle cell anaemia presenting at OAUTHC, Ile-Ife.

Most patients with sickle cell anaemia (SCA) show evidence of cardiac dysfunction. This study aimed at clinically and electrocardiographically assessing the exercise capacity of steady state SCA patients using self-paced walking exercise. Forty one (17 males and 24 females) steady state SCA patients between the ages of 15 and 37 years were prospectively studied with 41 age and sex-matched (17 males and 24 females) normal AA controls. All subjects had clinical evaluation, resting 12-lead electrocardiography (ECG), 12 minutes self-paced walking exercise, and were tested for haematological and biochemical abnormalities. The clinical features of the patients reflected a hyperdynamic circulation which was evidenced by faster heart rates, wide pulse pressure, cardiomegaly, loud heart sounds and cardiac murmurs. Non-specific ECG findings were observed in this study. The mean QRS voltage (Sokolow-Lyon criteria) was significantly higher in patients compared to controls (P < 0.05). The mean rate, P wave duration and corrected QT interval of SS patients were significantly higher than the controls. The patients also had a significantly lower mean QRS frontal axis than the controls (P < 0.05) but there was no difference between the two groups in the mean QRS duration and PR interval. There was no abnormal QRS axis in the two groups. The self-paced walking exercise test showed significant limitation of exercise capacity in SCA patients, as evidenced by the significant reduction in speed and distance covered by the patients compared with the controls. While both groups achieved similar post exercise heart rate and systolic BP, the change in heart rate was significantly less in the patients. This study concluded that SCA patients have larger hearts and non-specific ECG changes. They showed significant limitation of exercise capacity with self-paced walking exercise, which was a safe and reproducible measure of cardiac reserve in them.

Oral health and dental treatment needs in Nigerian patients with epilepsy.

PURPOSE: We determined the prevalence of oral disorders and the dental treatment needs of outpatients with epilepsy. METHODS: A questionnaire was administered to 56 consecutive patients (35 males, 21 females) presenting to an outpatient clinic. All patients underwent dental examinations. The clinical and diagnostic features of each patient's epilepsy were also obtained. RESULTS: The mean age (+/-SD) of the patients was 25.1 +/- 12.1 years (range, 12-56 years). Of 9 patients receiving phenytoin (PHT) monotherapy, 3 (33.3%) had gingival hypertrophy; 15 of 18 (83.3%) patients receiving PHT in combination with phenobarbital (PB) manifested the disorder. Traumatized anterior teeth were found in 26 (46.4%) patients with the males significantly more affected than females (p = 0.02). When the dental treatment needs were considered, 24 (42.9%) patients required dental prophylaxis with oral hygiene instruction, and an equal number required various types of restorative treatments. Only 13 patients (23.2%) had previously visited a dental clinic; the 43 (76.8%) who had never sought dental treatment claimed they did not see any need for it. CONCLUSIONS: Our study showed an increased predilection to anterior dental injuries in patients with epilepsy as compared with the prevalence earlier reported for those without epilepsy in Nigeria (p = 0.00). There is a clear need for effective interaction between medical and dental practitioners in the management of epilepsy.

A three year clinical review of the impact of angiotensin converting enzyme inhibitors on the intra hospital mortality of congestive heart failure in Nigerians.

Angiotensin converting enzymes inhibitors are now regarded as the cornerstone of congestive heart failure therapy owing to established reduction in mortality and the symptomatic amelioration following their use. Although the response to converting enzyme inhibitor therapy may be influenced by race, we have reported a trend to reduce intra hospital mortality, the correction of hyponatremia and shortened hospitalization in Nigerians treated with converting enzyme inhibitors. We have now conducted an extended retrospective study, to evaluate the trends in the use of enalapril or captopril and its impact on prognosis in Nigerian patients with heart failure alone, admitted between January 1992 to December 1994. The proportion of heart failure treated with (captopril or enalapril) increased from 37pc in 1992, to 50pc in 1993, to 65pc in 1994. The demographic variables and cause of heart disease were similar in patients treated with converting enzyme inhibitors (n = 55) and those treated conventionally (n = 36). The cumulative mortality among converting enzyme inhibitors treated patients, was (8/55, 14pc) compared to patients not treated (17/36, 48pc) x2 = 12.4; p < 0.0001. There was no sex predilection in mortality (M = 25pc, F = 28pc, mean 27pc). However, initial serum Na+,125mmol was significantly (x2 = 11.1; p < 0.001) more common in the dead patients, 25pc compared to the survivors discharged home 7.5pc. The median hospital stay was 17 days in captopril treated survivors (range two to 44 days) and 19 days (range four to 67 days) in conventionally treated patients. Thus converting enzyme inhibitor therapy may reduce intra hospital mortality in Black Africans hospitalized for congestive heart failure and shorten hospital stay, despite the epidemiologically low plasma renin in Blacks. Hyponatremia may be a poor prognostic index in heart failure in our patients, and its reversal by converting enzyme inhibitors may reflect neurohormonal inhibitor. Earlier and more wide spread use of angiotensin converting enzyme inhibitors in Nigerian and Black Africans with chronic heart failure is now clearly indicated.

Oral therapy with combined enalapril, prazosin and hydrochlorothiazide in the acute treatment of severe hypertension in Nigerians.

OBJECTIVE: The efficacy, safety, tolerability and speed of onset of the hypotensive action of the combination of oral enalapril (10 mg) prazosin (1 mg) and hydrochlorothiazide (50 mg) has been assessed in 12 Nigerians with severe hypertension (Diastolic BP > or = 115 mmHg). PATIENTS: The ages of the patients ranged from 30-60 years, and the serum creatinine from 52-732 mumol.l-1. The initial blood pressure was 200/130 mmHg. RESULTS: The combination significantly reduced systolic and diastolic blood pressure respectively. The hypotensive action appeared within 0.5 h and led to a fall in BP to 175/120 mmHg, and the peak action occurred at 4 h, when the BP was 138/99 mmHg, and it persisted upto 24 h (160/101 mmHg). Despite the significant fall in blood pressure, no reflex tachycardia was observed. Transient dizziness was seen in 2 patients, but otherwise all claimed improvement in clinical status and a clearer sensorium. CONCLUSION: The combination may be a useful oral treatment for the rapid control of severe hypertension in Blacks.

The efficacy and tolerability of amlodipine and hydrochlorothiazide in Nigerians with essential hypertension.

The efficacy and safety of the novel calcium antagonist Amlodipine (Pfizer Laboratories, New York, New York) and hydrochlorothiazide were evaluated and compared in a randomized, single-blind, parallel group study in black Africans with essential hypertension. Twenty Nigerians with newly diagnosed mild to moderate essential hypertension were randomized to receive ascending doses of Amlodipine (5 mg and 10 mg) or hydrochlorothiazide (25 mg or 50 mg), and blood pressure and heart rate were measured at baseline and at 2, 4, and 6 weeks of therapy. Both Amlodipine and hydrochlorothiazide significantly reduced supine and erect blood pressure. Supine blood pressure on Amlodipine fell from a mean of 190/104 mm Hg to 150/79 mm Hg, and on thiazide from 180/103 mm Hg to 141/84 mm Hg. There was, however, no significant difference between both drugs in antihypertensive efficacy. Neither drug induced a reflex increase in heart rate. The fall in blood pressure on both agents was associated with an increase in plasma urea. Amlodipine induced no change in plasma potassium, but hydrochlorothiazide caused hypokalemia. Both agents were well tolerated, and Amlodipine should undergo further study in the treatment of hypertension in blacks.

Disproportionate intraventricular septal hypertrophy in Nigerians with essential hypertension.

It is not clear how frequently hypertrophic cardiomyopathy coexists with essential hypertension or whether chronic hypertension per se, induces hypertrophic cardiomyopathy (hypertensive hypertrophic cardiomyopathy). Eighty-three Nigerians with essential hypertension alone underwent M-mode and 2 dimensional echocardiographic study. Twenty per cent (17 patients) had disproportionate intraventricular septal hypertrophy (septum: posterior wall ratio > or = 1.4). These subgroup tended to be elderly, with average age of 57.7 years, and were predominantly male (70%). Two patients in this subgroup (2.4% of total) additionally had thickened posterior left ventricles and a hyperdynamic left ventricular systolic function (fractional fibre shortening of > or = 45%). This picture is consistent with "hypertensive hypertrophic cardiomyopathy". Routine echocardiography may permit the early identification and thus a closer scrutiny and follow up of essential hypertensive patients with disproportionate septal thickness. The prognostic implications of this requires long term study.