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.

[Epidemiological and clinical aspects of atrial fibrillation at the cardiology department of kati university hospital]

Atrial fibrillation is the most frequent permanent rhythm disorder.Theaim of this work was to determine the epidemiological and clinical aspects of atrial fibrillation cases hospitalized in the cardiology department of the University Hospital of Kati.

MATERIALS AND METHODS

We carried out a descriptive retrospective study, from January 2018 to December 2019.Patients of all ages and both sexes with clinical and EKG atrial fibrillation admitted to the department during the study period were included in the study.The variables studiedwere: socio-demographic characteristics, clinical signs, classification of atrial fibrillation, and comorbidities associated.

RESULTS

A total of 52 patients were included in the studyof 203 cases hospitalized in the department, with a hospital prevalence of 25.61%, the female sex was predominant 69.23%. The main reason for consultation was heart failure syndrome (46.15%).Arterial hypertension (55.76%) was the mostassociatedcomorbidity. Permanent atrial fibrillation accounted for 63.46% of cases .

CONCLUSION

Atrial fibrillation is the most frequent arrhythmia in our environment, preventive measures must be put in place for early detection and better management of comorbiditiesassociatedwith atrial fibrillation.

[Epidemiology of Covid-19 and high blood pressure association at Mali'shospital]

INTRODUCTION

High blood pressure is a major cardiovascular risk factor. Patients with cardiovascular risk factors are at risk of developing COVID-19. The objective of this study was to determine epidemiology of Covid-19 infected in patients with high blood pressure.

PATIENTS AND METHOD

Descriptive cross-sectional study from April 2020 to June 2020 about patients hospitalized for Covid 19 by PCR diagnosis at the Hopital du Mali Bamako and having high blood pressure. Admission registry and patient charts were used to collect data.

RESULTS

We collected 78 out of 484 in patients which mean hospital frequency of 16.11%. The mean age was 55.21 +/- 14.61 years. Sex ratio M / F was 1.36. Patients were followed for high blood pressure in 59% of cases. Medical history was ischemic heart disease in 2.6% and dilated cardiomyopathy in 2.6%. Main functional signs were cough in 41.02% and lost of taste in 11.53%. High blood pressure on admission was grade 2 in 37.2% and grade 3 in 3.8%. Treatments received were calcium channel blockers 41.02%, inhibitors of the reninangiotensinaldosterone system 16.66% and combinations 15.38%. Hospital mortality was 10.3%. There was no statistically significant difference in mortality between known hypertensive patients and de novo hypertensive patients. There was also no statistically significant difference in mortality by grade of hypertension.

CONCLUSION

High blood pressure can be associated to Covid 19. Treatment is based on calcium channel blockers and reninangiotensinaldosterone system inhibitors. It has an impact on the prognosis of the disease with significant mortality.

[Interest of multidetector CT virtual hysterosalpingography in the diagnosis of utero-peritoneal fistulas about 4 cases]

We report four cases of uterine fistula found with the multidetector CT virtual hysterosalpingography. Patients were received for suspicious of a utero-peritoneal fistula at hysterosalpingography. They were young people at childbearing age (average age of 33 years), multigravidae, two of whom were nulliparous, one primiparous and one multiparous. We noted a history of voluntary interruption of pregnancy by curettage and a cesarean section. For the opacification, we used the classic hysterography standard equipment by means of 1/5 diluted iodine with saline solution as contrast. The multidetector CT virtual hysterosalpingography revealed small uterine perforations including three which were located in uterine posterior face at cervico-isthmic area and corporeal area, bringing about a utero-peritoneal fistula. The multidetector CT virtual hysterosalpingography is a simple and powerful technique for the diagnosis of utero-peritoneal fistula. It is convenient and then deserves an important place in the evaluation of uterine fistula.

[Knowledge and practices of hypertension in nursing staff of the Hospital Gabriel Touré and Point G]

OBJECTIVE

This work aimed to study the quality of diagnosis and management of high blood pressure (HBP) by the practitioners of the Gabriel TOURÉ and point G teaching hospitals of Bamako.

MATERIALS AND METHODS

It was a descriptive and analytical, cross-sectional study during the study period from 1st March 2009 to 28 February 2010. It included all physicians and paramedics of the teaching hospital of the Point G and Gabriel TOURÉ in Bamako.

RESULTS

A total of 283 practitioners (physicians and the paramedics) from both teaching hospitals have accepted our questionnaire, including 133 doctors and 185 paramedics. CHU Gabriel TOURÉ accounted for 55.1%, the majority came from the department of cardiology with 18.4%. Doctors accounted for the largest square with 47.0%. The majority of our practitioners (59%) say it takes at least one session during three medical consultations to diagnose the HBP. Only 29,60% define the HBP from 140/90 mm Hg. With a blood pressure goal of 58, 30% and 57.20% of practitioners claimed to retain 140/90 mm Hg, respectively for the diabetic and the renal-insufficient patients. A considerable number of our practitioners (27.9%) still used in pregnant women the triplet diuretic/IEC/diet without salt. The information of patients on some important aspects of the pathology prior to any therapeutic strategy had been conducted in 63.6.

CONCLUSION

The high blood pressure must be a major concern for medical and paramedical staff today.

[Indications and anomalies of extended electrocardiogram recording (24 hours) at the Gabriel Toure university hospital in Bamako]

AIM

To specify indications and main anomalies of the 24 hours electrocardiogram in Bamako.

METHODOLOGY

The study was retrospective and conducted from 1st January 2008 to 31st July 2013, on patients whose file comprised a readable recording holter. The Holter recordings were analyzed by the software synetec (syneview 2) of ELA medical. Patients data were analyzed by SPSS 18 and redaction made using Word 2010.

RESULTS

90.2% of the recordings were retained. Mean Age of the sample was of 44,02 ± 16,95 years, the sex-ratio H: F 1,18 with 79.3% of patients coming from the services of cardiology. The indications were: palpitations (32.6%), suspicions of disorder of the rate/rhythm (27.2%), loss of consciousness, cerebral vascular accidents ischemic each one 15.2% and seeks of cause of faintness in (9.8%). An anomaly was found for the indications of disorder of the cardiac rhythm, palpitations, the cerebral vascular accidents ischemic, fainting and the losses of consciousness in resp. 80%, 66.6%, 28.5%, 22.2% and 14.2%.

CONCLUSION

The 24 hours electrocardiographic recording is an examination of a great value in looking for cardiac rhythm disorders field of the disorders of the cardiac rhythm. Its provision will have to be effective in the university structures and the evolution towards the forms at longer duration quickly undertaken in Mali.

[Chronic kidney failure at subclinical stage in hypertensive patients in the cardiology department of the Gabriel TOURE university hospital]

OBJECTIVE

This work aimed to describe the epidemiological, clinical, biological and ultrasound aspects of the subclinical renal failure in hypertensive patients in the department of cardiology of the Gabriel TOURÉ University Hospital of Bamako.

PATIENTS AND METHODS

The study was cross-sectional and prospective from 1 January 2007 to 31 December 2007 in the cardiology department of the Gabriel Touré University Hospital. These were all patients who achieved at least the basic test for renal impairment such as serum creatinine, 24h proteinuria, renal ultrasound.

RESULTS

Total of 114 patients with kidney failure without evocative clinical symptoms have been included, among them 60 men and 54 women, average age of 57 years. In the hypertensive population, the beginner to moderate chronic renal failure had a frequency of 12.9% (114/880), the sex ratio was 1.11 in favor of men. Patients aged less than 60 years were more numerous with a frequency of 61.5%. Dyspnea (38.6%), and headache (36.8%) were the main manifestations of the high blood pressure (HBP). Renal disease characterized by microalbuminuria was predominant compared to the macro-albuminuria: 25.5% versus 7%. Renal ultrasound was abnormal in 14.1% with a predominance of stage 0 (86%), stages 1 and 2 were each 7%, we have not found any stage 3.

CONCLUSION

Chronic renal failure is a frequent complication of the hypertension. Some biological tests are necessary for the diagnosis. Renal ultrasound remains a useful test for its assessment. The optimal treatment of high blood pressure is essential, as it not only reduces the overall cardiovascular risk of patients, but also slows or even stabilizes the worsening of renal function.

[Arterial hypertension and pregnancy in Bamako: epidemiologic and clinical aspects]

AIM

To study epidemiological aspects of the high blood pressure in pregnancy in Bamako.

MATERIAL AND METHODS

The study was prospective from january to december 2006 about 250 pregnant with arterial hypertension and without any other cardiovascular disorder. The study was performed in CHU Gabriel Touré and CSRef I and V in Bamako using SPSS v. 11 for collecting and analyzing data.

RESULTS

Arterial hypertension prevalence was 6,5%, with 38% between 20-29 years. 36,8% of them were primigravida 32,4% and 32,4% had 1-3 gestations. 85,6% were married, 74% housewives. 57,6% of the pregnant were not send to school and 28% had primary school instruction 16,4% took contraceptives and 6% were obese. 57,2% didn't have the required minimal number of 3 prenatal consultations and 76,8% were seen in the third trimenon. High blood pressure stage 1 was seen in 40% and stage 2 in 42,4%. Pre-eclampsia and chronic Hypertension made resp. 50,4% and 22%.

CONCLUSION

High blood pressure in pregnancy is characterized by an later occur, by housewives with predominance of stage 1 and 3. Prenatal care is characterized by difficulties in realizing investigations and consultations in quantitative insuffisant prenatal consultations.

[Epidemiology and prognosis of cervix cancer. Experience of the University Gynecology and Obstetric Clinic Ignace Deen of Conakry in 10 years: 1982-1991]

The cancer of the cervix is a tumor that can be detected at an early stage. Unfortunately, it is still detected lately in our service. Thus, it is the underlying cause of death by gynecological affection. After a preliminary work in 1982 about 35 case histories, the authors undertake a 10 years retrospective study where they showed that: the cancer of the cervix is the primary gynecological cancer (78.7%), it obtains between 25 and 65 years, the most often associated factors are early sex, (28%), poor living conditions (22%), cercivitise (17%), metrorrhagias (24%) and leucorrhoea are the most frequent signs. buding lesions are the dominant macroscopic form (68%) epidermoid carcinoma is the most important histological type, 98.7% cancer cases are detected at advanced stages (T3 and T4), the prognosis is dramatic: most patients die at home. This is a great public health issue the solution of which implies the collective action of decision-markers, health personnel and the communities themselves in order to promote early detection.