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CARDIOVASCULAR JOURNAL OF AFRICA • Vol 26, No 5, October/November 2015
AFRICA
33
mmHg for the females (
p
=
0.045). Mean diastolic BP of males
was also higher than that of females. The majority (633, 89.1%)
had normal BP while 77 children (10.9%) were hypertensive.
Hypertension was commoner (15.9%) among the three-year-
old children. Males had a higher prevalence of hypertension
(11.8%) compared to females (9.9%).
Conclusion:
The blood pressure pattern in preschool children in
PHC demonstrates a high prevalence of hypertension at 10.9%.
There is a need for routine periodic screening of this popula-
tion sub-group for early intervention to prevent tracking into
adulthood.
BNP PREDICTS SYSTOLIC DYSFUNCTION IN PREG-
NANT WOMEN WITH CARDIAC DISEASE
Tibazarwa Kemi*, Nicholson Lauren,
1
Adam Tasneem
2
, Elliott
Catherin
3
, Anthony John
3
, Libhaber Elena
4
, Sliwa Karen
2
*
The Hatter Institute for Cardiovascular Research in Africa,
Cape Town, South Africa, and Muhimbili National Hospital,
Dar es Salaam, Tanzania;
Ktibazarwa@yahoo.com1
University
of Cape Town, South Africa
2
The Hatter Institute for Cardiovascular Research in Africa,
Cape Town, South Africa
3
Department of Obstetrics and Gynaecology, University of
Cape Town, South Africa
4
University of the Witwatersrand, Johannesburg, South Africa
Introduction:
In pregnancy, the importance of BNP levels have
mostly been evaluated in pre-eclampsia. Changes in BNP levels
among women with cardiovascular disease (CVD) complicating
pregnancy have not been characterised.
Methods:
As part of an on-going registry at a specialised
tertiary clinic in Cape Town, we examined the serum BNP
levels in 152 consecutive patients manifesting cardiovascular
disease in pregnancy, or within six months postpartum. Each
patient underwent clinical assessment, ECG, echocardiogra-
phy and laboratory tests, including serum BNP levels, which
were performed at baseline and six-months follow up. Twenty
controls with normal pregnancy also had BNP measurement;
half being antepartum, and half postpartum.
Results:
Median BNP levels were 95 pg/ml (IQR 47–186) at
baseline, and 91 pg/ml (IQR 47–181) at follow up. The base-
line and follow-up BNP levels in patients with cardiac disease
who either presented postpartum or within the first trimester
of pregnancy were 2.5 times greater than those presenting
during the second and third trimester (
p
=
0.0003 and 0.0007,
respectively). This differed from comparisons of BNP levels of
10 healthy pregnant women to 10 healthy women postpartum,
where the BNP levels postpartum were not statistically different
from those antepartum (
p
=
0.17).
There was no demonstrable association between gestational
age, or premature delivery and the corresponding BNP levels.
Despite a 16% sero-prevalence of HIV in our cohort, there was
no association with BNP levels in this cohort.
In addition to elevated BNP levels in patients with left heart
failure, patients with isolated right heart failure had BNP levels
twice that of those without right heart failure (
p
=
0.003),
although this was not associated with any particular underly-
ing primary diagnosis. Nine patients died within the six-month
follow-up period (6%), with the majority dying in the postpar-
tum period. Serum BNP levels at baseline and six months each
predicted left ventricular (LV) dimensions and systolic function
at each visit, respectively, as well as death. Furthermore, base-
line serum BNP was able to predict LV size and dimensions at
six months.
Conclusions:
Serum BNP levels correlated well with LV dimen-
sions, as well as LV and RV function, and may prove useful as
a simple tool for risk stratification of pregnant and postpar-
tum patients with cardiac disease who are at risk of poorer
outcomes. Larger studies may help to distinguish more specific
associations.
This study highlights some of the challenges faced in diag-
nosing heart disease in pregnancy; where not only can the
symptoms and some of the clinical signs overlap with those of
normal pregnancy, but where BNP levels, commonly used in
the management of heart failure, have been known to fluctuate
throughout pregnancy, thereby rendering it difficult to use as a
screening test for heart failure in pregnant women. Our study
helps to address that challenge by showing that for women with
heart disease presenting during certain periods of gestation and
those postpartum, blood BNP measurement may be useful in
detecting CVD, and perhaps even for prognosis.
THE TANZANIAN CARDIOVASCULAR DISEASE
(TANCarD) REGISTRY: FROM PILOT TO FULL PHASE
Tibazarwa Kemi*, Mvungi Robert, Kisenge Peter, Majani Naiz,
Kimambo Delilah, Waane Tatizo, Shemu Tulizo, Kubhoja
Sulenda, Nyangassa Bashir, Janabi Mohammed
Muhimbili National Hospital, Dar es Salaam, Tanzania;
Ktibazarwa@yahoo.comIntroduction:
Cardiovascular disease (CVD) has often taken
the lead among the growing NCD epidemic that many African
countries face, including that faced by Tanzania. However,
still far too little is known about the true burden of CVD in
Tanzania, including in Dar es Salaam. In recent years, scattered
attempts have been made to describe the frequency of CVD
and the risk factors in mostly rural parts of Tanzania. To date,
no systematic study of the epidemiology and natural history of
all-cause CVD has been done in Tanzania. Subsequently, there
is no reliable data on the burden of CVD in Tanzania, including
in the economic capital Dar es Salaam.
Within the national referral hospital Muhimbili National
Hospital (MNH), the Department of Cardiovascular Medicine
attends to over 17 000 patient visits a year (as out-patients and
in-patients), with suspected or, in the vast majority, confirmed
CVD). Given the magnitude of patient flow through this
department, and its reflection of the profile of CVD at large, it
is of highest importance to record and study our patient profile
in great detail to better understand trends in CVD within our
own setting.