Iron Deficiency Anemia in Nigerians with Heart Failure (IDAN-HF): Therapeutic efficacy of iron replacement: An interventional study

Background

Recent evidence has reported significant improvement in clinical profile, quality of life, and prognosis of heart failure subjects with iron replacement.

Aims

This study aimed to determine the safety and outcome of parenteral iron replacement among heart failure subjects in Nigeria.

Method

A randomized interventional study was done at the Cardiology Clinic of LAUTECH Teaching Hospital, Ogbomoso, Nigeria. One hundred and forty subjects with heart failure were recruited. Iron deficiency and anemia were determined according to standardized criteria. Parenteral iron dextran was administered to a block randomized group of 30 of those identified with iron deficiency and compared with controls. The primary outcome was the six minutes' walk test (6 MWT) after 8 weeks while the Kansas City Cardiomyopathy Questionnaire (KCCQ) score was used to assess the quality of life as a secondary outcome. Statistical analysis was done with the SPSS 20.0. P value <0.05 was taken as statistically significant.

Results

Iron deficiency was present in 84 (60.0%) of all study participants. Iron dextran was fairly tolerated with mild to moderate adverse reactions reported in 7 (23.3%) subjects who had an iron infusion. Improvement in the 6 MWT distance (390.1 ± 92.6 vs. 156.9 ± 72.5 meters, P < 0.05) and the KCCQ score (84.5 ± 3.7 vs. 64.2 ± 12.5%, P < 0.05) among iron-deficient heart failure subjects who received iron dextran was significantly higher than those who did not receive the iron replacement. Functional classification according to the New York Heart Association (NYHA) profile and heart rate were also much improved after the iron replacement than those who did not receive it.

Conclusion

Parenteral iron dextran therapy was fairly tolerated among heart failure subjects. Iron replacement is associated with improved quality of life, better temporal clinical profile, and functional classification among Nigerians with heart failure. Iron replacement therapy can be an additional therapeutic option in heart failure management among Africans to improve prognosis.

Prevalence of traditional cardiovascular risk factors among staff of Ladoke Akintola University of Technology, Ogbomoso, Nigeria

AIM

The aim was to describe the frequency of occurrence of traditional cardiovascular (CV) risk factors among selected university workers in Ladoke Akintola University of Technology (LAUTECH) Nigeria.

MATERIALS AND METHODS

A cross-sectional study of 206 staff of LAUTECH, Ogbomoso, Nigeria had an assessment for nine traditional CV risk factors. Demographic and clinical parameters were taken. Blood sample was taken to determine the random blood sugar and lipid profile. 12-lead resting electrocardiography (ECG) was done for all participants. Statistical analysis was performed with the aid of Statistical Package for Social Sciences (SPSS) version 17.0 (Chicago Ill., USA) Results: The study population included 96 males (46.6%) and 110 females. The mean age was 45.3 ± 7.9 years (range 27-73 years). The prevalence of CV risk factors were as follows: Hypertension 84 (40.8%), visceral obesity 92 (44.7%), generalized obesity 79 (38.3%), low high density lipoprotein 113 (54.9%), impaired blood glucose 16 (7.8%), diabetes mellitus 3 (1.5%), hypercholesterolemia 102 (49.5%), left ventricular hypertrophy-ECG 24 (11.7%), elevated low density lipoprotein-cholesterol 99 (48.1%). About - (72.3%) had two or more CV risk factors clustered together. Females had a higher prevalence of CV risk factors and its clusters than their male counterparts. Of those diagnosed with hypertension in this study, more than half had never been told they were hypertensive 48 (57.1%).

CONCLUSION

This study suggests a very high prevalence of CV risk factors among University Staff in LAUTECH, Ogbomoso, Nigeria. Clustering of CV risk factors is more prevalent among women. Appropriate preventive strategy in terms of education and modification of risk factors are important to reduce the burden of CV diseases among this population.

Mortality and Co-morbidities Among Hospitalised Hypertensives in Nigeria

<p>Background: The present study therefore aimed to systematically assess the co-morbidities and in-hospital outcomes among hypertensives admitted to 3 Teaching Hospitals in Nigeria.</p><p>Methods: Medical records of all subjects admitted to the medical wards of the study centres with an established diagnosis of hypertension in 2013 were reviewed.</p><p>Results: 288 hypertensive patients were consecutively admitted in the medical wards of the 3 centres in 2013, of whom 146 (59.8%) were males. 88.4% of males and 87.8% of females had 1 or more co-morbidities at admission, and the commonest among all patients was heart failure (HF) followed by stroke/transient ischemic attack (TIA), in 76 (31.2%) and 69 (28.3%) patients respectively. The most frequent co-morbidity among males was HF in 34.3% of them, while stroke/TIA was more common among female patients, in 34.7% of them. Non-cardiovascular co-morbidities were uncommon, and the most frequent was community acquired pneumonia in 7.4% of all patients. 7.8% of all patients (13 males and 6 females; p=0.427) died in-hospital. The deceased had higher Systolic Blood Pressure than the survivors, and majority of them (52.6%) were not on any antihypertensive medications at admission, which was the only predictor of mortality in the present study, increasing its odds by 7.5 fold (odds ratio=7.5; 95%confidence interval=2.8-20.0; p&lt;0.001).</p>Conclusion: The most frequent co-morbidity among males was HF while stroke and TIA were most common among female patients. The prevalence of in-hospital mortality was relatively low, and not being on antihypertensive treatment at admission increased its odds by 7.5 fold.

Gender specific pattern of left ventricular cardiac adaptation to hypertension and obesity in a tertiary health facility in Nigeria

BACKGROUND

Cardiac adaptation to hypertension and obesity may be related to many factors such as race, gender and haemodynamic status. Some gender specific associations with left ventricular structure and function have been described among Caucasians.

OBJECTIVES

To describe the sex specific pattern of left ventricular adaptations to obesity and hypertension among Nigerians.

METHODOLOGY

It was a cross sectional study carried out at LAUTECH Teaching Hospital, Osogbo, Nigeria. 313 subjects had full echocardiography performed. Participants were divided into four groups: normal, obese, hypertensives and obese-hypertensives. Indices of LV adaptation were compared between the groups. SPSS 16.0 was used for analysis.

RESULTS

Relative to normal subjects, LV mass (LVM), LV mass index (LVMI) and wall thickness were significantly higher among hypertensive men and obese hypertensive men. They were similar between normal and obese men. However, LVM, LVMI and wall thickness were increased among obese women compared to normal women while they were similar among obese, hypertensive and obese-hypertensive women. Men with concurrent obesity and hypertension presented with a further increase of LVM and wall thickness above values in the merely obese or hypertensive subjects. Female obese-hypertensive seem to present more with eccentric hypertrophy than male obese-hypertensive subjects (17.2% vs. 9.1% respectively, p<0.05) while male obese-hypertensive seem to present more with concentric hypertrophy (54.5% vs. 43.1% respectively, p>0.05) than female obese-hypertensive subjects.

CONCLUSION

Structural, functional and geometric LV adaptation to obesity and hypertension varies between the two genders among Nigerians. The impact of isolated obesity on LV adaptation in women appears very significant.

Impact of urbanization and gender on frequency of metabolic syndrome among native Abuja settlers in Nigeria

BACKGROUND

Metabolic syndrome (MetS) is an important cause of morbidity and mortality. Nigeria is currently undergoing rapid epidemiological transition. The objective was to study whether urbanization is associated with increased prevalence of MetS between native rural Abuja settlers and genetically related urban dwellers.

MATERIALS AND METHODS

It was a cross-sectional study. Three hundred and forty-two urban native Abuja settlers and 325 rural dwellers were used for the study. Fasting blood lipid, glucose, waist circumference, blood pressure, and body mass index were determined. MetS was defined according to three standard criteria. SPSS 16.0 was used for statistical analysis. P<0.05 was used as statistically significant.

RESULTS

Obesity, hypertriglyceridemia, and hypertension were commoner among urban dwellers than rural dwellers. MetS was associated more with the female gender. Urbanization significantly increases the frequency of MetS using the three standard definitions. The prevalence of MetS using International Diabetes Federation, World Health Organization, and National Cholesterol Education Program Adult Treatment Panel III among rural versus urban dwellers were 7.7% vs. 14.9%, P<0.05; 0% vs. 0.9%, P>0.05; and 3.7% vs. 13.7%, P<0.05, respectively.

CONCLUSION

This study shows that MetS is a major health condition among rural and urban Nigerians and that urbanization significantly increases the prevalence of MetS. This can be explained on the basis of higher prevalence of dyslipidemia, obesity, and hypertension in urban setting, possibly as a result of stress, diet, and reduction in physical activity. Effective preventive strategy is therefore required to stem the increased risk associated with urbanization to reduce the cardiovascular risk associated with MetS among Nigerians.

Microalbuminuria and hypertensive retinopathy among newly diagnosed nondiabetic hypertensive adult Nigerians

OBJECTIVE

Microalbuminuria (MA) is a marker of vascular damage and has prognostic implications in hypertension. The objective of this study was to determine if the presence of MA increases the risk of hypertensive retinal damage in nondiabetic adult Nigerians with hypertension.

MATERIALS AND METHODS

A total of 96 consecutive newly diagnosed hypertensive patients attending the outpatient clinic and who consented and met the criteria for the study were recruited. There was also the same number of age- and sex-matched normotensive controls.

RESULTS

MA was present in 31 (32.3%) of the patients and 6 (6.3%) of the controls. The mean (±SD) ages of patients with and without MA were 52.5 ± 11.9 years and 48.3 ± 13.0 years, respectively. The diastolic blood pressure (P = 0.03) and mean arterial pressure (P = 0.01) were statistically higher in hypertensive patients with MA than in their counterparts without it. Patients with MA were more likely to have hypertensive retinopathy (HRP) than patients without it (71% vs 37%, P = 0.001). Advanced HRP, i.e., Grades III - IV, was more common in patients with MA than in those without it (22.6% vs 1.5%).

CONCLUSION

This study shows a high prevalence of HRP in Nigerian hypertensives with MA.

Case report of a 26 year old primigravida with patent ductus arteriosus (PDA) in heart failure

Congenital heart disease is an important cause of maternal morbidity and mortality during pregnancy. Pregnancy alters the circulatory and respiratory physiology with attendant deleterious effect on the mother with congenital heart disease and the foetus. Additional insult to the circulatory physiology by other factors coexisting together with congenital heart disease can further reduce the cardiac reserve in pregnancy and precipitate heart failure. These factors include anaemia, thromboembolism, hypertension, multiple pregnancy, strenuous physical activity, extremes of temperature and the normal physiological edema of pregnancy.Patent ductus arteriosus (PDA) can present for the first time in pregnancy. Moderate to large PDA result in significant volume overload, left ventricular dilation and dysfunction. In the woman with a hemodynamically important PDA, pregnancy may precipitate or worsen heart failure. We report a successful pregnancy in a 26 year old primigravida with previously undetected patent ductus arteriosus with preeclampsia who presented in heart failure. This case highlights the importance of intensive careful examination of pregnant patients to identify such conditions.

Burden of obesity in essential hypertension: pattern and prevalence

Obesity continues to be an epidemic worldwide. There also continues to be a relationship between obesity and hypertension both causal and consequentially. The study aims at determining the prevalence and pattern of overweight and obesity among our patients being managed for essential hypertension.

MATERIAL AND METHODS

The study was a cross sectional study. Consecutive patients diagnosed with essential hypertension were recruited from two university teaching hospitals in the South West of Nigeria. Demographic data such as age, gender, weight and height were obtained from patients at recruitment. Patients with congestive heart failure, secondary hypertension, chronic kidney disease, and other chronic diseases were excluded. Pregnant women were also excluded. Obesity was defined according to WHO classification. Statistical analysis was done by the Statistical Package for Social Sciences version 11.0.

RESULTS

One thousand one hundred and two (1102) consecutive hypertensive patients were recruited. Two hundred and eighty six (286) were dropped due to evidence of overt heart failure (98) and chronic kidney disease and others (188). There were (420) males (51.5%) and 396 females (48.5%), mean age 54.97 (±13.14) years. (Range 10-91). 7.6% (62) were underweight (36 males, 26 Females): 260 (31.9%) were overweight, consisting of 148 males and 112 females: 135 (16.5%) had mild obesity consisting of 48 males and 87 females: 43(5.3%) had moderate obesity with 15 males and 28 females while 30(3.7%) had severe obesity (consisting of 22 females).

CONCLUSION

About two thirds of the hypertensive patients seen in two teaching hospitals in the South West of Nigeria in this study were either overweight or obese. Therefore lifestyle modification geared toward weight reduction should be emphasized in these patients.

Microalbuminuria and its relations with serum lipid abnormalities in adult Nigerians with newly diagnosed hypertension

BACKGROUND

Microalbuminuria (MA) has been associated with increased risk of adverse cardiovascular events in nondiabetic hypertensive patients. This may be partly due to increased serum lipid abnormalities in these patients. The objective was to evaluate the association between MA and serum lipid abnormalities in nondiabetic adult Nigerians with hypertension.

MATERIALS AND METHODS

A prospective study which recruited 96 consecutive newly diagnosed adult Nigerian hypertensive met the study criteria. These patients were compared with the same number of age- and sex-matched healthy normotensive individuals.

RESULTS

52 (54.2%) and 44 (45.8%) of patients were males and females, respectively. Mean +/- SD ages were 51.2 +/- 10.1 and 48.2 +/- 8.8 years for male and female patients, respectively. Microalbuminuria was more than five times more prevalent in the patients than in the controls. The means +/- SD serum total cholesterol (5.0 +/- 0.56 vs. 4.05 +/- 0.50 mmol/L, P = 0.04) and low-density lipoprotein cholesterol (3.99 +/- 0.49 vs. 2.84 +/- 0.58 mmol/L, P = 0.001) were significantly higher, while the mean +/- SD for high-density lipoprotein cholesterol was (0.91 +/- 0.16 vs. 1.04 +/- 0.13 mmol/L, P = 0.03) significantly lower in microalbuminuric patients than in non-microalbuminuric patients.

CONCLUSION

This study has shown that adult nondiabetic Nigerians with MA are significantly more likely to have dyslipidemia than patients without MA. Hence, this subset of hypertensive patients constitutes a high risk group. Screening for MA, and early recognition and prompt treatment of serum lipid abnormalities in these patients may reduce the risk of adverse cardiovascular events.

Effect of systemic hypertension on right ventricular morphology and function: an echocardiographic study

BACKGROUND

Hypertension is an important cardiovascular risk factor worldwide. It is associated with left ventricular hypertrophy (LVH). Both diastolic and systolic dysfunction may occur in hypertensive heart disease. The ventricles are structurally and functionally interdependent on each other. This was an echocardiographic study intended to describe the impact of left ventricular pressure overload and hypertrophy due to hypertension on right ventricular morphology and function.

METHODS

One hundred subjects with systemic hypertension and 50 age- and gender-matched normotensive control subjects were used for this study. Two-dimensional (2-D), M-mode and Doppler echocardiographic studies were done to evaluate the structure and function of both ventricles. Data analysis was done using the SPSS 16.0 (Chicago, Ill). Statistical significance was taken as p < 0.05.

RESULTS

Age and gender were comparable between the two groups. Hypertensive subjects had significantly increased left ventricular end-diastolic dimensions, posterior wall thickness, interventricular septal thickness, left atrial dimensions and left ventricular mass and index. The mitral valve E/A ratio was reduced among hypertensive subjects when compared to normal controls (1.15 ± 0.75 vs 1.44 ± 0.31, respectively; p < 0.05). A similar pattern was found in the tricuspid E/A ratio (1.14 ± 0.36 vs 1.29 ± 0.30, respectively; p < 0.05). Hypertensive subjects also had reduced right ventricular internal dimensions (20.7 ± 8.0 vs 23.1 ± 3.1 mm, respectively; p < 0.001) but similar peak pulmonary systolic velocity. The mitral e/a ratio correlated well with the tricuspid e/a ratio.

CONCLUSION

Systemic hypertension is associated with right ventricular morphological and functional abnormalities. Right ventricular diastolic dysfunction may be an early clue to hypertensive heart disease.

Prognostic significance of QT interval prolongation in adult Nigerians with chronic heart failure

BACKGROUND AND OBJECTIVES

Prognostic survival studies for heart-rate corrected QT interval in patients with chronic heart failure are few; although these patients are known to have a high risk of sudden cardiac death. This study was aimed at determining the mortality risk associated with prolonged QTc in Nigerians with heart failure.

MATERIALS AND METHOD

Ninety-six consecutive patients with heart failure were recruited with 90 age and sex-matched controls. All the subjects had a 12-lead electrocardiogram at a paper speed of 25 mm/sec and a rhythm strip (lead II) at 50 mm/sec. The latter was used to calculate the QTc using the Bazett's formula. Left ventricular systolic and diastolic functions were assessed using 2D guided M-mode and Doppler echocardiogram respectively. They were followed-up for six months.

RESULTS

Ninety-one patients and 90 controls completed the study. Five patients were lost to follow-up. The mean age (51.9 +/- 16 years) of the patients was similar to that of the controls (50.3 +/- 15) (P = 0.475). Twenty-eight (30.8%) patients died after 6 months of follow-up against none of the controls. The mean QTc was significantly longer in the non-survivors (0.494 +/- 0.027) than in the survivors (0.462 +/- 0.035) (P = 0.0001). The percentage mortality in patients with prolonged QTc against those with normal QTc was 41% and 14% respectively (P = 0.001). In the stepwise regression analysis, QTc was an independent predictor of mortality (R = 0.412, R2 = 0.17, P= 0.001).

CONCLUSION

QTc prolongation is a predictor of mortality in CHF and may be an important adjunct in risk stratification of patients with heart failure.

Prevalence of QTc prolongation in adult Nigerians with chronic heart failure

BACKGROUND

The heart rate corrected QT interval (QTc) on the electrocardiogram (ECG) has been proposed as a risk factor for ventricular arrhythmias and death in apparently healthy populations, patients with myocardial infarction and diabetes mellitus. However, data on the significance of QTc prolongation in heart failure are scarce.

OBJECTIVE

Our objective was to examine the prevalence of QTc prolongation in adult Nigerians with heart failure and its association with arrhythmias.

METHODS

Ninety consecutive patients with heart failure were recruited along with 90 age-and sex-matched controls. All the subjects had a 12-lead ECG and a rhythm strip (lead II). The latter was used to calculate the QTc using the Bazett's formula. Left ventricular systolic and diastolic functions were assessed using a 2D guided m-mode and Doppler echocardiogram respectively.

RESULTS

The mean age of the patients was 51.9 (16) years compared with 50.3 (15.2) years for the control group, p = 0.47. Mean left ventricular ejection fraction was significantly lower in the patients than in the controls (38.9 (11)% versus 72.2 (8)%), p = 0.001. The mean QTc was significantly prolonged in the patients than in the controls (0.472 (0.036) versus 0.390(0.032) respectively), p = 0.001. The prevalence of QTc prolongation was 63% in the patients against 4.4% in the controls. There was a significant association between ventricular arrhythmias and QTc prolongation.

CONCLUSION

The results of this study shows that there is a high prevalence of QTc prolongation in adult Nigerians with heart failure and this may be harbinger for ventricular arrhythmias and sudden death.

Intracardiac tumor: a risk factor for stroke in the young--a case report

BACKGROUND

Stroke occurs commonly in individuals above 65 years, especially in the background of atherosclerosis and other risk factors. In young persons below 45 years it is a rare disorder with devastating sequelae on the affected individual.

OBJECTIVE

Presently there are few reports on the aetiology/risk factors for stroke in young adults in Nigeria. This is due to limited facility for thorough investigation; therefore management of such cases poses a diagnostic challenge. In this report we present a case of embolic stroke in a male undergraduate that began with two brief episodes of transient left sided weakness before a completed stroke four hours later. 2-D echocardiography showed that the likely source of emboli to be a non-pedunculated left atria tumour attached to the root of posterior mitral valve leaflet.

CONCLUSION

Intracardiac mass should be considered a possible risk factor for ischemic stroke in young adult, especially in the absence of other risk factors such as connective tissue disorders, HIV/AIDS, hemoglobinopathy or use of recreational drugs. High index of suspicion is required in order not to overlook such source of emboli. Early diagnosis offers the best panacea for a definitive therapy and prevention of stroke recurrence with its devastating sequelae.

Systolic hypertension in adult Nigerians with hypertension

OBJECTIVE

To determine the prevalence of both systolic and diastolic hypertensions in relation to age and their impacts on target organ among adult Nigerians with hypertension.

DESIGN

Observational study.

PLACE AND DURATION OF STUDY

The Cardiovascular Clinic of the University of Ilorin Teaching Hospital, Nigeria, from July 2002 to June 2003.

PATIENTS AND METHODS

Newly diagnosed adult hypertensives, with blood pressure >or= 140/90mmHg, taken twice with mercury column sphygmomanometer at 3 weeks interval, were studied. The total number of hypertensive patients treated over this period was also taken into consideration. The newly diagnosed hypertensives were classified using JNC VI classification. The frequency of occurrence of target organ damage such as Left Ventricular Hypertrophy (LVH), heart failure, renal impairment etc. was charted according to systolic and or diastolic pressures. The occurrence of systolic or diastolic blood pressure was also related with the age of the patients. Blood metabolic parameters were compared in both systolic and diastolic blood pressures for their possible contributory role.

RESULTS

Two thousand seven hundred and ninety-two adult hypertensive patients were managed over the study period. Of them, 218 (7.8%) were newly diagnosed and studied. There were 94 males and 124 females. Seventy-seven (35.3%) were aged 60 years and above with equal frequency in the gender. One hundred and seventy-eight (81.7%) cases had combined systolic and diastolic pressures. Twenty-nine (13.3%) patients had systolic hypertension. Twenty-five (86.2%) of these 29 were aged 50 years and above and 20 (69.0%) were aged 60 years and above. Eleven (5.0%) patients had isolated diastolic hypertension and they were all in the age bracket 40-49 years. Systolic blood pressure was found to be rising with advancing age while diastolic blood pressure peaked at mid 40's and declined. Target organ damage occurred more frequently with systolic hypertension and advancing age than with diastolic hypertension.

CONCLUSION

Systolic hypertension occurred more frequently in this series of adult Nigerians with hypertension. It was higher with advancing age and associated with more target organ damage than the diastolic hypertension.

High Risk Coronary Heart Disease, Lipid Fractions and Transferrin Saturation among Hypertensive Nigerians

BACKGROUND AND OBJECTIVES

Hypertension and hypercholesterolemia are well established independent risk factors of coronary heart disease. Moreover, drug treatment of hypertension also affects lipid metabolism. Recently, body iron status has also been implicated as a risk factor of coronary heart disease. It is not however clear whether hypertension or hypercholesterolaemia directly or indirectly influences body iron status. This study was therefore decided to look at the association between transferrin saturation and hypercholesterolaemia in adult hypertensive Nigerians with high risk Coronary Heart Disease (CHD) lipid fraction.

MATERIALS AND METHODS

The study group comprises eighty two adult Nigerians who are known hypertensives with high risk coronary heart disease lipid fraction: that is the ratio of high density lipoprotein cholesterol to total cholesterol (HDL-C/TC) <= 0.13 while the control subjects comprises eighty adult Nigerians who are also known hypertensives with normal HDL-C/TC ratio (>=0.30).

RESULTS

The total iron binding capacity is not significantly different between the two groups. Also, serum iron and transferrin saturation were not significantly different in the two groups. Transferrin saturation does not show appreciable correlation with total cholesterol, LDL-cholesterol, HDL-cholesterol and triglyceride levels in any of the two groups.

CONCLUSION

The association between transferrin saturation and hypercholesterolaemia in hypertensive is not strong enough to possibly suggest that one influences the other. However, the influence of antihypertensive drugs on lipid metabolism cannot be ruled out in this study because subjects and controls were not selected based on type or class of medication.

KEYWORDS

transferrin saturation, high risk CHD lipid fraction, hypertensives.

Prevalence of coronary heart disease risk factors in Nigerians with systemic hypertension

This study is to determine the prevalence of coronary heart disease risk factors in Nigerians with systemic hypertension. Serum lipid profile and fasting blood glucose were determined in one hundred and thirty six newly diagnosed hypertensives selected from the Medical Outpatient Department. Basic demographic data as well as medico-social history was extracted from the records. Coronary heart disease risk was calculated from the ratios of high-density lipoprotein cholesterol to total cholesterol. High risk were defined as CHD ratio <0.18, while average and low CHD risk ratio was 0.18 to 0.40 and >0.40 respectively, according to the European Athersclerosis society guidelines. There were 76 (55.9%) males and 60 (44.1 %) females aged 24-70 years (mean = 47+8.5) studied. The coronary risk ratio in the study groupts was 0.34 as against 0.57 in the controls. The prevalence of high coronary heart disease risk in newly diagnosed hypertensives was 22%. The overall prevalence rate of hypercholesterolaemia was 62.5%, with high-risk group prevalence of 70%. The high-risk group was also associated with other non-lipid factors such as overweight -54% (BMI > 25Kg/m2), glucose intolerance-55% (FBS > 6.1 mmol/L), and alcoholism (55%). The overall prevalence of hypertriglyceridaemia was 20.4%, with higher serum values amongst females, and no risk group difference. The female patients were more affected by the metabolic risk parameters especially in the high and average risk groups. There is a need therefore, for clinicians to be encouraged to investigate lipid, lipoprotein cholesterol indices and other non-lipid risk factors to calculate the risk run by hypertensive patients of developing cardiovascular complications.

Relation of electrocardiographic left ventricular hypertrophy to blood pressure, body mass index, serum lipids and blood sugar levels in adult Nigerians

Left ventricular hypertrophy (LVH) is considered an independent risk factor even in the absence of systemic hypertension. Electrocardiographic (ECG) LVH with repolarisation changes has been found in some countries to carry more coronary risk than LVH alone. How far this observation is true among adult Nigerians is not known. We therefore decided to study adult Nigerians with ECG-LVH with or without ST-T waves changes and compare them with normal age matched controls (without ECG-LVH) in relation with established modifiable risk factors such as systemic hypertension (BP), body mass index (BMI), fasting blood sugar (FBS) and serum lipids such as total cholesterol (Tc), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and triglyceride (TG). Adult Nigerians who were consecutively referred to the ECG laboratory were randomly recruited. Three hundred patients were studied. Their blood pressures (BP) as well as body mass indices were recorded after recording their resting 12 read ECG using portable Seward 9953 ECG machine. Their waist-hip ratio (WHR) was also recorded. Blood samples were taken to determine their fasting blood sugar and serum lipids. Their ECG tracings were read by the cardiologists involved in the study while the blood samples were analysed by the chemical pathologist also involved in the study. At the end of the ECG reading, the patients were divided into 3 groups according to whether there was no ECG-LVH (control group A), ECG-LVH alone (group B), and ECG-LVH with ST-T waves changes (group C). One hundred and fifty (50%) patients belonged to group A, 100 (33.3%) patients to group B and 50 (16.7%) group C. Group B patients were found to have higher modifiable risk factors in form of systemic BP. Tc, LDL-C, and WHR compared to group A. However, the group C patients had increased load of these coronary risk factors in terms of BP elevation, higher BMI, FBS, and scrum cholesterol compared to group B. In addition, more female patients were involved in group C. The mean age of group C patients compared to group B was also significantly higher (P<0.001) even though no significant age difference was noted between group C and group A patients. It is concluded that Nigerians with ECG-LVH with ST-T waves changes have increased risk of cardiovascular risk factors compared to normal group A patients and even patients with EGC-LVH (group B) alone. Hence, they represent subset of patients to be aggressively followed up with multiple risk factors intervention.

Ventricular arrhythmias: Q-T prolongation and left ventricular hypertrophy in adult Nigerians with hypertensive heart disease

Seventy adult Nigerians with hypertensive heart disease (HHD) and 68 healthy controls were studied for ventricular arrhythmias (VA). The roles of QT prolongation and left ventricular hypertrophy in these arrhythmias were received. The mean age of the study population was 49.9 +/- 6.0 years. 14 (20.0%) patients had cardiac arrhythmias with 3 patients having premature ventricular contractions (PVC). Ten (14.3%) cases had QTc prolongation out of which 1 patient had PVC. Some factors that were found to be associated with QT prolongation in HHD include: left ventricular hypertrophy, persistently elevated systolic blood pressure and female gender. There was a positive correlation between left ventricular hypertrophy and QTc prolongation and also between QTc prolongation and frequency of ventricular arrhythmias.

Acute encephalopathy associated with metronidazole therapy

A forty-eight year-old male with amoebic liver abscess became encephalopathic 3 days following oral metronidazole. Withdrawal of the drug led to prompt resolution of all encephalopathic symptoms.