Blood pressure-lowering medicines implemented in 12 African countries: the cross-sectional multination EIGHT study.

OBJECTIVE: In Africa, the number of patients with hypertension is expected to reach 216.8 million by 2030. Large-scale data on antihypertensive medications used in Sub-Saharan Africa (SSA) are scarce.Here, we describe antihypertensive drug strategies and identify treatment factors associated with blood pressure (BP) control in 12 Sub-Saharan countries. SETTING: Outpatient consultations for hypertension in urban tertiary cardiology centres of 29 hospitals from 17 cities across 12 SSA countries between January 2014 and November 2015. PARTICIPANTS: Patients ≥18 years of age with hypertension were enrolled at any visit during outpatient consultations in the cardiology departments MAIN OUTCOME MEASURE: We collected BP levels, demographic characteristics and antihypertensive treatment use (including traditional medicine) of patients with hypertension attending outpatient visits. BP control was defined as seated office BP <140/90 mm Hg. We used logistic regression with a random effect on countries to assess factors of BP control. RESULTS: Overall, 2198 hypertensive patients were included and a total of 96.6% (n=2123) were on antihypertensive medications. Among treated patients, 653 (30.8%) patients received a monotherapy by calcium channel blocker (n=324, 49.6%), renin-angiotensin system blocker (RAS) (n=126, 19.3%) or diuretic (n=122, 18.7%). Two-drug strategies were prescribed in 927 (43.6%) patients including mainly diuretics and RAS (n=327, 42% of two-drug strategies). Prescriptions of three-drugs or more were used in 543 (25.6%) patients. Overall, among treated patients, 1630 (76.7%) had uncontrolled BP, of whom 462 (28.3%) had BP levels ≥180/110 mm Hg, mainly in those on monotherapy. After adjustment for sociodemographic factors, the use of traditional medicine was the only factor significantly associated with uncontrolled BP (OR 1.72 (1.19 to 2.49) p<0.01). CONCLUSION: Our study provided large-scale data on antihypertensive prescriptions in the African continent. Among patients declared adherent to drugs, poor BP control was significantly associated with the use of traditional medicine.

May Measurement Month 2019: an analysis of blood pressure screening results from Republic of the Congo.

The aim of this study was to determine the proportion with hypertension among an opportunistic sample of the population of the Republic of the Congo. Screening was conducted during the period from 15 May to 15 June 2019. Participants included, consenting persons 18 years of age and over, from five cities: Brazzaville, Pointe-Noire, Oyo, Owando, and Ouesso. In total, 3157 participants were screened as part of the campaign. The mean age was 44.7 years (SD: ±14.9), and 47% were male. Based on the total participants, 881 (27.9%) were overweight and 447 (14.2%) were obese. A total of 583 (18.5%) participated in MMM 2017 or 2018 screenings. The proportion with hypertension was 33.5% (n = 1057), 42.6% of those were aware and 37.3% were taking antihypertensive medication. Of the participants on treatment, 62.4% were controlled (<140/90 mmHg). Overall, 23.3% of patients with hypertension were controlled. After imputation, the proportions with hypertension were 30.1% (n = 1475) according to standardized age and sex. Obesity (P < 0.001) and alcohol intake (P < 0.001) were associated with higher BP compared with normal weight and non-drinkers, respectively. With regards to the social disparities of the different regions of Congo, large scale screening is necessary, in order to report the real situation of hypertension. This will improve the overall management policy for this condition in our country.

[Epidemioclinical and evolutionary profile of dilated cardiomyopathies at the University Hospital in Brazzaville, Congo]. / Profil épidémio-clinique et évolutif des cardiomyopathies dilatées au Centre Hospitalier Universitaire de Brazzaville, Congo.

This study aims to contribute to the improvement of treatment protocols for patients with dilated cardiomyopathies (DCMs) in Brazzaville. We conducted a prospective analytical study at the University Hospital in Brazzaville between 1 January 2014 and 30 June 2015. All patients hospitalized with heart failure (HF) associated with DCM in the Department of Cardiology were included in the study. The study involved 100 patients. Hospitalization rate for DCM was 32.1%: 38 men (38%) and 62 women (62%) with an average age of 52.9 ± 17.1 years. Seventy two patients had comprehensive heart failure (72%). ECG showing normal sinus rhythm (95%) objectified left ventricular hypertrophy (40%), left bundle-branch block (16%), atrial fibrillation (5%). Mean left ventricular ejection fraction (EF) was 33.4 ± 6.8% and left ventricle end-diastolic diameter was 65.5 ± 7.0 mm. Treatment was based on loop diuretic (100%), ACE Inhibitors, Angiotensin II Receptor Blockers (ARBs) (100%), beta blocker (38%), digitalis (30%), anti-aldosterone (16%) and anti-vitamin K (11%). After 12-month follow-up period, overall case-fatality rate was 9%, readmission rate was 12% and the rate of patient lost-to-follow-up was 41%. This study shows that DCM is frequent and it is one of the leading causes of heart failure. The short follow-up period and the high rate of people lost to follow up do not enable assessment of survival rate of patients at our Department.

[Contribution of Holter ECG in the etiologic diagnosis of the ischemic stroke in Brazzaville, Congo]. / Apport du Holter ECG dans le bilan étiologique des infarctus cérébraux à Brazzaville, Congo.

To determine the prevalence of the rhythmic disorders during ischemic stroke, and to identify the predictive factors of paroxysmal atrial fibrillation (PAF). It was about a cross-sectional study, descriptive and analytical, conducted to Brazzaville between january 2012 and december 2016. It related to a consecutive series of 267 patients victims of a transient ischemic attack (n = 17) or ischemic stroke (n = 250), documented by cerebral tomodensitometry or brain MRI. All these patients profited from a recording 24h Holter ECG, carried out within the framework of etiologic research. The principal recorded rhythmic anomalies were indexed and the logistic regression allowed the identification of the predictive factors of PAF. They were 164 men (61.4%) and 103 women (38.6%), old on average of 60.2 ± 12.1 years. The identified cardiovascular risk factors were hypertension (80.1%), diabetes (13.5%), and tobacco use (6.7%). The 24h Holter ECG, normal in 216 cases (81%), was pathological in 51 cases (19%). The principal recorded anomalies consisted into ventricular ectopic beats (n = 32), PAF (n = 7), supraventricular ectopic beats (n = 5), non-sustained ventricular tachycardia (n = 4), sustained ventricular tachycardia (n = 2), and type 2 atrio-ventricular block (n = 1). The frequency of PAF was 2.6%. In bivariate analysis, it was not noted correlation between PAF and sex (p = 0.55), hypertension (p = 0.42), diabetes (p = 0.64), and tobacco use (p = 0.61). In multivariate analysis, only the age was the predictive factor of PAF during ischemic stroke (p = 0.0134). It comes out from this preliminary study that the emboligenous arrhythmias are relatively rare during ischemic stroke in Brazzaville. PAF, though little attends, remains primarily correlated at the age. Its systematic research at the old subjects contributes to improve the assumption of responsibility.

[Severe ventricular arrhythmias in a patient with dilated cardiomyopathy and automated implantable defibrillator (AID)]. / Orage rythmique chez un patient porteur d'une cardiomyopathie dilatée et un défibrillateur automatique implantable (DAI).

Severe ventricular arrhythmias are frequent during heart failure; they are a life-threatening condition due to the increased risk of sudden death. Efficient management remains limited in sub-Saharan Africa because of the limited or unavailable medical resources as automated implantable defibrillator (AID). We report the case of a 56-year old patient with non ischemic dilated cardiomyopathy with very low left ventricular ejection fraction (LVEF)who underwent AID implantation for primary prevention of sudden cardiac death due to ventricular arrhythmias in 2012. Maintenance therapy combined diuretic, angiotensin-converting enzyme (ACE) inhibitor and anti-vitamin K. In the month of November 2014 the patient had iterative episodes requiring the delivery of electric shocks by the AID, without the sensation of palpitations suggestive of episodes of arrhythmias. Clinical examination is a poor screening test, especially for heart failure. AID detected multiple episodes of tachycardia and ventricular fibrillation justifying antitachycardia pacing (ATP) therapy or the delivery of electric shocks of 15J. The patient was treated with amiodarone and beta blocker. Evolution was favorable at 3-months follow-up. The patients had resumed normal activities, without experiencing new episodes requiring the delivery of electric shocks. This study emphasizes the essential role of anti-arrhythmic drug therapy for severe ventricular arrhythmias, even in the presence of AID.

Fighting fake medicines: First quality evaluation of cardiac drugs in Africa.

BACKGROUND: The growing menace of poor quality and falsified drugs constitutes a major hazard, compromising healthcare and patient outcomes. Efforts to assess drug standards worldwide have almost exclusively focused on anti-microbial drugs; with no study to date on cardiovascular drugs. Our study aims to assess quality of seven routinely used cardiovascular medications (anticoagulants, antihypertensives and statins) in ten Sub-Saharan African countries. METHODS: Drugs were prospectively collected using standardized methods between 2012 and 2014 from licensed (random pharmacies) and unlicensed (street-markets) places of sale in Africa. We developed a validated reversed-phase liquid chromatography with tandem mass spectrometry method to accurately quantify the active ingredient in a certified public laboratory. Three quality categories were defined based on the ratio of the measured to the expected dosage of the active ingredient: A (good quality): 95% to 105%, B (low quality): 85 to 94.99% or 105.01 to 115%, C (very low quality): <85% or >115%. RESULTS: All expected medicines (n=3468 samples) were collected in Benin, Burkina-Faso, Congo-Brazzaville, the Democratic Republic of Congo, Guinea, Côte d'Ivoire, Mauritania, Niger, Togo and Senegal. Out of the 1530 samples randomly tested, poor quality (types B and C) was identified in 249 (16.3%) samples. The prevalence of poor quality was significantly increased in certain specific drugs (amlodipine 29% and captopril 26%), in generic versions (23%) and in drugs produced in Asia (35%). The proportion of poor quality reached 50% when drugs produced in Asia were sold in street-markets. CONCLUSION: In this first study assessing the quality of cardiovascular drugs in Africa, we found a significant proportion of poor quality drugs. This requires continued monitoring strategies.