Objective: To determine the prevalence of circadian BP patterns and to assess factors associated with the non-dipping pattern in untreated and treated hypertensive patients, studied separately. Methods: Clinical data and ABPM were obtained from 52 untreated and 168 treated hypertensive patients referred for ABPM to Monkole Hospital in Kinshasa. Twenty-four ABPM was performed using an oscillometric device. Non-dipping pattern encompasses non-dipping (nocturnal systolic BP dip less than 10% of daytime systolic BP) and reverse dipping (mean night SBP higher than the day SBP). Results: the prevalence of non-dipping pattern was 75% (63.5% non-dipping and 11.5% reverse dipping) and 70% (60.1% non-dipping and 10.1% reverse dipping) in untreated and treated hypertensive patients, respectively. Advanced age (adjusted OR 1.80; 95%CI 1.96 -3.38; p = 0.015), female sex (adjusted OR 2.28; 95%CI 1.19 -4.36; p = 0.013), diabetes (adjusted OR 5.06; 95%CI 1.38 -6.95; p = 0.014), reduced kidney function (adjusted OR 3.10; 95%CI 1.50 -6.43; p = 0.018), inflammation (adjusted OR 2.65; 95%CI 1.76 -6.48; p = 0.031), LVH (adjusted OR 4.45;; p = 0.024) and antihypertensive therapy (adjusted OR 0.19; 95%CI 0.12 -0.64; p = 0.018) emerged as the main independent factors significantly associated with the non-dipping pattern in the study population. Conclusion: the non-dipping pattern was a common findHow to cite this paper: Mvunzi, T

Hypertension (HT) is the largest contributor to cardiovascular disease mortality and is characterized by high prevalence and low awareness, treatment, and control rates in sub-Saharan Africa. May Measurement Month (MMM) is an international campaign intended to increase awareness of high blood pressure (BP) among the population and advocate for its importance to the health authorities. This study aimed to increase awareness of raised BP in a country where its nationwide prevalence is yet unestablished. Investigators trained and tested how to use the campaign materials, collected participants’ demographic data, lifestyle habits, and obtained from each one three BP measurements. Hypertension was defined as a BP ≥140/90 mmHg, or use of antihypertensive medication. Of the 18 719 screened (mean age 41 years; 61.4% men), 26.1% were found to be hypertensive of whom 46.3% were aware of their condition and 29.6% were taking antihypertensive medication. The control rate of HT was 43.0% in those on medication and 12.7% among all hypertensive respondents. Comorbidities found were—diabetes (3.3%), overweight/obesity (35.5%); and a previous stroke and a previous myocardial infarction were reported by 1.2% and 2.0%, respectively. Imputed age- and sex-standardized BP was higher in treated hypertensive individuals (135/85 mmHg) than those not treated (124/78 mmHg). Based on linear regression models adjusted for age and sex (and an interaction) and antihypertensive medication, stroke survivors, those who drank once or more per week (vs. never/rarely), and overweight/obese participants were associated with higher BP. MMM18 results in the Democratic Republic of the Congo corroborated the high prevalence of HT in Kinshasa screenees with low rates of treatment and control. Extension of the MMM campaign to other parts of the country is advisable.

Background: Flight and cabin crew are known to be at increased risk for atherosclerotic cardiovascular disease (ASCVD). However, ASCVD risks have not yet been compared in flight and cabin crew in low resource settings like sub-Saharan Africa. Objectives: To assess absolute ASCVD risk estimate and its clinical correlates among flight and cabin crew. Methods: From June 1 st 2015 to December 30 th 2015, 379 consecutive aviation navigants (Flight crew: 62.5%, pilots: 46.2%, women: 29.6%, Caucasians 23.2%) were enrolled in a cross-sectional survey of ASCVD risk estimate using the Framingham tools. They underwent a physical examination for either initial or renewal medical certificate Class 1 or 2 including blood chemistry, ECG, and echocardiogram as per International Civil Aviation Organization (ICAO) and Civil Aviation Authority (CAA-DRC) medical regulations. We modeled the risk of moderate and high ASCVD estimate in a stepwise logistic regression. Results: Low, moderate and high ASCVD risk estimates were observed respectively in 248 (65.4%), 64 (16.9%), and 67 (17.7%) navigants. Moderate and high ASCVD risk estimates predominated among flight than cabin crew (23.6% vs. 5.6%; p < 0.0001 and 28.3% vs. null; p < 0.001), low ASCVD risk estimate among cabin than flight crew (94.4% vs. 48.1%; p ≤ 0.001). Low ASCVD risk estimates were mostly encountered in Blacks (86.5%) and moderate in Caucasians (43.8%). Clinical correlates of moderate ASCVD risk estimates included being flight crew (adjusted OR 3.33 [1.42-7.81]; p = 0.006), Caucasian (adjusted OR 2.71 [1.43-5.

INTRODUCTION: We assessed determinants of serum hs-CRP level in pilots and air traffic controllers (ATCs) and its impact on their atherosclerotic cardiovascular disease (ASCVD) risk.METHODS: We obtained serum hs-CRP measurements, evaluated traditional cardiovascular risk factors and assessed global ASCVD risk based on 2018 ESH/ESC guidelines. Elevated hs-CRP was hs-CRP values > 3 mg L1. Determinants of elevated hs-CRP were assessed using stepwise logistic regression analysis. We used the net reclassification method to evaluate the impact of hs-CRP levels on global ASCVD risk.RESULTS: Of the 335 subjects (mean age 45.4 11.6 yr, 70% pilots, 99% men, 37% Caucasians), 127 individuals (39.5%) presented with elevated hs-CRP levels. Compared to those with normal hs-CRP, individuals with elevated hs-CRP were older with faster heart rate and higher blood pressure, BMI, and P wave amplitude. The proportion of individuals with elevated hs-CRP was greater among those with smoking habits, physical inactivity, MetS, tachycardia, altered P wave axis, LVH, and HT-TOD. Aging (aOR 2.15 [1.676.98]), hypertension (aOR 3.88 [2.296.58]), type 2 diabetes (aOR 6.71 [1.7710.49]), tachycardia (aOR 2.03 [1.914.53]), and LVH (aOR 2.13 [1.647.11]) were the main factors associated with elevated hs-CRP levels. Low, moderate, high, and very high risk were observed in 24 (15%), 68 (41%), 62 (37%), and 12 (7%) subjects, respectively. Including hs-CRP resulted in the net reclassification of 25% of subjects, mostly from moderate to high risk.CONCLUSION: The integration of hs-CRP improved the estimation of global ASCVD risk stratification. However, a survey with a comprehensive population assessing the cost/benefit impact of such a referral is needed.Buila NB, Ntambwe ML, Mupepe DM, Lubenga YN, Bantu J-MB, Mvunzi TS, Kabanda GK, Lepira FB, Kayembe PK, Ditu SM, MBuyamba-Kabangu J-R. The impact of hs-CRP on cardiovascular risk stratification in pilots and air traffic controllers. Aerosp Med Hum Perform. 2020; 91(11):886891.

Objective: To assess the prevalence of left ventricular hypertrophy (LVH) and linked cardiovascular risk factors in civilian aircrew.Methods: Cardiovascular risk factors were assessed among flight and cabin crew undergoing routine clinical and biological evaluation for initial or renewal of aeromedical license. The evaluation also included a standard 12-lead ECG and echocardiography. Echo-based LVH was LVM ≥ 49 g/m2.7 (men) or ≥ 45 g/m2.7 (women). LVH was categorized as mild (men: 49-55 g/m2.7; women: 45-51 g/m2.7), moderate (men: 56-63 g/m2.7; women: 52-58 g/m2.7), or severe (men: ≥ 64 g/m2.7; women: ≥ 59g/m2.7) according to Lang’s report.Results: Among the 379 aircrew members (70.4% men; 23% Caucasians; 62.5% flight crew; mean age 40.6 ± 12.8 years), LVH was present in 36 individuals (9.5%) with mild, moderate and severe pattern observed respectively in 19.4%, 33.3% and 47.2% of the cases. The rate of LVH amounted to 16.7% in normotensive subjects, 25.0% in those with prehypertension, and 58.3% among hypertensive individuals. In addition to age of 40-59y (OR: 8.48; 95% CI: [2.23-12.23]; p = .002) or more (4.22 [1.57-11.35]; p = .004), hypertension (3.55 [1.50 - 8.41]; p = .004), overweight/obesity (5.33 [1.14 - 25.05]; p = .034) and hyperuricemia (5.05 [2.11 - 12.09]; p = .001), all well-known constituents of the metabolic syndrome, were the main factors significantly associated with LVH.Conclusion: The frequency and link of LVH to the components of the metabolic syndrome highlights the need for a comprehensive approach to the management of cardiovascular risk factors in civilian aircrew.