CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 2, March/April 2011
AFRICA
81
years) and with 11.1% of all the participants being
≤
40 years old.
The mean duration of hypertension was 6.2
±
6.5 years and there
was a slight female preponderance in the study population (male
=
44.1%). The mean BMI was 28.1
±
5.3 kg/m
2
and most of the
patients were categorised as either overweight or obese (72%).
Patients with a history of diabetes made up 19.6% of the study
population and 2.4% were unaware of their diabetes status. There
was a high number of patients with associated hypertension-
related end-organ damage or co-morbidities (35.6%), such as
previous cerebrovascular accidents, coronary artery disease and
heart failure, accounting for 6.9, 1.3 and 6.5%, respectively. At
the start of the study, only 17.1% of the patients had no known
CV risk factor. No statistically significant differences were
observed between the different countries in the baseline charac-
teristics of the patients.
At baseline, the mean SBP and DBP were 168.9
±
19.2
and 102.6
±
12.3 mmHg, respectively and most of the patients
(70.8%) had been on only one or no anti-hypertensive agent
before the study. Also, most of the patients (99.1% at V1, 91.5%
at V2 and 88.7% at V3) started and remained on a standard dose
(5/25 mg) or half-standard dose (2.5/12.5 mg) of the fixed-
dose combination ramipril/HCTZ for the duration of the study
(Table 3).
The patterns of BP changes observed in this study were
similar across the five participating countries. At V2 and V3,
BP significantly changed from baseline: –24.7/–31.7 for SBP
mmHg (
p
<
0.001) and –14.2/–17.9 mmHg (
p
<
0.001) for DBP
(Table 3). Table 4 shows the mean and changes in SBP and
DBP from visit one in patients receiving monotherapy and dual
or more therapy before and after commencement of the study.
SBP and DBP changes were similar in patients who had been on
monotherapy and those who had been on dual or more therapy.
There were 60.2% of the non-diabetic patients on prior mono-
therapy who fulfilled the primary BP goal at V3 for SBP and
DBP, versus 26.5% of diabetic patients on monotherapy. Of those
patients on prior dual or more anti-hypertensive therapy, 41.5%
of the non-diabetics (vs 14.3% of diabetics) met the primary BP
goal at visit three (Table 5).
TABLE 1. THE BASELINE DEMOGRAPHICAND CLINICAL CHARACTERISTICS OF THE PATIENTS
Characteristic
All
(
n
=
449)
Cameroon
(
n
=
100)
Congo
(
n
=
87)
DRC
(
n
=
62)
Madagascar
(
n
=
100)
Nigeria
(
n
=
100)
Age (years)
54.7
±
11.7 55.2
±
11.1 58.3
±
13.1 54.0
±
12.3 51.7
±
10.4 54.2
±
11.3
Male (%)
198 (44.1)
46 (46.0)
31 (35.6)
27 (43.5)
44 (44.0)
50 (50.0)
BMI (kg/m
2
)
28.1
±
5.3
29.2
±
5.3
27.6
±
5.3
28.6
±
5.6
25.6
±
3.9
29.9
±
5.4
Alcohol users (%)
87 (19.4)
32 (32.0)
19 (21.8)
10 (16.1)
8 (8.0)
18 (18.0)
Duration of hypertension (years)
6.2
±
6.5
4.4
±
5.2
7.2
±
7.8
5.9
±
4.9
7.1
±
5.6
6.6
±
7.9
Number of anti-hypertensive agents in use:
0
40 (8.9)
10 (10.0)
–
5 (8.1)
15 (15.0)
10 (10.0)
1
278 (61.9)
50 (50.0)
78 (89.7)
35 (56.4)
72 (72.0)
43 (43.0)
2
99 (22.0)
29 (29.0)
8 (9.2)
18 (29.0)
10 (10.0)
34 (34.0)
3
28 (6.2)
11 (11.0)
1 (1.1)
2 (3.2)
3 (3.0)
11 (11.0)
4
3 (0.7)
–
–
2 (3.2)
–
1 (4.0)
Not sure
1 (0.2)
–
–
–
–
1 (4.0)
SBP (mmHg)
168.9
±
19.2 178.6
±
19.9 180.7
±
24.9 173.7
±
20.7 174.2
±
20.4 166.3
±
22.1
DBP (mmHg)
102.6
±
12.3 105.0
±
12.1 103.5
±
13.0 101.7
±
12.3 105.0
±
11.5 101.3
±
13.0
No using
≤
1 anti-hypertensive agents (%)
318 (70.8)
60 (60.0)
78 (89.7)
40 (64.5)
87 (87.0)
53 (53.0)
DRC: Democratic Republic of Congo, BMI: body mass index, SBP: systolic BP, DBP: diastolic BP. Values are given as mean
±
SD or as number
of cases (%).
TABLE 2. PERCENTAGES OF PATIENTSWITH CO-MORBIDITIESAND SPECIFIED CARDIOVASCULAR RISK FACTORS
Co-morbidities or CV risk factors
All
n
(%)
Cameroon
n
(%)
Congo
n
(%)
DRC
n
(%)
Madagascar
n
(%)
Nigeria
n
(%)
Patients with associated co-morbidities
160 (35.6)
32 (32.0)
29 (33.3)
50 (80.7)
14 (14.0)
35 (35.0)
Cerebrovascular accident
31 (6.9)
10 (10.0)
9 (10.3)
3 (4.8)
2 (2.0)
7 (7.0)
Coronary artery disease
6 (1.3)
–
3 (3.4)
2 (3.2)
–
1 (1.0)
Heart failure
29 (6.5)
1 (1.0)
3 (3.4)
19 (30.6)
–
6 (6.0)
Diabetic nephropathy and microalbuminuria 19 (4.2)
5 (5.0)
3 (3.4)
5 (8.0)
–
6 (6.0)
Others
75 (16.7)
16 (16.0)
11 (12.5)
21 (34.1)
12 (12.0)
14 (14.0)
Cardiovascular risk factors
Overweight/obese
320 (71.6)
63 (63.0)
46 (52.9)
33 (53.2)
54 (54.0)
50 (50.0)
Smokers
21 (4.7)
2 (2.0)
1 (1.1)
2 (3.2)
14 (14.0)
2 (2.0)
Dyslipidaemia
72 (16.0)
9 (9.0)
13 (14.9)
13 (21.0)
24 (24.0)
13 (13.0)
Diabetes
88 (19.6)
7 (7.0)
33 (37.9)
4 (6.4)
24 (24.0)
20 (20.0)
No CV risk factor
77 (17.1)
2 (2.0)
22 (25.3)
17 (27.4)
24 (24.0)
12 (12.0)
DRC: Democratic Republic of Congo.
