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CARDIOVASCULAR JOURNAL OF AFRICA • Vol 26, No 5, October/November 2015
28
AFRICA
as the primary diagnosis in patients presenting at the Cardiology
Unit of the University of Abuja Teaching Hospital over an
eight-year period.
Results:
There were 1 187 female patients (49.4%) of the 2 398
subjects, with a mean age of 51
±
12.8 years. Presenting symp-
toms and signs were most commonly palpitation in 691 patients
(28.8%), followed by dyspnoea on exertion in 541 (22.6%),
orthopnea in 532 (22.2%), pedal oedema in 468 (19.5%), and
paroxysmal nocturnal dyspnoea in 332 (13.8%), whereas only
31(1.3%) presented with chest pain. Risk factors were obesity in
671 patients (28%), 523 (21.8%) had a total cholesterol level
>
5.2 mmol/l, diabetes mellitus was present in 201 (8.4%) and 187
(7.8%) were smokers.
End-organ damage was present in the form of echocardio-
graphic left ventricular hypertrophy in 1 336 patients (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 encepha-
lopathy in 10 (0.4%) and coronary artery disease in six (0.26%).
There were marked differences in gender as women were more
obese and men presented with more advanced disease.
Conclusion:
The burden of hypertension and its complications in
this carefully characterised African cohort was quite enormous
with more than two-fifth having one form of complication. The
need of effective primary and secondary preventive measures to
be mapped out to tackle this problem cannot be overemphasised.
RIGHT VENTRICULAR SYSTOLIC DYSFUNCTION IS
COMMON IN HYPERTENSIVE HEART FAILURE: A
PROSPECTIVE STUDY IN SUB-SAHARAN AFRICA
Ojji Dike*, Opie Lionel
1
*Cardiology Unit, Department of Medicine, University of
Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria; dikeo-
jji@yahoo.co.uk1
Hatter Institute for Heart Research, Interuniversity Cape Heart
Group of the MRC, University of Cape Town Medical School,
South Africa
Introduction:
Right ventricular (RV) systolic dysfunction is now
widely recognised as a strong and independent predictor of
adverse outcomes in patients with heart failure (HF). Reduction
of RV systolic function more closely predicts impaired exercise
tolerance and poor survival than does left ventricular (LV)
systolic function. In spite of this, there is a dearth of data on RV
function in hypertensive HF, which is the commonest form of
HF in sub-Saharan Africa. We therefore conducted a prospec-
tive cohort study of hypertensive HF patients presenting to the
University of Abuja Teaching Hospital, Abuja, Nigeria over an
eight-year period.
Methods:
This was prospective cohort study. Hypertension
was defined according to the JNC VII guidelines. The subjects
also had one or more clinical features of long-standing hyper-
tension, which included thickened arterial wall, locomotor
brachialis and at least grade 2 hypertensive retinopathy. HF
was diagnosed according to the guidelines of the European
Society of Cardiology. The functional status of the HF subjects
was categorised according to the New York Heart Association
functional classification. RV systolic function was defined as a
tricuspid annular plane systolic excursion (TAPSE)
<
15 mm
using M-mode echocardiography.
Results:
RV systolic dysfunction was identified in 272 (44.5%)
of the 611 subjects that were studied. Subjects with TAPSE
<
15 mm had a worse prognosis compared to those with TAPSE
≥
15 mm.There was a significant correlation between TAPSE and
other adverse prognostic markers, including left and right atrial
area, LV size, LV mass, LV ejection fraction, restrictive mitral
inflow and RV systolic pressure (RVSP). However, LV ejection
fraction and right atrial area were the only independent deter-
minants of RV systolic dysfunction.
Conclusion:
Hypertensive HF is a major cause of RV systolic
dysfunction, even in a population with a low prevalence of coro-
nary artery disease, and RV systolic dysfunction is associated
with a poor prognosis in hypertensive HF. Detailed assessment
of RV function should therefore be part of the echocardio-
graphic evaluation of patients with hypertensive HF.
ASSESSING ANTIHYPERTENSIVE ADHERENCE WITH
THERAPEUTIC DRUG MONITORING
Rayner Brian*, Jones Erika, Castel Sandra, Blockman Marc,
deCloedt Eric, Schwager Sylva, Sturrock Edward, Lesossky
Maia
University of Cape Town, Groote Schuur Hospital, Cape Town,
South Africa;
brian.rayner@uct.ac.zaObjective:
The proportion of South African hypertensive patients
with controlled blood pressure (BP) is low. Non-adherence
may play an important role but monitoring adherence remains
difficult. Two commonly used antihypertensives are amlodipine
and enalapril. This study aimed to determine whether monitor-
ing amlodipine levels and inhibition of angiotensin converting
enzyme (ACE) are feasible means to determine patient adherence.
Methods:
Patients attending a referral clinic for resistant hyper-
tension who were prescribed enalapril and amlodipine (
±
other antihypertensives) were enrolled. After informed consent,
patients underwent BP monitoring, filled in a questionnaire
on adherence, and blood was sampled for amlodipine levels
and ACE activity. Assessments were repeated. Amlodipine was
assayed using liquid chromatography–mass spectrometry. The
degree of ACE inhibition was determined by the z-phenylala-
nine-histidine-leucine and hippuryl-histidine-leucine (zFHL/
HHL) ratio.
Results:
One hundred patients (age
±
50.5 years and 46% male)
were enrolled, with 65 follow-up assessments. There was no
difference between the mean BP from visit one to two. Most
patients (90%) self-medicated, and 24% used pillboxes.
ACE inhibitor results:
control data suggest a zFHL/HHL ratio
<
1.4 to be consistent with no ACE inhibition. Ten patients (17%)
were found to be non-adherent at both visits and 12 (20%) at
either visit one or two; 38 (63%) were adherent at both visits.
Five patients had missing data. There were significant differ-