Lipid and Some Other Cardiovascular Risk Factors Assessment in a Rural Community in Eastern Nigeria.

BACKGROUND: Continuous re-evaluation of modifiable cardiovascular risk factors (cardiovascular diseases [CVDs]) in developing nations is imperative as it lays foundation for early preventive/intervention measures at grass root level to improve/prevent CVD morbidity and mortality in those nations where health indices still score below the standard. AIM: The aim was to assess CVD risk factors as a continuous re-evaluation of these may underscore the need for early intervention measures at grass root level. SUBJECTS AND METHODS: A total of 257 apparently healthy inhabitants aged 18-85 years were recruited in a rural community in South Eastern Nigeria by convenient sampling. Blood pressure, waist circumference and blood lipid analysis were done procedurally and data analyzed using SPSS 16.0 statistical software. RESULTS: The males were older (59.41 [5.22]) than the females (53.31 [16.90]). 69.2% (133/192) were low level farmers, retirees and dependents. Total cholesterol (TC), low density lipoprotein (LDL), and risk predictive index were higher in females while triglyceride (TG), high density lipoprotein and very LDL (VLDL) were higher in males. The middle aged and elderly respectively had higher TG and VLDL compared to the young. Aside hypertriglyceridemia, all lipid abnormalities were higher in females than males both singly (high TC: 28.9% [35/121] vs. 16.9% [12/71]; high LDL cholesterol: 52.0% [63/121] vs. 31.0% [22/71]) and in combination hypercholesterolemia with hypertriglyceridemia (42.9% [52/121] vs. 36.6% [26/71]). "Multiple risk factors" also occurred more in females with seeming further increase in older age. CONCLUSION: The chances of a female having CVD after menopause seemed to outweigh that of the male. CVD preventive measures should be focused at the primary/community level as a means to curtailing the increasing morbidity and eventual mortality from CVDs.

Evaluation of antioxidant status of female diabetic patients in Nnamdi Azikiwe University Teaching Hospital, Anambra State, Nigeria.

Diabetes mellitus has become an onerous disease to developing countries such as Nigeria. Rapid acceptance of urbanisation and sedentary life styles pose an encumbrance to its prevention and management. Increased oxidative stress in diabetes mellitus has been implicated as a culprit in perpetuating antioxidant depletion and diabetic complications in diabetes mellitus individuals. This study aims to evaluate the level of antioxidant status in type 2 diabetes mellitus (DM) female participants visiting the out-patient diabetic clinic of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Anambra State, Nigeria. A total of 86 participants aged 51±10 years were recruited for this study. The test group consists of 43 already confirmed type 2 diabetes mellitus females, while the control group consists of 43 apparently healthy females. The test subjects were further subgrouped into good and poor glycaemic control groups, using a cut-off of <7% for HbA1c. Whole blood was collected from participants and aliquoted into specified sample containers for analysis of the following parameters: random blood glucose (RBG; mg/dL), glycosylated haemoglobin (HbA1c; %), glutathione reductase (GR; U/L) and total antioxidant status (TAS; mmol/L). Results from this study showed that the mean differences in RBG (197.74±49.29 mg/dL) and HbA1c (9.86±1.44%) were significantly higher in the test group compared to the control group RBG (104.79±11.33 mg/dL) and HbA1c (5.21±1.23%) (P<0.05). The mean differences of GR (45.81±20.45 U/L) and TAS (1.81±1.04 mmol/L) were significantly lower in the test group compared to the control group GR (61.21±14.34 U/L) and TAS (2.73±2.08 mmol/L) (P<0.05). The poor glycaemic test group was observed to have the highest RBG (200.34±50.4 mg/dL) and HbA1c (10.23±1.33%) compared both to good glycaemic test group RBG (186.38±45.39 mg/dL), HbA1c (6.54±0.45%) and non-diabetic group RBG (104.79±11.33 mg/dL) and HbA1c (5.21±1.23%) (P<0.05). Glutathione reductase (40.66±15.48 U/L) and TAS (1.80±1.08 mmol/L) were significantly more depleted in the poor glycaemic test group compared to the non-diabetic group GR (61.21±14.34 U/L), TAS (2.73±2.08 mmol/L) and good glycaemic test group GR (68.38±25.09 U/L), TAS (1.86±0.92 mmol/L) (P<0.05). Out of the 43 participants in the test group, only 18.6% had good glycaemic control and 81.4% had poor glycaemic control. There were significant negative correlations between RBG and TAS (r=-0.260; P=0.015); RBG and GR (r=-0.403; P=0.000) and HbA1c and GR (r=-0.471; P=0.000) (P<0.05). However, HbA1c and TAS showed no significant correlation (r=-0.170; P=0.119) (P>0.05). This study concludes that there is antioxidant depletion in females with type 2 diabetes.

Evaluation of hormonal changes in menstrual cycle of women infected with pulmonary tuberculosis in Nnewi, south eastern Nigeria.

BACKGROUND & OBJECTIVE: The present study was designed to evaluate the hormonal changes in menstrual cycle of premenopausal women infected with pulmonary tuberculosis in Nnamdi Azikiwe University Teaching Hospital Nnewi. MATERIAL AND METHODS: A prospective study involving sixty-seven (67) female participants within the child-bearing age were randomly recruited and grouped based on their tuberculosis status as: Symptomatic TB infected females (n=20), Symptomatic TB infected females on ATT (n=20) and Control females (n=27). After due consent, a detailed medical history was obtained and routine investigations of pulmonary tuberculosis and confirmation using Ziehl Neelsen and sputum culture techniques for AFB and chest x-ray were done. Blood samples collected from the participants were used for hormonal assay using immunoenzymometric method. RESULTS: The results showed that the serum levels of FSH and LH (IU/ml) were significantly higher while progesterone and estradiol were significantly lower in Symptomatic TB females compared to Symptomatic TB females on ATT at follicular and luteal phases of menstrual cycle (P<0.05). The serum levels of FSH and LH were significantly reduced in Symptomatic TB females on ATT while progesterone and estradiol were significantly increased at follicular and luteal phases of menstrual cycle (P<0.05). FSH was significantly higher at follicular phase while estradiol was significantly higher at luteal phase of menstrual cycle in Symptomatic TB females on ATT. CONCLUSION: Tuberculosis induced hypogonadism in affected women which seemed to be reversed on treatment. Routine investigation for Tuberculosis should be done for women presenting with infertility, since early treatment can reverse the abnormality.

Iron status of some pregnant women in Orlu town--eastern Nigeria.

BACKGROUND: High prevalence of anaemia has been reported among pregnant women especially in developing nations. This paper considers maternal haemoglobin (Hb) level, serum total iron, iron binding capacity, and serum ferritn iin antenatal women in Orlu-Imo State Nigeria. PATIENTS AND METHODS: Haemoglobin level, serum iron, serum ferritin, and total iron binding capacity (TIBC) were measured in different trimesters among 90 pregnant women aged 20-45 years, on iron supplements attending antenatal clinic of Imo State University Teaching Hospital Orlu. First trimester comprised of 16.7% (n = 15), second trimester comprised of 50% (n = 45) while as third trimester comprised of 33.3% (n = 30). 30 non-pregnant women aged 26-40 years were used as controls. RESULT: The mean Hb level was 11.28 +/- 1.4 g/dl in first trimester, 9.51 +/- 1.9 g/dl in second trimester, 10.4 +/- 1.2 g/dl in third trimester, and 10.9 +/- 1.5 g/dl in controls. Mean serum iron level was 142 +/- 23 microg/ml in first trimester, 235 +/- 118 microg/ml in second trimester, 251 +/- 118 microg/ml in third trimester, and 99.7 +/- 19.4 microg/ml in controls. Mean serum ferritin was 57.7 +/- 30 ng/ml in first trimester, 37.6 +/- 17 ng/ml in second trimester, 37.3 +/- 20 ng/ml in third trimester, and 86.7 +/- 16.9 ng/ml in controls TIBC was 337 +/- 90 microg/dl in first trimester, 441 +/- 19 microg/dl in second trimester, 482 +/- 149 microg/dl in third trimester and 271.8 +/- 89.0 microg/ml in controls. Hb level was relatively stable in pregnancy, but was significantly (p < 0.05) lowest in the second trimester compared with controls Serum iron and TIBC progressively increased from first trimester to third trimester. Conversely, serum ferritin declined progressively from first trimester to third trimester. The increments in serum iron was statistically significant (p < 0.05) between first and second trimester, but not significant between second and third trimester. TIBC was significantly higher in third trimester compared with first trimester. Serum ferritin was significantly lower in second and third trimesters compared with controls. This implies a progressive mineral transfer from mother to fetus. TIBC and serum iron were significantly (p 0.05) lowest in non-pregnant controls compared with the three trimesters of pregnancy. Conversely ferritin was significantly (p < 0.05) higher among the non-pregnant controls compared with the three trimesters of pregnancy. This implies that the nonpregnant women had more iron store and had less iron need than their pregnant counterpart. The higher iron need in pregnancy necessitated its mobilization from its stores. CONCLUSION: This study encourages more critical antenatal care especially at second trimester of pregnancy with much emphasis on dietary supplementation of iron and minerals through adequate consumption of local vegetables and other food diets rich in iron. There was poorest antenatal attendance in the first trimester. Pregnant women in this environment should be encouraged to register early for antenatal care.

Changes in lipids and lipoprotein indices in relation to the severity of hypertension in newly diagnosed hypertensive nigerians.

Hypertension and dyslipidaemia are important components of metabolic syndrome and both are known to complicate each other. Materials and Methods. A total of 149 subjects consisting of 107 hypertensive patients, grouped into 3 (of 37, 35, and 35 patients categorized based on the grade of hypertension as grade 1, grade 2, and grade 3, resp.) and 42 controls, were recruited for this study. Each subject had a recording of the bio- and anthropometric data comprising of the age, height, weight, body mass index (BMI), and abdominal circumference (AC). The blood pressure was also recorded. Fasting blood was collected and serum was used for the estimation of the lipids: total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG), while low density lipoprotein cholesterol (LDL-C) and VLDL were estimated using Friedewald formula. Findings. Patients with hypertension had higher lipid and lipoprotein levels than the controls and the values became more significant with increasing severity of hypertension. The difference was statistically significant for TC, LDL-C, and VLDL-C (P < 0.05). Conclusion. This study showed that lipid and lipoprotein cholesterol abnormalities exist and even worsen with severity of hypertension. It is important that investigations in patients with hypertension should include a lipid profile.

Evaluation of blood pressure and indices of obesity in a typical rural community in eastern Nigeria.

AIM: With increasing urbanization of lifestyle, cardiovascular morbidity and mortality have been on the increase in Africans. Studies on cardiovascular risk factors in rural communities in South East Nigeria are scarce. This study focused on hypertension and obesity in adult Nigerians dwelling in a rural setting in Eastern Nigeria. MATERIALS AND METHODS: A total of 218 participants from the rural community were recruited into the study. A questionnaire was used to assess prior knowledge of their weight and blood pressure status as well as drug history for those found to have hypertension. Each participant's blood pressure was measured and any value ≥140/90 mmHg was regarded as high blood pressure (HBP). Their heights and weights were measured and their body mass indices (BMI) calculated using the standard formula of BMI = Weight in Kg/Height in m 2 ; BMI ≥30 Kg/m 2 was referred to as global obesity. Their waist circumferences (WC) were also measured and any value ≥102 cm for males and ≥88 cm for females was regarded as abdominal obesity. RESULTS: The general prevalence of HBP in the rural community was 44.5%. The prevalence of HBP increased as age increased and awareness about HBP was low (15.2%). Females were more aware than the males. The prevalence of HBP was higher in males (49.3%) compared with their female counterparts (42.3%), whereas the females had a higher prevalence of all forms of obesity (abdominal: 36.2%, global: 14.8%) compared with the males (abdominal: 14.5%, global: 10.1%). Higher BMI was associated with higher systolic and diastolic BP values. Hypertensive participants had higher BMI and WC than those who had normal BP. CONCLUSION: The prevalence of both hypertension and obesity seems to be increasing in rural communities in Nigeria and thus, the available prevalence documented in previous studies for rural communities may no longer represent the current trend. Awareness of the participants about these major cardiovascular risk factors is still very low. Higher BMI was associated with higher values of both systolic and diastolic BP.

Comparative study of C-reactive protein and other biochemical parameters in patients with hepatitis B and malaria in Calabar, Nigeria.

Serum levels of C-reactive proteins (CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total protein, albumin and globulins were investigated using high sensitivity immunoturbidometric and colorimetric techniques in individuals with hepatitis (n=50), malaria (n=50) and 40 control subjects in age range of 30 to 65 years. The hepatitis patients had a significantly higher (P < 0.01) level of aminotransferases when compared to malaria patients and control subjects. The mean value of ALT was 103.50 ± 71.4 IU/L and 46.72 ±17.48 IU/L for hepatitis and malaria respectively. The values for AST were 116.76 ± 63.27 IU/L and 57.74 IU/L ± 15.18 IU/L for hepatitis and malaria respectively while the values for control were 34.75 ± 14.64 and 35.25 ± 15.56 IU/L for AST and ALT respectively. The malaria patients showed a significantly higher level (P < 0.01) of aminotransferases when compared to the control. The mean serum CRP levels were 0.71 ± 0.11 mg/dL and 0.78 ± 0.13 mg/dL for hepatitis and malaria respectively. These values were significantly higher (P < 0.01) than those of the controls which was 0.32 ± 0.12 mg/dL. The values of CRP in malaria were significantly higher (P< 0.05) when compared with hepatitis. In malaria, AST correlated with CRP (r = 0.58). The mean serum proteins of hepatitis patients were significantly lower (P < 0.05) than those of the control and malaria while there were no significant differences between the total protein in malaria when compared with control. Albumin levels in both patients were significantly lower (P > 0.05) than those of the controls. The mean values were 33.40 ± 3.40g/L and 34.47 ± 3.56g/L for hepatitis and malaria respectively and 37.00 ± 3.43 g/L for the control. C-reactive protein correlated negatively with albumin in malaria (r = -0.26) while albumin had a negative correlation with globulin(r = -0.36). Also albumin-globulin ratio were significantly (P < 0.05) decreased in both patients when compared with controls. This result suggests that a systemic acute phase response is present in hepatitis and malaria patients hence measurement of C-reactive proteins may be helpful in the diagnosis and management of hepatitis and malaria; especially in the malaria endemic region such as Nigeria.

Evaluation of blood pressure and indices of obesity in a typical rural community in eastern Nigeria

Aim: With increasing urbanization of lifestyle; cardiovascular morbidity and mortality have been on the increase in Africans. Studies on cardiovascular risk factors in rural communities in South East Nigeria are scarce. This study focused on hypertension and obesity in adult Nigerians dwelling in a rural setting in Eastern Nigeria. Materials and Methods: A total of 218 participants from the rural community were recruited into the study. A questionnaire was used to assess prior knowledge of their weight and blood pressure status as well as drug history for those found to have ypertension. Each participant's blood pressure was measured and any value =140/90 mmHg was regarded as high blood pressure (HBP). Their heights and weights were measured and their body mass indices (BMI) calculated using the standard formula of BMI = Weight in Kg/Height in m 2 ; BMI =30 Kg/m 2 was referred to as global obesity. Their waist circumferences (WC) were also measured and any value =102 cm for males and =88 cm for females was regarded as abdominal obesity. Results: The general prevalence of HBP in the rural community was 44.5. The prevalence of HBP increased as age increased and awareness about HBP was low (15.2). Females were more aware than the males. The prevalence of HBP was higher in males (49.3) compared with their female counterparts (42.3); whereas the females had a higher prevalence of all forms of obesity (abdominal: 36.2; global: 14.8) compared with the males (abdominal: 14.5; global: 10.1). Higher BMI was associated with higher systolic and diastolic BP values. Hypertensive participants had higher BMI and WC than those who had normal BP. Conclusion: The prevalence of both hypertension and obesity seems to be increasing in rural communities in Nigeria and thus; the available prevalence documented in previous studies for rural communities may no longer represent the current trend. Awareness of the participants about these major cardiovascular risk factors is still very low. Higher BMI was associated with higher values of both systolic and diastolic BP

Serum urea and uric acid concentration in pregnant women in sub-urban commercial community in Africa.

Serum uric acid and urea levels were determined in 27 pregnant and 17 non-pregnant black African women. Uric acid levels for the pregnant women were significantly raised, and the relationship between uric acid elevation and gestational proteinuric hypertension was discussed. In conclusion, we recommend that uric acid estimation should be included during routine antenatal clinics in normal pregnancy. That the use of uric acid levels should be encouraged for the diagnosis and management of gestational proteinuric hypertension in African pregnant women. The above recommendation will help to reduce prenatal morbidity and mortality in African pregnant women.

Changes in remnant-like particle cholesterol level during treatment of hypertension with amlodipine and cilnidipine

This study was designed to determine the effect of antihypertensive agents (calcium channel blockers) on the levels of remnant-like particle (RLP) cholesterol; a major risk factor for coronary heart disease, during treatment of hypertension. Thirty six hypertensive patients of both sexes were selected into this study. Twenty-five of them were treated with amlodipine while eleven patients were treated with cilnidipine all for 3 months. At the beginning and after 3 months of treatment, serum RLP-cholesterol levels were measured in the two treatment groups. RLP-cholesterol level was significantly reduced after clinidipine treatment while the reduction in RLP-cholesterol level after amlodipine treatment was not statistically significant. Our findings show that calcium channel blockers may lower the risk of myocardial infarction, coronary atherosclerosis and/or coronary thrombus formation through reduction in RLP-cholesterol levels during antihypertensive pharmacotherapy

Effects of cilnidipine on lipids, lipoproteins and fibrinolytic system in hypertensive patients.

Sixteen Japanese patients of both sexes aged 46-78 years with essential hypertension were studied at the cardiac clinic of the Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan. Serum lipids, lipoproteins, plasma fibrinolytic parameters, renin and noradrenaline were determined before and after 3 months of cilnidipine treatment. Systolic and diastolic blood pressures and heart rate were reduced while renin and noradrenaline levels remained unchanged after cilnidipine treatment. Total cholesterol and tissue plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1) and t-PA-PAI-1 complex were reduced. Changes in the other lipids, lipoproteins and fibrinolytic parameters were not significant after cilnidipine treatment. A negative correlation was found between low-density lipoprotein cholesterol and t-PA antigen levels after cilnidipine treatment. In conclusion, cilnidipine was effective for the treatment of hypertension and did not cause reflex tachycardia in Japanese patients. Cilnidipine treatment produced a beneficial lipid profile (decrease in total cholesterol), but did not show a consistent effect on fibrinolytic parameters in hypertensive patients. The metabolic interaction between beneficial lipid changes and fibrinolysis will be of value to better our understanding of the antiatherogenic effects of cilnidipine treatment in hypertensive patients.

Influence of baseline values on lipids, lipoproteins and fibrinolytic parameters during amlodipine treatment of hypertension in Japanese patients.

Twenty-four Japanese hypertensive patients of both sexes, grouped as having 'medium' and 'high' baseline total lipid values, had their serum lipids, lipoproteins and plasma fibrinolytic parameters, renin and noradrenaline levels determined after 3 months of amlodipine treatment. For the patients with 'medium baseline values', total plasminogen activator inhibitor-1 (PAI-1) and t-PA-PAI-1 complex levels decreased, while the changes in lipids and lipoproteins were not significant after amlodipine treatment. For the patients with 'high baseline values', the mean triglyceride and very low density lipoprotein cholesterol (VLDLC) levels were reduced while the reductions in total and free PAI-1 and the increase in tissue plasminogen (t-PA) levels were not significant after amlodipine treatment. Negative correlations were observed between t-PA and high density lipoprotein cholesterol (HDLC) and HDLC/total cholesterol (TC) ratio in the patients with 'medium baseline values' while t-PA positively correlated with HDLC/TC ratio in patients with 'high baseline values'. The mean levels of renin and noradrenaline remained unchanged before and after amlodipine treatment in the two baseline groups. These findings show that baseline lipid levels of the hypertensive patients could influence lipids and fibrinolytic parameters differently during amlodipine treatment. The baseline lipid levels also influenced the metabolic association between lipids and fibrinolytic function in hypertensive patients during amlodipine treatment. The baseline total lipid values could therefore provide explanations for the complex metabolic interaction between lipids and fibrinolytic function as well as for the antiatherogenic actions of amlodipine treatment in hypertensive patients.

Influence of baseline values on lipids, lipoproteins and fibrinolytic parameters during treatment of hypertension with cilnidipine.

Sixteen adult hypertensive patients of both sexes, classified as having 'medium' (total lipid profile 240-300 mg dl(-1)), and 'high' (total lipid profile >300 mg dl(-1)) baseline values, underwent serum lipids, lipoproteins and plasma fibrinolytic parameters evaluations after 3 months of cilnidipine treatment. Patients with 'medium baseline values' did not have any change in lipids, lipoproteins and fibrinolytic parameters while patients with 'high baseline values' had beneficial lipid and lipoprotein changes [decreases in total cholesterol (TC), triglycerides (TG), very low density lipoprotein-cholesterol (VLDLC) and increases in high density lipoprotein-cholesterol (HDLC), and HDLC/TC ratio] after cilnidipine treatment. Changes in lipids were negatively associated with fibrinolysis for the patients with 'medium baseline values' and positively associated in patients with 'high baseline values' after cilnidipine treatment. Reduction in blood pressure was related to fibrinolysis and reduced risk of coronary heart disease in the patients with 'high baseline values' after cilnidipine therapy. These results show that during cilnidipine treatment, the baseline lipid profile levels of the patients may influence the lipid altering actions as well as the interaction between lipids and fibrinolysis.

Utilisation of clinical chemistry tests, with special reference to lipid profile, in disease management in a Nigeria setting.

BACKGROUND: Previous reports show that most Nigerian patients have not been subjected to detailed clinical chemistry investigations, especially lipid profiles during the course of their management. OBJECTIVE: To evaluate the level of utilisation of clinical chemistry tests, especially lipid profile, in the management of certain selected diseases. DESIGN: Analytical study of clinical chemistry tests done in patients with hypertension, liver diseases, nephrotic syndrome and peripheral neuropathy and in control subjects between January 1995 and December 1996. SETTING: Department of Chemical Pathology, Nnamdi Azikiwe University Teaching Hospital, Nigeria. RESULTS: The distribution of the chemical pathology tests in all the disease groups varied significantly. The mean values of TC, LDLC, TG and VLDLC increased while HDLC/TC ratio reduced in the hypertensive patients when compared with the control subjects. The variations in the mean values of HDLC and urea among the hypertensive patients and controls were not statistically significant. CONCLUSION: Our findings suggest an increase in the risk of cardiovascular disease in hypertensive patients and these observations should be remembered by all clinicians and other health workers during the management of hypertension and other diseases. We recommend that the investigations of lipid and lipoprotein indices and other clinical chemistry parameters should be encouraged during management of disease in Nigerians.

Lipid and lipoprotein cardiovascular risk factor changes during normal pregnancy in Africans.

OBJECTIVES: The study was designed to determine how pregnancy affects lipid and lipoprotein profiles among women living in a typical suburban commercial community in Africa, and to highlight the consequences of such changes. STUDY DESIGN: Lipid and lipoprotein levels and coronary heart disease (CHD) risk predictor index [High density lipoprotein-cholesterol (HDLC)/Total cholesterol (TC)] were evaluated in 27 African pregnant and 17 non-pregnant women of the same age and demographic profiles. RESULTS: Total cholesterol and low density lipoprotein-cholesterol (LDLC) levels increased, while HDLC level and HDLC/TC ratio decreased in the pregnant women. CONCLUSIONS: These findings suggest that African women are more prone to hyperlipidemia during normal pregnancy. The consequences of the adverse lipid and lipoprotein changes as seen in the pregnant women, on the fetal development and welfare should be explored in further studies. In general, these results have added to our understanding and knowledge of the numerous factors that could cause abnormal lipid and lipoprotein levels in African women.

Influence of baseline values on lipids and lipoprotein changes during amlodipine treatment of hypertension.

Twenty adult hypertensive patients classified as having 'low', 'medium' and 'high' baseline values, underwent plasma lipids and lipoproteins assessment after 12 weeks treatment with amlodipine. For the patients with low baseline values, the mean triglycerides and very low density lipoprotein-cholesterol levels increased after amlodipine therapy. No significant variation was observed in the mean values of the lipids and lipoproteins before and after amlodipine therapy for the patients with 'medium baseline values', while in patients with 'high baseline values', mean low density lipoprotein-cholesterol decreased after amlodipine therapy. These findings therefore suggest that the levels of the baseline lipid and lipoprotein profiles may have a significant influence on the lipid altering actions of amlodipine pharmacotherapy.

Influence of baseline values. I: Effects on plasma total cholesterol and triglyceride levels during doxazosin treatment for hypertension.

Forty-six African patients with essential hypertension aged 40 to 65 years had plasma total cholesterol and triglyceride levels determined at four different periods during a 12-month treatment with doxazosin. The patients were classified according to their pretreatment (baseline) values into 'low', 'medium' and 'high' baseline value groups. The mean total cholesterol levels significantly decreased in the three baseline groups while mean triglyceride levels reduced only in the patients that belonged to the medium and high baseline value groups. The baseline values of total cholesterol did not influence the beneficial cholesterol changes in all the patients, while the lack of significant favorable triglyceride changes was influenced by the low baseline values of triglyceride of the patients during doxazosin treatment. A similar study involving lipoprotein fractions and sub-fractions is also in progress.

Influence of baseline values. II: Variations in plasma lipoprotein fractions during doxazosin treatment for hypertension.

Forty-two Nigerian hypertensive men and women aged 40 to 60 years treated with doxazosin for 12 consecutive months were studied. Before the doxazosin therapy, all the patients had their baseline lipoprotein fractions determined and that was used to classify the patients into 'low', 'medium' and 'high' baseline values. The assays were repeated 4 times at every 3 months during the 12-month treatment with doxazosin. The mean high density lipoprotein-cholesterol (HDLC) levels were significantly reduced in the patients with high baseline values, and remained unchanged for the patients with low and medium baseline values during doxazosin therapy. Low density lipoprotein-cholesterol (LDLC) levels were apparently reduced in all the groups and this was significant for the patients with high baseline values. The mean levels of very low density lipoprotein-cholesterol (VLDLC) increased in the patients with low baseline values, and decreased in the patients with medium and high baseline values during the 12 months of doxazosin therapy. We therefore conclude that although the overall risk of developing coronary heart disease as measured by the risk predictor index LDLC/HDLC ratio was not affected by the baseline values of the patients, it is, however, important to note that adverse lipoprotein changes such as raised VLDLC and reduced HDLC may be seen in patients with low and high baseline values, respectively, during doxazosin treatment for hypertension. These observations will call for more serious monitoring of these lipoprotein fractions in patients with variable baseline values, by physicians and all health workers concerned during doxazosin treatment for hypertension.