Cardiovascular Journal of Africa: Vol 26 No 5 (September/October 2015)

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CARDIOVASCULAR JOURNAL OF AFRICA • Vol 26, No 5, October/November 2015 AFRICA 29
ences in BP between adherent and non-adherent patients: 141 ±
22/84 ± 15 mmHg vs 168 ± 30/105 ± 18 mmHg for visit one (p <
0.0001); and 146 ± 23/86 ± 17 mmHg vs 172 ± 34/99 ± 22 mmHg
for visit two (p = 0.002 for SBP and p = 0.19 for DBP).
Amlodipine results: an undetectable level of amlodipine was
found at both visits in 10 (15.4%) patients and in four (6.2%)
patients at either visit. Fifty-one (78.5%) patients were adher-
ent at both visits. The BP of patients adherent to amlodipine
at visit one was 141 ± 22/85 ± 14 mmHg vs 176 ± 27/108 ± 19
mmHg in the non-adherent group (p < 0.0001). At visit two the
adherent group had a BP of 148 ± 29/86 ± 17 mmHg vs 173 ±
21/102 ± 22 mmHg (p = 0.008 and p = 0.005 for SBP and DBP).
At both visits 67% of those non-adherent to amlodipine were
non-adherent to enalapril.
Conclusion: Monitoring antihypertensive adherence through
therapeutic drug monitoring is a feasible option at the clinic.
Non-adherence strongly predicts the presence of uncontrolled BP.
ECHOCARDIOGRAPHIC ASSESSMENT OF PULMO-
NARY ARTERY SYSTOLIC PRESSURE AND OUTCOMES
IN AMBULATORY HEART FAILURE PATIENTS: A
MOROCCAN STUDY
Sabri Fatima Ezzahra*, Abelhad Meriam, Habbal Rachida
Department of Cardiology, Ibn Rochd University Hospital,
Casablanca, Morocco;
Purpose: Pulmonary hypertension (PH) is a predictor of morbid-
ity and mortality in patients with chronic heart failure (HF) but
it is poorly described in our population. We sought to study the
prevalence, determinants and prognostic significance of PH in a
large representative population with HF.
Methods: We retrospectively studied 1 613 patients with chronic
heart failure on the HF registry of the University Hospital Ibn
Rochd, Casablanca. Systolic pulmonary artery pressure (PASP)
was determined by echocardiography and pulmonary hyperten-
sion was defined as PASP > 50 mmHg.
Results: The proportion of patients with PASP ≥ 35, ≥ 40, ≥ 45
and ≥ 50 mmHg was: 26.47, 22.87, 17.24 and 12.15%, respec-
tively. PH was present in 196/1 613 patients, with an average
age of 69 years. There was 40.30% women and 59.70% men;
96.43% of patients had low left ventricular ejection fraction
(LVEF) and only 1.02% had preserved LVEF. The aetiology
of HF was predominantly ischaemic (17.86%). Most patients
were receiving diuretics (66.33%), beta-blockers (58.16%) and
ACE inhibitors (86.22%), whereas 55.10% were on spironolac-
tone. The aetiology of PH was mostly due to left heart disease,
while only 1.02% was due to primary HF and 2.04% of patients
had chronic obstructive pulmonary disease (COPD). Patients
with PH had a rate of 6.06% occurrence of acute heart failure
decompensation (AHFD). The association with right ventricu-
lar dysfunction (RVD) increased the risk of AHFD and compli-
cations. We noted that patients with both PH and RVD had a
greater risk of AHFD (14.28%).
Conclusion: PH is common in HF patients, which is associated
with a worse LV function and it provides incremental prognostic
information. The combination of PH and RVD is particularly
ominous: elevated PASP, determined by echocardiography, can
identify ambulatory patients with HF at increased risk for
adverse events.
PREVALENCE AND FACTORS ASSOCIATED WITH
NON-DIPPING PATTERN IN MOROCCAN HYPERTEN-
SIVE PATIENTS: ABOUT 50 CASES REPORTS
Sabri Fatima Ezzahra*, Elhammiri Ayoub, Bentaouen Tarik,
Habbal Rachida
Department of Cardiology, Ibn Rochd University Hospital,
Casablanca, Morocco;
Objective: Ambulatory blood pressure (BP) monitoring has
become useful in the diagnosis and management of hypertensive
individuals. In addition to 24-hour values, the circadian varia-
tion of BP adds prognostic significance in predicting cardiovas-
cular outcome. Our aims were to determine the prevalence of
non-dipping patterns and to assess clinical conditions associ-
ated with this status in groups of both treated and untreated
hypertensive subjects, studied separately.
Methods: Clinical data and 24-hour ambulatory BP monitor-
ing were obtained from 50 hypertensive patients. There were
20 previously untreated and 30 treated hypertensive patients.
Ambulatory BP monitoring was performed on 40 patients with
an oscillometric device. A non-dipping pattern was defined
when the nocturnal systolic BP dip was < 10% of the daytime
systolic BP.
Results: The prevalence of non-dipping was 44% in the untreat-
ed group and 52% in treated patients. In both groups the non-
dipping pattern was associated with advanced age, obesity,
diabetes mellitus and overt cardiovascular or renal disease. In
treated patients, non-dipping was associated with the use of a
higher number of antihypertensive drugs but not with the time
of the day at which antihypertensive drugs were administered.
Conclusion: The non-dipping pattern is common in hypertensive
patients. A clinical pattern of high cardiovascular risk is associ-
ated with non-dipping, so it is important to assess this measure-
ment in hypertensive patients.
VALUE OF NON-INVASIVE ASSESSMENT OF PULMO-
NARY HYPERTENSION IN HEART FAILURE WITH
PRESERVED EJECTION FRACTION, AND ITS PROG-
NOSTIC IMPORTANCE
Sabri Fatima Ezzahra*, Abelhad Meriam, Habbal Rachida
Department of Cardiology, Ibn Rochd University Hospital,
Casablanca, Morocco;
Objectives: Pulmonary hypertension (PH) is a frequent compli-
cation in heart failure (HF). However, its impact factor in heart
failure with preserved ejection fraction (HFPEF) is not well
known. This study aimed to identify the prognostic value of PH
measured by echocardiography in patients with HFPEF.