Masquerading Bundle Branch Block in a Patient with Heart Failure in Nigeria.

BACKGROUND: Masquerading bundle branch block (MBBB) is a rare and important electrocardiographic pattern. It consists of right bundle branch block (RBBB) in precordial leads and left bundle branch block (LBBB) in limb leads. It indicates advanced conduction system abnormality usually associated with severe underlying heart disease. MBBB is associated with poor prognosis. MBBB patients are at increased risk of complete atrioventricular (AV) block. To our knowledge, there is no previous published report of MBBB in heart failure in Nigeria. AIM: To present a case of an African patient with heart failure and masquerading bundle branch block, a rare and important finding on 12-lead electrocardiogram. OBJECTIVE: To highlight the electrocardiographic feature of masquerading bundle branch block in a heart failure patient in our environment and the need for early recognition and close monitoring. PATIENT AND METHODS: A 65-year-old man, known hypertensive and asthmatic, who presented with cough productive of whitish frothy sputum, bilateral leg swelling, and difficulty in breathing of 3 weeks duration. There was associated paroxysmal nocturnal dyspnea, orthopnea, and early satiety. No central chest pain on exertion or at rest. RESULTS: The 12-lead electrocardiography (ECG) showed precordial type MBBB with right bundle branch block in V1 and LBBB without deep and wide S waves in leads V5 and V6. Echocardiography confirmed heart failure with reduced ejection fraction of 19%, grade 3 diastolic dysfunction with E/A velocity ratio of 2.31, E/e' of 29.7. Chest X-ray revealed unfolded aorta and cardiomegaly with cardio-thoracic ratio (CTR) of 65%. Patient was stabilized on anti-failure drugs and is being followed up. CONCLUSION: We have reported electrocardiographic feature of MBBB in an African patient with heart failure. Early recognition of this rare electrocardiographic pattern, close monitoring and follow-up of these patients is important because of its association with poor prognosis.

Mixed connective tissue disease complicated by heart failure in Ile-Ife, Nigeria: management challenges in a resource-limited economy.

BACKGROUND: Mixed connective tissue disease (MCTD; also known as Sharp's syndrome) is a rare autoimmune inflammatory disorder characterized by high titer of U1 ribonucleoprotein (U1RNP) antibody and clinical and serological overlap of systemic lupus erythematosus, systemic sclerosis, and polymyositis. The diagnosis is based on clinical and serological factors in criteria such as Alarcon-Segovia, Khan, Kusakawa, and Sharps. Cardiac disease can be a complication of connective tissue disease (CTD). There are few reports in Africa. AIMS: To present MCTD as underlying cause of heart failure with reduced ejection fraction and highlight challenges of investigations and treatment. OBJECTIVES: To highlight the first case in our center and discuss the cardiac, respiratory, and rheumatologic management. PATIENT AND METHODS: We present a 52-year-old woman with 3 weeks history of productive cough with whitish sputum, severe dyspnea, orthopnea, paroxysmal nocturnal dyspnea, right sided abdominal pain, leg swellings, a one year history of recurrent fever, Raynaud's phenomenon, small joint swellings and deformities with pain in both hands. RESULTS: On examination there was microstomia, tethered forehead and lower eyelid skin, tender swelling of the interphalangeal joints and arthritis mutilans. Laboratory findings showed estimated glomerular filtration rate <60 mL/kg/min/1.73 m2, U1RNP antibody levels were eight times upper limit of normal, elevated rheumatoid factor, speckled antinuclear antibody pattern, negative anticentromere antibody, anti Scl-70 and anticyclic citrullinated peptide. Chest X-ray/CT revealed pulmonary fibrosis. Echocardiography findings showed reduced ejection fraction of 40%, elevated pulmonary arterial pressure at rest of 60.16 mmHg. The patient showed improvement on antifailure drugs, but prednisolone was stopped for sudden reversal of previously controlled stage 2 hypertension (HTN), and the patient was discharged in a stable condition. Difficulties ensued in obtaining prompt definite results due to the unavailability of serologic tests in the hospital, and the tests were done outside the state and country. CONCLUSION: Identifying MCTD is critical, especially in patients requiring steroids that may worsen systemic HTN and heart failure. There is a need to have definitive investigative facilities for such patients in hospitals.

Joint predictability of physical activity and body weight status on health-related quality of life of patients with hypertension.

This study investigated the predictability of physical activity (PA) and body weight status (BWS) on health-related quality of life (HRQoL) of patients with hypertension. A cross-sectional study involved 250 patients with hypertension (≥140/90≤179/109 mmHg) selected from government hospitals in Osun State, Nigeria. Purposive sampling technique was used to select participants. Socio-demographic characteristics and cardiovascular parameters were recorded. PA and HRQoL were assessed using the International Physical Activity Questionnaire and Short Form health survey questionnaire respectively. Sufficient PA equals ≥150 min/wk while BWS was defined using body mass index classification. Data were analyzed using descriptive and inferential statistics. Alpha level was set at P<0.05. Of all participants, 63.6% reported sufficient PA and 78.4% was either overweight or obese. The HRQoL of participants become poorer in all domains with higher body weight. The HRQoL including role limitation due to physical health (RLdPhp) and emotional problems (RLdEmp) had worst scores. Participants in the categories of normal and overweight/obese with sufficient PA demonstrated higher (better) HRQoL in all domains than those with insufficient PA (P<0.05). When adjusted for body weight, significant differences were found in all domains of HRQoL except in RLdPhp, RldEmp, and bodily pain (P>0.05). There were significant correlations between PA and all domains of HRQoL except in RldEmp, emotional well-being and bodily pain (P>0.05). Regression models established PA as a significant predictor of HRQoL. Sufficient PA is a better predictor of HRQoL among patients with hypertension irrespective of BWS. Regular PA is recommended for improving HRQoL among patients with hypertension.

Pulmonary hypertension in Nigerian adults with sickle cell anemia.

BACKGROUND: Sickle cell anemia (SCA) is the commonest hemoglobinopathy and is associated with high morbidity and mortality. Pulmonary hypertension (PH) is reported to play a significant role in this regard. There is very limited literature on PH in SCA in Nigeria. OBJECTIVES: The objectives of this study were to determine the prevalence of Doppler-derived PH in SCA, assess its influence on exercise capacity, and determine the correlates and predictors of measures of estimated pulmonary pressure. METHODS: A total of 92 SCA subjects had echocardiography and 6-minute self-paced walking exercise. PH was diagnosed by Doppler echocardiography on finding a tricuspid regurgitant velocity (TRV) of ≥2.5 m/s. The pulmonary flow profile was also assessed to estimate mean pulmonary arterial pressure (MPAP). RESULTS: Doppler-derived PH was detected in 23.9% of adults with SCA. The 6-minute walking distance (6MWD) was significantly lower in SCA adults with PH than in those without PH (380.33 ± 63.17 m vs 474.28 ± 76.74 m; p = 0.014). TRV and estimated MPAP had a significant inverse correlation with the 6MWD (r = -0.442; p < 0.001 and r = -0.571; p < 0.001, respectively). CONCLUSION: PH as derived by Doppler is common in Nigerian adults with SCA and has a significantly negative influence on exercise capacity. Screening for PH should be encouraged to optimize management and thus improve their quality of life and life expectancy.

Prognostic indices among hypertensive heart failure patients in Nigeria: the roles of 24-hour Holter electrocardiography and 6-minute walk test.

BACKGROUND: Hypertensive heart failure (HHF) is associated with a poor prognosis. There is paucity of data in Nigeria on prognosis among HHF patients elucidating the role of 24-hour Holter electrocardiogram (ECG) in concert with other risk factors. OBJECTIVE: The aim of this study was to determine the prognostic utility of 24-hour Holter ECG, the 6-minute walk test (6-MWT), echocardiography, clinical and laboratory parameters among HHF patients. METHODS: A total of 113 HHF patients were recruited and followed up for 6 months. Thirteen of these patients were lost to follow-up, and as a result only 100 HHF patients were analyzed. All the patients underwent baseline laboratory tests, echocardiography, 24-hour Holter ECG and the 6-MWT. HHF patients were analyzed as "mortality vs alive" and as "events vs no-events" based on the outcome at the end of 6 months. Events was defined as HHF patients who were rehospitalized for heart failure (HF), had prolonged hospital stay or died. No-events group was defined as HHF patients who did not meet the criteria for the events group. RESULTS: HHF patients in the mortality group (n = 7) had significantly higher serum urea (5.71 ± 2.07 mmol/L vs 3.93 ± 1.45 mmol/L, p = 0.003) than that in those alive. After logistic regression, high serum urea conferred increased mortality risk (p = 0.035). Significant premature ventricular complexes (PVCs) on 24-hour Holter ECG following logistic regression were also significantly higher (p = 0.015) in the mortality group than in the "alive" group (n = 93) at the end of the 6-month follow-up period. The 6-minute walk distance (6-MWD) was least among the HHF patients who died (167.26 m ± 85.24 m). However, following logistic regression, the 6-MWT was not significant (p = 0.777) for predicting adverse outcomes among HHF patients. Patients in the events group (n = 41) had significantly higher New York Heart Association (NYHA) class (p = 0.001), Holter-detected ventricular tachycardia (VT; p = 0.009), Holter-detected atrial fibrillation (AF; p = 0.028) and PVCs (p = 0.017) following logistic regression than those in the no-events group (n = 59). CONCLUSION: High NYHA class, elevated serum urea, Holter ECG-detected AF and ventricular arrhythmias are predictive of a poor outcome among HHF patients. The 6-MWT was not a useful prognostic index in this study.

Comparison between treadmill and bicycle ergometer exercise tests in mild-to-moderate hypertensive Nigerians.

BACKGROUND: Comparative cardiovascular responses to treadmill and bicycle ergometer (bike) exercise tests in hypertensive Nigerians are not known. This study compared cardiovascular responses to the two modes of exercise testing in hypertensives using maximal exercise protocols. METHODS: One hundred and ten male subjects with mild-to-moderate hypertension underwent maximal treadmill and bike test one after the other at a single visit in a simple random manner. Paired-sampled t-test was used to compare responses to both exercise tests while chi-squared test was used to compare categorical variables. RESULTS: The maximal heart rate (P<0.001), peak systolic blood pressure (P=0.02), rate pressure product (P<0.001), peak oxygen uptake (P<0.001), and exercise capacity (P<0.001) in metabolic equivalents were signifcantly higher on the treadmill than on the bike. CONCLUSION: Higher cardiovascular responses on treadmill in Nigerian male hypertensives in this study, similar to findings in non-hypertensives and non-Nigerians in earlier studies, suggest that treadmill may be of better diagnostic utility in our population.

Pattern of arrhythmias among Nigerians with congestive heart failure.

BACKGROUND: In patients with heart failure, death is often sudden due to life-threatening arrhythmias. This work was carried out to evaluate the pattern of arrhythmias in Nigerians with heart failure. MATERIALS AND METHODS: Thirty subjects with congestive heart failure (CHF), 30 subjects with hypertensive heart disease, and 15 normal subjects with no obvious features of heart disease were evaluated with resting and 24-hour electrocardiographic monitoring and transthoracic echocardiography. Data were analyzed with one-way analysis of variance with post hoc Duncan's analysis, Fisher's exact test, and linear regression analysis using SPSS version 16. RESULTS: CHF subjects had more instances of supraventricular tachycardia (P=0.005), ventricular extrasystoles (P<0.001), bigeminy (P<0.001), trigeminy (P<0.001), couplets (P<0.001), triplets (P<0.001), and nonsustained ventricular tachycardia (VT) (P=0.003) than the other two control groups. They also showed a significantly longer VT duration (4.6±5.6 seconds) compared with the other groups (P<0.001). Linear regression analysis showed a significant direct relationship between VT and the maximum number of ventricular extrasystoles per hour (P=0.001). CONCLUSION: Cardiac arrhythmias are common in subjects with CHF and are more frequent when compared with patients with hypertensive heart disease and normal subjects.

Evaluation of the indications and arrhythmic patterns of 24 hour Holter electrocardiography among hypertensive and diabetic patients seen at OAUTHC, Ile-Ife Nigeria.

BACKGROUND: There are very limited published studies in Nigeria on the use of 24 hour Holter electrocardiogram (Holter ECG) in the arrhythmic evaluation of hypertensive and diabetic patients. OBJECTIVE: To evaluate indications, arrhythmic pattern of Holter ECG, and heart rate variability (HRV) among patients with hypertensive heart disease (HHD) with or without heart failure and type 2 diabetes mellitus (T2DM) seen in our cardiac care unit. METHODS: Seventy-nine patients (32 males and 47 females) were studied consecutively over a year using Schiller type (MT-101) Holter ECG machine. RESULTS: Out of the 79 patients, 17 (21.5%) had HHD without heart failure, 33 (41.8%) had HHD with hypertensive heart failure (HHF), while 29 (36.7%) were T2DM patients. The mean (standard deviation) ages of HHD without heart failure, HHF and T2DM patients were 59.65 (±14.38), 65.15 (±14.30), and 54.66 (±8.88) respectively. The commonest indication for Holter ECG was palpitation (38%), followed by syncope (20.3%). Premature ventricular contraction was the commonest arrhythmic pattern among the 79 patients, especially among HHF patients. The HRV using standard deviation of all normal-normal intervals was significantly reduced in T2DM patients (81.03±26.33, confidence interval [CI] =71.02-91.05) compared to the HHD without heart failure (119.65±29.86, CI =104.30-135.00) and HHF (107.03±62.50, CI =84.00-129.19). There was a negative correlation between the duration of T2DM and HRV (r=-0.613). CONCLUSION: Palpitation was the commonest Holter ECG indication and premature ventricular contractions were the commonest arrhythmic pattern among our patients. HRV was reduced in T2DM patients compared with hypertensive patients.

Blood pressure control and exaggerated blood pressure response in nigerians with essential hypertension.

BACKGROUND: Blood pressure (BP) control in hypertensives is important in preventing cardiovascular (CV) morbidity and mortality. This work was done to assess control of BP among Nigerian hypertensives at rest and during exercise. MATERIALS AND METHODS: A total of 85 male hypertensives were recruited consecutively and had clinical evaluation and treadmill (TM) exercise testing using the Bruce protocol. Independent t-test, chi-square, and Fisher's exact tests were used to compare patients with controlled and uncontrolled BP using SPSS version 16 software. Adjustment for confounders was by logistic regression and general linear model. RESULTS: Resting systolic BP (rSBP) (mmHg) and resting diastolic BP (rDBP) (mmHg) were significantly lower in the controlled group (115.0 ± 12.29, 133.1 ± 12.27, P = <0.001 and 76.00 ± 6.55, 91.4 ± 8.00, P = <0.001). The proportion of subjects with controlled BP was 37.7%. Adjusted peak SBP (PSBP) during exercise (mmHg) was significantly higher in the uncontrolled than in the controlled group (210.5 ± 27.31, 191.8 ± 20.77, P = 0.001). Adjusted exaggerated blood pressure response (EBPR) was found in 37 subjects (44%) in the uncontrolled group while seven subjects (0.1%) had EBPR in the controlled group (P = 0.003). CONCLUSION: This study shows that EBPR is significantly higher in subjects with uncontrolled BP compared with those with controlled BP. Therefore, good BP control may be the key factor in preventing EBPR in hypertensives.

Prevalence and pattern of overweight and obesity in three rural communities in southwest Nigeria.

BACKGROUND: Limited data exist on the prevalence of overweight and obesity in the Nigerian adult rural population. This study therefore assessed the prevalence and pattern of overweight and obesity in adults in three rural communities of the Ife North Local Government Area, Nigeria. MATERIALS AND METHODS: A total of 777 adults between 20 and 90 years of age were recruited into this cross-sectional study, which was performed over a 6-month period using a multistage proportional stratified random sampling technique. Sociodemographic data and anthropometric variables were obtained. RESULTS: A total of 385 (49.5%) men and 395 (50.5%) women participated in the study. The mean age and body mass index of the participants were 36.3±14.3 years and 23.53±4.6 kg/m(2), respectively. The overall crude prevalence of overweight and obesity in the total population were 20.8% and 8.4%, respectively. Obesity increased across the age gradient, peaking in the 51- to 60-year age-group in men and women. Among the overweight and obese subjects (n=227), 70.9% of them were overweight and the remaining 29.1% were obese, with class I obesity accounting for 20.7% of these overweight and obese subjects. CONCLUSION: The prevalence of overweight and obesity in these communities was 20.8% and 8.4% respectively, indicating a trend towards increased prevalence. Class I obesity is the most common obesity pattern, and obesity increased across the age gradient, peaking in the 51- to 60-year age-group. There is a need for regular community education on healthy lifestyles, and regular health screening to control the rising prevalence of overweight and obesity, as well as to prevent or reduce the risk of obesity comorbidities in these communities.

Prevalence of hypertension in three rural communities of Ife North Local Government Area of Osun State, South West Nigeria.

BACKGROUND: The prevalence of hypertension is increasing rapidly in sub-Saharan Africa, but data are limited on hypertension prevalence. In addition, few population-based studies have been conducted recently in Nigeria on the prevalence and correlates of hypertension in both urban and rural communities. Therefore, we determined the prevalence of hypertension in adults in the three rural communities of Ipetumodu, Edunabon, and Moro, in South West Nigeria. MATERIALS AND METHODS: One thousand adults between 15 and 90 years of age were recruited into this cross-sectional study, over a 6-month period, using a multistage proportional stratified random sampling technique. Sociodemographic data and anthropometric variables were obtained, and resting blood pressure (BP) was measured using an electronic sphygmomanometer. Diagnosis of hypertension was based on the JNC VII guidelines, the WHO/ISH 1999 guidelines, and the BP threshold of 160/95 mmHg. RESULTS: Four hundred and eighty-six men (48.6%) men and 514 women (51.4%) participated in the study. Their mean age, weight, height, and body mass index were 32.3±14.7 years, 62±13 kg, 1.5±0.1 m, and 23.02 kg/m(2), respectively. The prevalence of hypertension, based on the 140/90 mmHg definition, was 26.4% (Male: 27.3%; Female: 25.4%). The prevalence of hypertension, based on the 160/95 mmHg definition, was 11.8% (Male: 13.5%; Female: 10.1%). There were significant positive correlations between BP and some anthropometric indicators of obesity. CONCLUSION: The prevalence of hypertension in the three rural communities was 26.4%, indicating a trend towards increasing prevalence of hypertension. There was also a significant positive correlation between anthropometric indicators of obesity and BP in this population.

Echocardiographic assessment of left ventricular geometric patterns in hypertensive patients in Nigeria.

Left ventricular (LV) hypertrophy is an important predictor of morbidity and mortality in hypertensive patients, and its geometric pattern is a useful determinant of severity and prognosis of heart disease. Studies on LV geometric pattern involving large number of Nigerian hypertensive patients are limited. We examined the LV geometric pattern in hypertensive patients seen in our echocardiographic laboratory. A two-dimensional, pulsed, continuous and color flow Doppler echocardiographic evaluation of 1020 consecutive hypertensive patients aged between 18 and 91 years was conducted over an 8-year period. LV geometric patterns were determined using the relationship between the relative wall thickness and LV mass index. Four patterns of LV geometry were found: 237 (23.2%) patients had concentric hypertrophy, 109 (10.7%) had eccentric hypertrophy, 488 (47.8%) had concentric remodeling, and 186 (18.2%) had normal geometry. Patients with concentric hypertrophy were significantly older in age, and had significantly higher systolic blood pressure (BP), diastolic BP, and pulse pressure than those with normal geometry. Systolic function index in patients with eccentric hypertrophy was significantly lower than in other geometric patterns. Doppler echocardiographic parameters showed some diastolic dysfunction in hypertensive patients with abnormal LV geometry. Concentric remodeling was the most common LV geometric pattern observed in our hypertensive patients, followed by concentric hypertrophy and eccentric hypertrophy. Patients with concentric hypertrophy were older than those with other geometric patterns. LV systolic function was significantly lower in patients with eccentric hypertrophy and some degree of diastolic dysfunction were present in patients with abnormal LV geometry.

The "obesity paradox" in Nigerians with heart failure.

BACKGROUND: Previous studies have suggested that a high body mass index (BMI) was associated with improved outcome in congestive heart failure (CHF). The aim of this study was to examine the relationship between BMI and echocardiographic variables of cardiac function in stable outpatients with heart failure. METHODS AND MATERIALS: This is a cross-sectional study in which the cardiology clinic out-patients of Obafemi Awolowo University Teaching Hospital with heart failure were recruited. Patients were categorized using baseline BMI as normal weight BMI = 18.5-24.9 kg/m(2) and overweight/obese (BMI > 25.0 kg/m(2)). Risks associated with BMI groups were evaluated and the data were analyzed with the aid of SPSS 15.0 software. RESULTS: Patients with higher BMI have higher left ventricular ejection fraction and fractional shortening and lesser tendency to have an abnormal left ventricular geometry and better functional (New York Heart Association) class of heart failure at presentation. CONCLUSION: Overweight and obese patients had less severe degree of heart failure than normal weight patients and efforts should be made to prevent excessive weight loss in patients with heart failure.

Assessment of exercise capacity in African patients with chronic heart failure using six minutes walk test.

BACKGROUND: The purpose of this study was to assess the functional capacity during a 6-minute corridor walk and a 6-minute bicycle ergometry exercise in patients with chronic heart failure (CHF). METHOD: Thirty five patients with stable CHF were recruited for the study. Each subject performed six minutes corridor walk and 6-minute bicycle ergometry testing. The 6-minute walk required the subjects to walk at a self selected speed on a 20 meter marked level ground for 6-minute. All the subjects also performed a 6-minute exercise on a stationary bicycle ergometer with initial resistance of 20 watts and increased by 10 watts after 3-minutes. The perceived rate of exertion was assessed using a modified Borg Scale after each exercise mode. The maximum oxygen consumption was derived using American College of Sport Medicine equations. RESULTS: Result showed high positive correlation between distance walked in the 6-minute and the maximum volume of oxygen (VO(2) max) (r = 0.65, P < 0.01). The average distance walked was 327 m +/- 12.03 m. The VO(2) max estimated during bicycle ergometry was higher (13.7 +/- 1.9 L) than during the six minutes walk (8.9 +/- 1.2 L). CONCLUSION: Six minutes walk could be useful to evaluate exercise tolerance in patients with chronic heart failure, while the bicycle ergometer could be more appropriate in the assessment of maximum functional capacity in these patients.

Prevalence of metabolic syndrome in a rural community in Nigeria.

BACKGROUND: There has been an increasing interest in metabolic syndrome, but few, if any, epidemiological studies on the subject have been conducted in Nigeria. The purpose of this study was to assess the prevalence of metabolic syndrome in a Nigerian rural community. METHODS: A total of 132 participants from three rural towns in southwestern Nigeria were recruited for the study. Anthropometric variables, fasting blood glucose, triglyceride, total and high-density lipoprotein cholesterol (HDL-C), and blood pressure were assessed. The survey was carried out within 2 months after community mobilization and consent. RESULTS: The mean ages of participants were 58.6 +/- 16.9 males and 46.1 +/- 18.7 females. The overall prevalence of metabolic syndrome was found to be 12.1%, with males and females at 12.7% and 11.8%, respectively. There was no significant difference in males and females with the syndrome. Although the prevalence of abdominal obesity was higher in females than males, 16.9% and 7.3%, respectively, the men exhibited a higher mean serum level of triglyceride (P < 0.05). Only 2 (1.5%) of the males had a high fasting serum glucose level. CONCLUSIONS: These results from a representative sample of the Nigerian rural population show a high prevalence of metabolic syndrome. The large number of Nigerians with the metabolic syndrome may have important implications for the health-care sector.

Obesity prevalence in adult residents of Ile-Ife, Nigeria.

BACKGROUND: Few data on obesity exist on Sub-Sahara population in Africa. This study investigated the prevalence of obesity and Body Mass Index (BMI) percentile and quartiles in accordance with sex and age in adult residents of the historic ancient semi-urban community of Ile-Ife, South-West, Nigeria. METHODS: 2097 adults aged 21 years and above were recruited into the door-to-door survey through a multistage cluster sampling technique. The World Health Organization (WHO) criteria based on BMI was used in the definition of overweight and obesity. Height and weight were measured using standardized procedures. RESULTS: The mean age and BMI of the participants were 44.2 years and 24.2 Kg/m2 respectively. Although age-matched; the females had higher BMI values compared to males (23.8 vs. 24.5 Kg/m2). The overall crude prevalence of overweight (25.0-29.9 Kg/m2) and obesity (>30 Kg/m2) were 20.3% and 12.5% respectively. The rates of overweight (17.9 vs. 22.1 Kg/m2) and obesity (9.7 vs. 14.5 Kg/m2) were both higher in women than men. Obesity increased across age gradient from young to old adults; peaking in the 60-69-year age group. The first to fourth BMI quartiles were = 20.4 Kg/m2, 20.5-24.1 Kg/m2, 24.2-25.2 Kg/m2, = 25.3 Kg/mr respectively in the study population. At all ages; more females (32.4%) than males (24.7%) were placed within fourth BMI quartile. The 95th percentile BMI in the study population was 33.4 Kg/m2. CONCLUSION: Overweight and obesity are common in Nigerians, particular among females and elderly. The prevalence estimates of overweight and obesity in Nigerians is comparable with prevalence among Blacks in other populations.

Relationship of anthropometric indicators with blood pressure levels and the risk of hypertension in Nigerian adults.

BACKGROUND AND PURPOSE: Studies on cardiovascular risks in relation to anthropometric factors are limited in Sub-Sahara Africa. The aims of this study were to examine the relationship between anthropometric parameters and blood pressure; and to evaluate body mass index (BMI) across the range of underweight and obesity as a primary risk factor of hypertension in adult Nigerians. MATERIAL AND METHODS: 2097 adults aged between 20 and 100 years consented and participated in this door-to-door survey. All participants underwent blood pressure and anthropometric measurements using standard procedures. The population study was separated in normotensive and hypertensive males and females and the possible risk for hypertension were categorized into different classes of value based on BMI definition. RESULTS: The relative risks (odds ratio [OR] and 95% confidence interval [CI]) of developing hypertension among the obese compared with the underweight, normal weight, and overweight persons were (OR 5.75; CI 5.67-5.83), (OR 1.73; CI 1.65-1.81), and (OR 1.54; CI 1.46-1.62) for all the participants, respectively. Among obese (BMI >/= 30.0 Kg/m(2)) males, the OR for hypertension was three times (OR 2.78; CI 2.76-2.80) that of normal weight (BMI >/= 18.5-24.9 Kg/m(2)) males. Females with obesity had a risk of hypertension three times (OR 3.34; CI 3.33-3.35) that of normal weight females. CONCLUSION: Our results indicated that the there was a significant positive correlation of obesity indicator with blood pressure. In Nigeria, we found a strong gradient between higher BMI and increased risk of hypertension among all ages. Approaches to reduce the risk of hypertension may include prevention of overweight and obesity.

Prevalence and pattern of hypertension in a semiurban community in Nigeria.

BACKGROUND: Hypertension has been reported to be a major problem of the blacks. There is a paucity of studies, however, on community-based surveys on the prevalence and pattern of hypertension in Nigeria in the recent time. This study sought to investigate the prevalence and pattern of hypertension in the adult population living in the ancient semiurban community of Ile-Ife, southwest Nigeria. DESIGN AND METHODS: Two thousand and ninety-seven adults of above 20 years of age were recruited into the door-to-door survey through a multistage cluster sampling technique. Diagnosis of hypertension was based on blood pressure (BP) threshold of 160/95 mmHg and the World Health Organization /International Society of Hypertension guidelines (Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines) definitions. Resting blood pressure was taken using electronic sphygmomanometer. RESULTS: The mean age and BP of the participants were aged 44.2 +/- 11.6 years and 127/77 mmHg, respectively. The participants (36.6%) had a BP of greater than or equal to 140/90 mmHg whereas 13.3% had BP of greater than or equal to 160/95 mmHg. 22.1% had isolated systolic hypertension whereas 14.5% had isolated diastolic hypertension using the BP of greater than or equal to 140/90 mmHg cut off-point. Using the BP of greater than or equal to 160/95 mmHg, isolated systolic hypertension and isolated diastolic hypertension were 6.63%, respectively. A male-to-female ratio of 1.7 : 1 and 1 : 5 was observed for BP greater than or equal to 140/90 mmHg and BP greater than or equal to 160/95 mmHg, respectively. Hypertension prevalence increased across age gradient from young to old adults. CONCLUSION: The prevalence estimates of hypertension obtained in this study was higher than those found in most earlier studies from Nigeria, other West Africa nations and for African-Americans.

An assessment of cardiovascular risk among the people of a Nigerian university community.

BACKGROUND: The purpose of this study was to assess the level of cardiovascular disorder risk among the staff and students of Obafemi Awolowo University, Ile-Ife, Nigeria. METHODS: Six hundred apparently healthy subjects voluntarily participated in this study. They consisted of 200 students, 200 junior workers and 200 senior staff. Subjects' weight, height and blood pressures were taken. Subsequently, the questionnaire used for the Framingham Heart Study was given for completion. The questionnaire sought information on cardiovascular risk factors including smoking habits, sedentary lifestyle, diet, personality trait, age and sex. RESULTS: Students had a mean risk score of 10.24, junior staff 11.38, and senior staff 12.42. Significant differences were found between the level of risk for the students and that of the senior staff. However, no significant difference existed between the junior and senior staff and no significant difference existed between the level of risk for the students and the junior staff. Further, there was no significant difference in the level of risk for males compared to females. CONCLUSION: We concluded that the level of cardiovascular risk was low among the subjects selected for this study.