Pattern of Right Ventricular Changes in Patients with Uncomplicated Systemic Hypertension at a Tertiary Centre in Southwest Nigeria.

BACKGROUND AND AIMS: Hypertension is an independent risk factor for cardiovascular complications. The effect of systemic hypertension on the right ventricle (RV) has received less attention probably due to its complex structure and location. The aim of the study was to assess the effect of systemic hypertension on the structure and function of the right ventricle using transthoracic echocardiography. METHOD: One hundred hypertensives and 100 healthy controls were recruited into the study. Transthoracic echocardiography was used to measure RV wall thickness (RVWT) in diastole, RV internal dimensions in diastole, tricuspid annular plane systolic excursion (TAPSE), right ventricular filling velocities (TE and TA), and RV systolic excursion velocity (RVSm). These measurements were repeated on the left ventricle. RESULTS: There was significantly thicker RV wall (0.51 + 0.08cm vs 0.44+0.08cm; p=0.001) in the hypertensive group and higher frequency of RV hypertrophy (48.45% vs 18.75%; p<0.001). Tricuspid annular plane systolic excursion (TAPSE) and the tricuspid annular peak systolic excursion velocity (TSm) were significantly lower in the hypertensive group (2.34+0.45cm vs 2.50+0.36cm; p=0.008, and 11.70+3.03cm/s vs 12.60+2.93cm/s p=0.039, respectively), though no participant had abnormal TAPSE. Tricuspid E/A ratio was lower in the hypertensive group (1.13+ 0.33 vs 1.24+0.27; p=0.011). The tricuspid E/A ratio had positive correlation with mitral E/A ratio. CONCLUSION: Right ventricular structural and functional changes are found in systemic hypertension, even in the absence of other systemic complications. These changes could have been mediated by ventricular interdependence and altered humoral factors.

CONTEXTES ET OBJECTIFS: L'hypertension artérielle est un facteur de risque indépendant pour les complications cardiovasculaires. L'effet de l'hypertension artérielle systémique sur le ventricule droit (VD) a reçu moins d'attention probablement en raison de sa structure complexe et de son emplacement. L'objectif de l'étude était d'évaluer l'effet de l'hypertension artérielle systémique sur la structure et la fonction du ventricule droit en utilisant l'échocardiographie transthoracique. MÉTHODE: Cent hypertendus et 100 témoins en bonne santé ont été recrutés dans l'étude. L'échocardiographie transthoracique a été utilisée pour mesurer l'épaisseur de la paroi du VD (EPVD) en diastole, les dimensions internes du VD en diastole, l'excursion plane systolique annulaire tricuspide (TAPSE), les vitesses de remplissage ventriculaire droit (TE et TA), et la vitesse d'excursion systolique ventriculaire droit (RVSm). Ces mesures ont été répétées sur le ventricule gauche. RÉSULTATS: Il y avait une paroi du VD significativement plus épaisse (0,51 ± 0,08 cm vs 0,44 ± 0,08 cm ; p=0,001) dans le groupe hypertendu et une fréquence plus élevée d'hypertrophie ventriculaire droite (48,45% vs 18,75% ; p<0,001). L'excursion plane systolique annulaire tricuspide (TAPSE) et la vitesse maximale systolique annulaire tricuspide (TSm) étaient significativement plus basses dans le groupe hypertendu (2,34 ± 0,45 cm vs 2,50 ± 0,36 cm ; p=0,008, et 11,70 ± 3,03 cm/s vs 12,60 ± 2,93 cm/s p=0,039, respectivement), bien qu'aucun participant n'ait eu de TAPSE anormal. Le rapport E/A tricuspide était plus bas dans le groupe hypertendu (1,13 ± 0,33 vs 1,24 ± 0,27 ; p=0,011). Le rapport E/A tricuspide avait une corrélation positive avec le rapport E/A mitral. CONCLUSION: Des modifications structurales et fonctionnelles du ventricule droit sont retrouvées dans l'hypertension artérielle systémique, même en l'absence d'autres complications systémiques. Ces changements pourraient avoir été médiés par l'interdépendance ventriculaire et des facteurs humoraux modifiés. MOTS-CLÉS: Hypertension ; Échocardiographie ; Hypertrophie ventriculaire droite ; Dysfonction diastolique ventriculaire droit.

Hypertension-related admissions and outcome in a tertiary hospital in northeast Nigeria.

Cardiovascular disease has reached near epidemic proportion in sub-Saharan Africa, and systemic hypertension (SH) remains the driver of cardiovascular complications. We studied hypertension-related admissions and their outcome at the Abubaker Tafawa Balewa University Teaching Hospital (ATBUTH) Bauchi, Northeast Nigeria. Records of all patients admitted into the medical wards between 1st November 2010 and 31st October 2011 were studied, and case files of those managed for SH complications were selected for detailed examination. Of the total 3108 admissions, 735 (23.7%) were hypertension related. Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 167.4 ± 18.2 and 98.6 ± 13.5, respectively, at presentation. Although, hypertension-related admissions were 23.7% of total admissions, there was an excess of mortality associated with SH complications (42.9%). Stroke was the commonest, and it accounted for 44.4% of cases. Stroke had the highest mortality (39.3%), followed by chronic kidney disease (36.6%); hypertensive emergencies (30.9%) and hypertensive heart failure had the lowest intrahospital mortality (27.5%). In conclusion, SH-related admissions are common among medical admissions in Bauchi Nigeria and are associated with high mortality. Community interventions that promote early diagnosis and reduction of cardiovascular risk profiles are urgently needed to reduce SH deaths.