[Vascular age and cardiovascular risk in hypertensive patients followed at the heart institute]

OBJECTIVE

To calculate the vascular age of hypertensive patients and assess the risk at 10 years of occurrence of an absolute cardiovascular event in outpatient consultation of the Abidjan Heart Institute.

PATIENTS AND METHODOLOGY

Cross-sectional study with descriptive and analytical purposes from June 2021 to September 2021, i.e. 4 months in patients at least 30 years of age followed in the outpatient department for arterial hypertension without cardiovascular complications. Data were collected using a questionnaire. We considered the parameters established in the D'Agostino chart for the calculation of vascular age. Each parameter was weighted and the total points obtained corresponded to the vascular age. The cardiovascular risk at 10 years was also obtained from another abacus established by D'Agostino by cross-referencing the total points of each patient with pre-established data.

RESULTS

Three hundred hypertensive people were included in this study. The calendar average age was 62.0 ± 10 years with extremes of 30 and 95 years. The gender distribution showed female predominance and there was no significant difference in vascular age by sex. The mean vascular age of all patients was 73.4 ± 9.9 years. The mean difference between actual and vascular age was 11.4 years. Dyslipidemia (p = 0.0002), diabetes (p = 0.0004) and unstandardized BP (p = 0.0000) significantly influenced vascular age. There was no significant difference between smokers and non-smokers (p = 0.1349). All men had a greater than 30% risk of having a cardiovascular accident while women before the age of 35 had no risk. Over the age of 60, almost all patients (both men and women) had a greater than 30% risk of having a cardiovascular accident at 10 years.

CONCLUSION

The calculation of vascular age made it possible to assess arterial aging and calculate the probability at 10 years of occurrence of a cardiovascular event. This study also highlights the importance of cardiovascular risk and vascular age assessment for management adaptation and therapeutic education.

[Evolution of epidemiology and management of acute coronary syndromes in Abidjan : A cross-sectional study of 1011 patients.]

BACKGROUND

To assess the evolution of the epidemiology and management of patients hospitalized to Abidjan Heart Institute for acute coronary syndrome (ACS).

METHODS

Cross-sectional study comparing two periods: from January 2002 to December 2009 (period 1) and from January 2010 to December 2016 (period 2), including all patients aged 18 years old, admitted to Intensive Care Unit of Abidjan Heart Institute for ACS.

RESULTS

One thousand eleven (1011) patients were included among the 6784 patients admitted to Intensive Care Unit of Abidjan Heart Institute for a cardiovascular disease. The overall prevalence of ACS was 14.9%. The prevalence in period 2 was significantly higher than in period 1 (22.6% and 7.3% respectively, p < 0.001). Diabetes (33.5%, p < 0.001) significantly, and smoking (30.7%, p = 0.30) had the largest rises from period 1 to period 2. ST-segment Elevation Myocardial Infarction was the main clinical presentation during both periods. The median time to treatment (p = 0.46) and length of hospital stay (p <0.001) decreased during period 2. Percutaneous coronary intervention (PCI) was performed in 173 patients (22.6%) during the period 2 and 42 patients (5.5%) underwent primary PCI. The rate of fibrinolysis increased significantly between the two periods (9.5%, p <0.001). In-hospital death increased during period 2 (10.4%, p = 0.07).

CONCLUSION

The burden of ACS and its related mortality have risen alarmingly past years in Côte d'Ivoire. Healthcare policies should help improve the management and outcomes of patients.

[Burden of comorbidities in heart failure patients hospitalized at the Abidjan Heart Institute]

OBJECTIVE

The aim of our work was to appreciate the importance of comorbidities of heart failure individually and globally in patients hospitalized at the Cardiology Institute of Abidjan.

PATIENTS AND METHODS

This was a prospective cohort study of adult heart failure patients hospitalized from January to December 2015, and followed up over 12 months. Co-morbidities were analysed through their prevalence, their relationship with the etiologies, and their impact on the prognosis.

RESULTS

Three hundred and two patients (mean age: 55.5±16.9 years, 61.6 % male) were recruited. High blood pressure, anaemia and kidney dysfunction were the most common co-morbidities (48 %, 43.7 % and 41.3 % respectively). There was an average of 3.4±1.8 comorbidities per patient with an increase in the number of comorbidities with age (P<0.05) and a more frequent association with hypertensive and ischemic heart disease (P<0.001). During the one-year follow-up, 96 patients died. Apart from hepatic dysfunction (RR=1.97, 95 % CI [1,19-3.25], P=0.008, a high score of Charlson index appeared as a risk factor of death as much in univariate analysis (RR=4.15 95 % CI [2.32-7.41], P<0.001), as in multivariate analysis according to the Cox model (RR=2.48. 95 % CI [1.08-5.09], P=0.03) confirmed by Kaplan Meier curves (P<0.001).

CONCLUSION

Comorbidities are common in our heart failure patients and significantly affect their prognosis.

P1586Research network in Africa (RNA): antihypertensive drugs strategies in 12 African countries

Background

High Blood Pressure is the worldwide leading global burden of disease risk factor. In Sub-Saharan Africa, the number of adults with raised blood pressure has alarmingly increased from 0.59 to 1.13 billion between 1975 and 2015. Blood pressure-lowering medicines are cornerstone of cardiovascular risk reduction. Data on management of anti-hypertensive drugs in sub-Saharan Africa are squarce.

Purpose

Our study aims to describe antihypertensive drugs strategies in Africa.

Methods

We conducted a cross-sectional survey in urban clinics during outpatient consultation specialized in hypertension cardiology departments of 29 medical centers from 17 cities across 12 African countries (Benin, Cameroon, Congo, Democratic Republic of Congo, Gabon, Guinea, Ivory Coast, Mauritania, Mozambic, Niger, Senegal, Togo). Data were collected on demographics, treatment and standardized BP measures were made among the hypertensive patients attending the clinics. Country income was retrieved from the World Bank database. All analyses were performed through scripts developed in the R software (3.4.1 (2017–06–30)).

Results

A total of 2198 hypertensive patients (58.4±11.8 years; 39.9% male) were included. Among whom 2123 (96.6%) had at least one antihypertensive drug. Overall, 30.8% (n=653) received monotherapy and calcium-channel blockers (49.6%) were the most common monotherapy prescribed follow by diuretics (18.7%). Two-drug strategies were prescribed for 927 patients (43.6%). Diuretics and Angiotensin-converting enzyme inhibitors was the combination most frequently prescribed (33.7%). Combination of three drugs or more was used in 25.6% (n=543) of patients. The proportion of drugs strategies differed significantly according to countries (p<0.001), monotherapy ranged from 12.7% in Niger to 47.1% in Democratic Republic of the Congo (figure). Furthermore we observed a significantly difference of strategies between low and middle income countries (55.3% and 44.7% of monotherapy respectively) (p<0.001). According to hypertension grades 1, 2 and 3, the proportion of three-drugs or more combination was 25%, 28% and 34% in middle-income and lower in low-income countries (18%, 19% and 25%). Furthermore, Grade 3 hypertension in low income countries was still treated with monotherapy (36%) instead of 19% in middle income countries (p<0.01).

Antihypertensive strategies by country

Conclusion

Our study described antihypertensive drugs use across 12 sub-Saharan countries, and identified disparities specific to the income context. Inequity in access to drugs combination is a serious barrier to tackle the burden of hypertension in Africa.

[Prevalence of obesity in school children in Ivory Coast]

BACKGROUND

According to the World Health Organization, an increased prevalence of hypertension in children is observed since several years due to an epidemic of childhood obesity. What is the extent of this epidemic in our African context?

METHOD

We conducted a prospective descriptive study of pupils encountered in primary and secondary schools of the district of Abidjan from May 3 to June 1st 2010. A sample of 2038 pupils aged 6 to 18 years was randomly selected. Overweight in pupils was assessed by body mass index (BMI).

RESULTS

There were 1182 girls (58%) and 856 boys (42%) whose average age was 12.7±3.6 years. The average weight was 42.6kg±16 (range 14.6 to 106.2kg), the average size was 1.48m±0.19 (range 1 to 1.95m). BMI was 17.2kg/m(2)±3.7 (range 14.6-35.7). The prevalence of obesity was of 5%. In addition, 4% of the students were overweight, 39% extremely thin, 25% thin and 27% normal. Obesity was more common in girls (6.8%) than boys (1.8%). The prevalence of obesity in hypertensives was 16%. BMI influenced the systolic and diastolic blood pressure in both sexes (P<0.001 in both cases).

CONCLUSION

Childhood obesity exists in a country like the Ivory Coast where wealthness is far from generalized. A well-organized management of childhood obesity is necessary to avoid complications such as hypertension.