Detection and characteristics of hypertension patients admitted in 37 cardiology departments from 17 Sub-Saharan African countries

Background

High blood pressure (BP) is a major risk factor for several common cardiovascular (CV) disease such as stroke, heart failure or chronic kidney disease. The Sub-Saharan Africa (SSA) should face the highest rate of hypertension worldwide with an overall prevalence estimation of 46%. Due to scarce resources and inadequate healthcare provision, SSA have scarce hard data on treatment and control of high BP.

Purpose

To assess the detection and characteristics of hypertension patients admitted in hospitalizations 17 SSA countries

Methods

We conducted a transversal and longitudinal study in CV department of 37 hospitals from 23 cities in 17 SSA countries (10 low income: Niger, Guinea, Benin, Mali, Democratic Republic of the Congo, Tchad, Burkina Faso, Togo, Burundi, Ethiopia and 7 middle income: Cote d'Ivoire, Senegal, Cameroon, Congo, Soudan, Mauritania, Gabon). The February study was designed by a multidisciplinary collaborative team of epidemiologists, pharmacists and cardiologists from Africa and France. This ongoing observatory included all inpatients in February from each year since 2016. Data including socio-demographic and clinical characteristics, causes of admission, clinical, biological, complementary examinations, treatments, length of stay and discharge diagnosis were collected by the investigating physicians. Hypertension and severity of hypertension were defined according to 2018 ESC/ESH guidelines and BP was measured twice using standardized method. All analyses were performed through scripts developed in the R software (4.0.3 (2020-10-10))

Results

The study involved 4360 patients. Hypertension was measured on 1906 (43.7%) patients at admission. Proportion of patients with high BP in hospital increased from 42.2% in 2016 to 52.2% in 2021 (p<0.05) and differed significantly across countries from 77.6% in Niger to 100% in Chad. Among hypertensive patients, men represented 59.6% of patients and mean of age was 59±15.1 years. Overall, 61.4% of patients were from low income countries. The mains causes of admission among hypertensive patients were heart failure (37.8%) and stroke (18.9%). Average of systolic BP was 159±29.3 mmHg and average of diastolic BP was 96.7±16mmHg. Overall, 760 (40.3%), 525 (27.8%) and 602 (31.9%) had grade 1, grade 2 and grade 3 hypertension respectively. History of CV disease was observed in 51.5% of patients. Thus, 70.4% of patients had at least one CV risk factor other than hypertension. Angiotensin converting enzyme inhibitors and diuretics was prescribed in 56.9% and 55.8% of patients respectively. The average amount of antihypertensive drugs prescribed in hospital was 2.09±1.18. Overall, 237 (12.4%), 295 (15.5%), 640 (33.6%) and 734 (38.5%) received respectively no drug, monotherapy, two-drug strategies and three and more drug strategies.

Conclusion

In patients admitted in cardiology departments, hypertension is a huge burden in SSA.

Funding Acknowledgement

Type of funding sources: None.

P3459Research Network in Africa (RNA): gender differences in cardiovascular risk factors and complications in 12 African countries

Background

Cardiovascular diseases are rapidly growing epidemic in Sub-Saharan Africa. Unlike other regions of the world, death rates due to hypertension are greater for women than men in Africa. Scarce data were available on factors associated with gender in cardiovascular risk factors and complications in Sub-Saharan Africa.

Purpose

To assess gender differences in cardiovascular risk factors pattern in patients with hypertension in 12 Sub-Saharan countries.

Methods

We conducted a cross-sectional survey in urban clinics of twelve countries in Africa. Data were collected on demographics, treatment and standardized BP measures were made among the hypertensive patients attending the clinics. BP control was defined as BP<140/90 mmHg and hypertension grades were defined according to European Society of Cardiology guidelines. The separate association between women factors and BP control was investigated using Generalized Linear Mixed-Effects Models adjusted on age; A random effect on the country was added (generalized estimated equation models) to account for inter-country variability.

Results

The EIGHT study enrolled 2198 patients with hypertension in 12 sub-Saharan countries between January 2014 and November 2015. The proportion of women (60,2%) was higher than men and varied significantly according to countries (p<0.001), ranged from 33.7% (Guinea) to 71.9% (Gabon). Mean age was 57.7±12.0 years for women and 59.2±11.4 years for men (p<0.001).

Compared to men, women had a higher rate of family cardiovascular background (79% vs 70%, for women and men respectively) (p<0.0001), cardiovascular risk factors (74.3% vs 68.1) (p=0.008), such as obesity (25.8% vs 12.1%) (p<0.0001), sedentary behavior (42.1% vs 35.0%) (p=0,006). BP control didn't differ according to gender, the repartition of grades of hypertension was similar between women and men and proportion of uncontrolled BP was 77.2% in women and 77.8% in men (p=0.4), with same proportion of women and men receiving antihypertensive treatment (96 vs 97.5%) (NS).

However, African women had less cardiovascular complications than men (39% vs 52.4%) (p<0.0001) (OR: 0.50 [CI 95% 0.41–0.61]).

Conclusions

Our study highlighted gender differences in cardiovascular risk factors pattern in Sub-Saharan hypertensive patients. Tailoring medical (public health) programs to improve cardiovascular disease prevention that take into women characteristics may enhance their effectiveness.

[Echocardiographic profile of Congolese hypertensive patients]

OBJECTIVES

To assess echocardiographic aspect of Congolese hypertensive patients, and to identify predictive factors of left ventricular hypertrophy (LVH).

PATIENTS AND METHODS

A transversal study was lead in Brazzaville from January 2011 to December 2013 (36 months). In total, 1125 hypertensive patients under treatment underwent transthoracic echocardiography. The test was carried out either as part of an initial assessment of the hypertension disease or during the development of evocative symptom or complication. Patients' sociodemographic data and echocardiographic parameters were collected and analyzed.

RESULTS

There were 621 males (55.2%) and 504 females (44.8%), mean age 54.7±12 years. The main indication of the test were the hypertension initial evaluation in 792 cases (70.4%), dyspnea in 122 cases (10.8%), investigation of ischemic stroke in 101 cases (9%), cardiac failure and chest pain in respectively 58 and 52 cases. 5.3±4.7 years known duration of hypertension status was associated with overweight/obesity in 829 cases (73.7%), physical inactivity in 669 cases (59.5%), hypertension family history in 540 cases (48%), diabetes mellitus in 122 cases (10.8%), dyslipidemia in 82 cases (7.3%), smoking in 29 cases (2.6%). Echocardiographic test was abnormal in 590 cases (52.4%) and showed hypertrophic cardiomyopathy in 510 cases (45.2%), dilated and hypertrophic cardiomyopathy in 46 cases (4.1%), dilated cardiomyopathy with systolic dysfunction in 31 cases (2.8%), coronary artery disease in 4 cases (0.4%). LVH was concentric in 470 cases (84.6%), eccentric in 70 cases (12.6%), and in 16 cases (3%), it was a concentric left ventricular remodeling. The left ventricular's systolic ejection fraction average was 70.5±9.3%, relaxation disorders in 480 cases (42.6%). Age, male gender, income, known duration of hypertension and treatment were predictive factors of LVH.

CONCLUSIONS

Echocardiographic profile of the Congolese hypertensive is quite various, left ventricular hypertrophy is the most predominant abnormality. Efficient management on the hypertension will lead to reduce its morbidity and mortality.

Cost of management of nonvalvular atrial fibrillation in Brazzaville (Congo): preliminary findings

The frequency of nonvalvular atrial fibrillation is increasing in sub-Saharan Africa, particularly as a consequence of population aging and the high prevalence of hypertension. The aim of this descriptive study was to determine the cost of management of this disease in the cardiology department at University Hospital of Brazzaville. The study included 50 patients aged 67.3 ± 12.8 years (range: 34 to 88 years). Among them, 21 (42%) were unemployed, and 49 (98%) had no health insurance. Their average monthly salary was 152.8 ± 149 € (range: 0 to 686 €). The mean total cost of care was 442.4 ± 109.8 € (range: 146.6 to 646.2 €). The average monthly salary was higher than the average cost of drugs (P <0.0001), or of additional tests (P <0.0001), or of hospital hospitality (P <0.0001). But the overall cost of care was substantially higher than the patients' mean salary (p <0.0001). This study illustrates the increasing healthcare costs related to the growing burden of cardiovascular disease in sub-Saharan Africa.

[Arterial hypertension and control in Brazzaville (Congo): role of ambulatory blood pressure monitoring (ABPM)]

OBJECTIVES

To evaluate the rate control in the hypertensive patients and to identify the predictive factors of non-control.

METHODS

It was about a cross-sectional study with prospective collection of data over a period of 36 months. It has been held in Brazzaville, and included a consecutive series of 620 hypertensive patients known and treated for at least 6 weeks, having profited from an ambulatory blood pressure monitoring (ABPM) with therapeutic aiming. We used the TONOPORT V and the software Cardiosoft 6.51 of GE Health Care, respectively for the recording and the data analysis. The threshold fixed on the average of 24-hour was BP<130/80 mmHg, and the patients divided into two groups according to whether they were or not controlled.

RESULTS

They were 352 men (56.8%) and 268 women (43.2%), old on average of 53.8 ± 9.7 years (ranges: 29 and 89 years). The standard of living of the patients was average in 330 cases (53.2%), weak in 132 cases (21.3%), and high in 71 cases (11.5%). The other associated risk factors were sedentariness in 275 cases (44.4%), overweight/obesity in 134 cases (21.6%), dyslipidemia in 121 cases (19.5%), diabetes mellitus in 90 cases (14.5%), and tobacco addiction in 25 cases (4%). The hypertension, old of 5.8 ± 5.7 years on average, was controlled among 215 patients (34.7%). The 24- hour BP average was 139 ± 14 mmHg for the SBP and 88.2 ± 10.2 mmHg for the DBP. The awake and asleep BP averages were respectively 141 ± 14 mmHg and 133 ± 16.2 mmHg for the SBP, 90.5 ± 10.5 and 81.2 ± 11.1 mmHg for the DBP. The antihypertensive protocol used was a monotherapy in 130 cases (21%), bitherapy in 287 cases (46.3%), tritherapy in 154 cases (24.8%), quadritherapy or more in 27 cases (4.3%). Prevalence of non-dipping was 43%. Age and male gender were the significant predictors of poor control.

CONCLUSION

The rate control of hypertension in our study population remains low. Its improvement passes by the education of the hypertensive patients and the improvement of their living conditions.

[Pericardial effusion with pretamponade leading to diagnosis of hypothyroidism: two cases in Congo]

The purpose of this report is to describe two cases of pericardial effusion with pre-tamponade leading to diagnosis of underlying hypothyroidism. Both patients were women with large longstanding pericardial effusion. The first patient was 47-years-old and the second was 46. Diagnosis of hypothyroidism, whose clinical features were equivocal in the first case case and frank in the second, was confirmed by hormone tests. Treatment consisted of pericardial drainage and hormone replacement therapy with increasing doses. Outcome was favorable in both cases with restoration of euthyroidism. Clinical status was satisfactory in both cases with a follow-up of five months in the first patient and three months in the second. Pericardial effusion with pretamponade is an exceptional complication of prolonged hypothyroidism that should be considered in patients presenting with large longstanding but well tolerated pericardial effusion with no evidence of infection or inflammation.

[Hypertensive emergencies at the University Hospital Center in Brazzaville, Congo]

The purpose of this retrospective study conducted in the emergency department of the University Hospital Center in Brazzaville, Congo was to determine the prevalence and clinical characteristics of hypertensive emergencies. With a total of 76 patients admitted during the study period, the prevalence of hypertensive emergency was 4%. The sex ratio was 1 and mean patient age was 57.3 years (range, 30 to 80 years). Risk factors included obesity in 62 cases (81.6%), history of hypertension in 65 (85.5%) and low socioeconomic level in 58 (76.3%). Mean delay for consultation was 50 hours (range, 1 to 240 hours). The disease underlying the hypertensive emergency was stroke with 38 cases (50%), heart failure in 20 (26.3%), hypertensive encephalopathy in 11 (14.4%), malignant hypertension in 9 (11.8%), and renal failure in 10 (13.1%). The mean length of emergency treatment was 14.7 hours (range, 5 to 48 hours). Eight deaths (10.5%) occurred during hospitalization in the emergency department.

[Cost of emergency cardiovascular care at the University Hospital Center in Brazzaville, Congo]

The purpose of this cross-sectional retrospective study was to evaluate the cost of managing cardiovascular emergencies in the Emergency Department of the Brazzaville University Hospital in the Republic of the Congo. This study included 197 patients admitted for stroke in 90 cases, heart failure in 65 and hypertensive emergency in 42 from July to December 2006. The mean duration of hospitalization was 45.2 +/- 18.3 hours (range, 6 to 72 hours). Cost calculation took into account consultation fees, blood tests, imaging, medication, therapeutic procedures and the first day of hospitalization. The overall cost of stroke care ranged from 147.000 to 177.000 CFA francs (220.50 to 265.50 euros), i.e., a mean per-patient cost of 158.120 +/- 6.900 CFA francs (237.18 +/- 10.35 euros). The overall cost of heart failure care ranged from 69.000 to 99.600 CFA francs (104.4 to 149.4 euros), i.e., a mean per-patient cost of 81.900 +/- 10.474 CFA francs (122.85 +/-15.71 euros). The overall cost of hypertension emergency care ranged from 74.600 to 18.4600 CFA francs (111.90 to 276.90 euros), i.e., a mean per-patient cost of 159.600 +/-44.107 CFA francs (239.40 +/- 66.20 Euros). Most people living in Brazzaville cannot afford emergency care for stroke, cardiac failure or hypertensive emergency. These findings underline the urgent need to implement a health insurance system and to encourage the use of generic drugs.

[Non traumatic thoracic pain in adults: etiology and management at the CHU of Brazzaville (Congo)]

This retrospective survey that is about the adult's non traumatic thoracic pains has been achieved during one period of three months in the service of the emergencies of the hospitable and academic center of Brazzaville. Her goal was to determine the prevalence of the thoracic pains, to specify their causes and the place of the cardiovascular diseases. We collected 88 cases left in 40 men (45.5%) and 48 women (54.5%). The sex-ratio was of 1.2. The middle age of the population of survey was of 38.8+/-17.3 years (extreme 18 and 74 years). The prevalence of the non traumatic thoracic pains was of 9.1%. Twenty-one patients (23.9%) were HIV, 9 patients (10.2%) were active smoke or weaned since less than three years. The associated signs were represented by the fever in 42 cases (47.7%), the dyspnoea in 37 cases (42%) and the cough in 33 cases (37.5%). The main diseases was represented by the respiratory diseases in 52 cases (59%), the oesophagus and gastric diseases in 16 cases (18.2%) and the cardiovascular disease in 10 cases (11.4%). The treatment analgesic has been used among 44 patients (50%) outside of the treatment of causes. The middle length of hospitalization in the service of the emergencies was of 25.7+/-8.3 hours, with the extremes of 12 and 48 hours. No deaths have been recorded.

[Heart failure in elderly patients in Brazzaville, Congo: clinical and etiologic aspects and outcome]

The aim of the study is to report clinical, etiologic aspects and the outcome of heart failure in elderly hospital patients treated in Brazzaville, Congo. This retrospective study was carried out over a 20-month period from January 1, 2005 to August 31, 2006. In addition to age over 60 years, the main inclusion criteria was diagnosis of heart failure based on clinical, radiological, electrocardiographic, and echocardiographic evidence. A total of 223 patients, i.e., 50.0% of 446 patients over the age of 60 years evaluated, were included in the study. There were 125 women (56.1%) and 98 men (43.9%) (p = 0.0105). Mean age in the overall population was 70.4 +/- 6.2 years (range, 60 to 100 years). Heart failure was global in 148 cases (66.4%), left sided in 49 (22.0%), and right sided in 26 (11.6%). Left ventricular dysfunction was systolic in 93 cases (47.2%) and diastolic in 83 (42.1%) (p = 0.31). Underlying causes were hypertension in 77 cases (34.5%), coronary disease in 57 (25.6%), valvulopathy in 21 (9.4%), and myocardiopathy in 17 (7.6%). Chronic pulmonary heart disease was diagnosed in 25 cases (11.2%). Other cardiac diseases were found in 8 cases (3.6%). All patients underwent medical treatment. Thrombolytics were not used in cases involving myocardial infarction. The death rate was 20.2% (n = 45), i.e., 12 cases involving hypertensive cardiopathy, 8 involving coronary artery disease, 3 involving valvular cardiopathy, and 5 involving chronic pulmonary heart disease. The type of cardiopathy was undetermined in 17 cases. Heart failure is common in the elderly. Prevention depends on reducing cardiovascular risk factors especially arterial hypertension.