Risk-Factor Profile and Comorbidities in 2398 Patients With Newly Diagnosed Hypertension From the Abuja Heart Study

Abstract

Risk factors, comorbidities, and end-organ damage in newly diagnosed hypertension (HT) are poorly described in larger cohorts of urban African patients undergoing epidemiological transition. We therefore decided to characterize a large cohort of hypertensive subjects presenting to a tertiary health center in sub-Saharan Africa.It is an observational cross-sectional study. We prospectively collected detailed clinical, biochemical, electrocardiography, and echocardiography data of all subjects with HT as the primary diagnosis in patients presenting at the Cardiology Unit of the University of Abuja Teaching Hospital over an 8-year period.Of 2398 subjects, 1187 patients (49.4%) were female with a mean age of 51 ± 12.8 years. Presenting symptoms and signs were most commonly palpitation in 691 (28.8%) followed by dyspnoea on exertion in 541 (22.6%), orthopnea in 532 (22.2%), pedal oedema in 468 (19.5%), paroxysmal nocturnal dyspnoea in 332 (13.8%), whereas only 31 (1.3%) presented with chest pain. Risk factors were obesity in 671 (28%); 523 (21.8%) had total cholesterol >5.2 mmol/L, diabetes mellitus was present in 201 (8.4%) and 187 (7.8%) were smokers.End-organ damage was present in form of echocardiographic left ventricular hypertrophy in 1336 (55.7%) followed by heart failure in 542 (22.6%). Arrhythmias occurred in 110 (4.6%) of cases, cerebrovascular accident in 103 (4.3%), chronic kidney disease in 26 (1.1%), hypertensive encephalopathy in 10 (0.4%), and coronary artery disease in 6 (0.26%). There were marked differences in sex as women were more obese and men presented with more advanced disease.The burden of HT and its complications in this carefully characterized African cohort is quite enormous with more than three-fourth having one form of complication. The need of effective primary and secondary preventive measures to be mapped out to tackle this problem cannot be overemphasized.

Use of single pill anti-hypertensive combination medications in Cardiology Clinic of a Tertiary Health Institution in Nigeria

“…Similar to previous studies, (17) our female hypertensive patients had significantly higher body mass index and LDL cholesterol.…”

Characteristics, treatment, and control of hypertension in public primary healthcare centers in Nigeria: baseline results from the Hypertension Treatment in Nigeria Program

“…The higher recruitment and hypertension control rates of female participants in hypertension studies in Africa has been shown in large population hypertension registries in Africa [16,17]. Potential reasons for these differences between sexes include earlier detection of hypertension in women at both antenatal and postnatal cares, and higher health-seeking behaviors in African women compared with men.…”

The Effect of Nebivolol on Office Blood Pressure of Blacks Residing in Sub-Saharan Africa (A Pilot Study)

“…In addition, 5 or 10 mg nebivolol resulted in response rates of >55%. These findings are of clinical importance, especially because of the excessive burden of hypertension and its complications and the low rates of blood pressure control in sub-Saharan Africa (2,16). The results imply that beta-1-selective beta-blockers like nebivolol apart from being used as monotherapy in grade 1 hypertension could be the fourth class of medication to be considered after maximum doses of a combination of long-acting calcium channel blockers, thiazide diuretics and renin-angiotensin-aldosterone blockers have been (6.90, 9.30) used in this population group.…”

“…Although hypertension affects every racial group, complications such as heart failure, chronic kidney disease and cerebrovascular accidents are more prevalent in the Black population ( 1 ). For example, in the Abuja Heart Study, about seventy-five percent (75%) of hypertensive patients presenting de novo to a tertiary healthcare institution had one or more complications on presentation ( 2 ). In addition, there is substantial clinical evidence indicating that monotherapy with beta-blockers, angiotensin converting enzyme inhibitors and angiotensin receptor blockers are less effective in reducing blood pressure among hypertensive Black patients compared to Whites ( 3 – 5 ).…”