Page 25 - 4th All African Conference on Heart Disease, Diabetes and Stroke

CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 5, May 2013 AFRICA 23
patients are unable to afford long-term drugs for hypertension, renal
sympathetic denervation could be a safe solution for this problem.
Subjects and methods: We studied 10 Indian patients (4 male, 6
female) in the age group 35–58 years with resistant hypertension on
a minimum of 3 antihypertensive drugs, including diuretic (thiazide
or torsemide), angiotensin receptor blockers like telmisartan or olme-
sartan, angiotensin-converting enzyme (ACE) inhibitors like ramipril,
beta-blockers (like metoprolol and nebivolol) and alpha-blockers like
prazosin and clonidine (in 2 cases). BP range (on three drugs) was
190/106 to 156/98 (average of 170 systolic and 100 diastolic). Renal
artery stenosis and azotaemia were ruled out. All were taken for renal
denervation procedure via femoral route in the cardiac catheter labora-
tory. Mild sedation (injection of midazolam 1 mg) was given during
the procedure. A 5F ablation catheter via a 6F femoral arterial sheath
was used for the procedure along with a Cordis radiofrequency ablator
used to deliver 6-8 watts RF energy. The ablation was performed in 3
opposite consecutive points in each renal artery about 4 mm apart.
Results: Post ablation patients had reduction in systolic and diastolic
blood pressures. After 1 week, BP range (on one or two antihyper-
tensive drugs) was 146/86 to 130/80; average 136/84. After 6 months
the BP range on one to two drugs was 140/78 to 130/70. Five patients
who were followed up for 1 year had BP range of 140/80 to 130/76
on 1 or 0 antihypertensive drugs. No complications of the procedure
were encountered.
Interpretation: Catheter-based renal sympathetic denervation is a
useful procedure for systemic hypertension and may find extensive
applications in Africa.
PREVALENCE ETCARACTERISTIQUES DES SYNDROMES
CORONARIENS AIGUS AABIDJAN
PREVALENCE AND CHARACTERISTICS OF ACUTE CORO-
NARY SYNDROMES INABIDJAN
N’Guetta R*, Ekou A, N’Cho-Mottoh MP, Koffi F, Kouame B, Tano
M, Yao H, Angoran I, Afassinou Y, Konin C, Adoh A
Institut de Cardiologie d’Abidjan, Côte d’Ivoire
Introduction: Les présentations cliniques de la maladie coronaire dans
notre mileu sont variées et posent des problèmes spécifiques de prise
en charge.L’objectif de ce travail était de déterminer la prévalence des
syndromes coronariens aigus (SCA) et décrire leurs caractéristiques.
Subjects and methods: Il s’agissait d’une étude rétrospective et
prospective transversale réalisée à l’Institut de Cardiologie d’Abidjan
sur la période allant du 1er Janvier 2002 au 31 Décembre 2012. Tous
les patients hospitalisés en Unité de Soins Intensifs Cardiologiques
pour SCA ont été inclus dans l’étude. Nous avons analysé les cara-
ctéristiques épidémiologiques, les présentations cliniques et la prise en
charge thérapeutique des patients.
Results: La prévalence des SCA était de 13.9% (731 cas/5 244 hospi-
talisations). L’âge moyen des patients était de 54.5 ± 11 ans. On notait
une prédominance masculine avec un sex ratio de 4.12. Les facteurs
de risque cardiovasculaire étaient dominés par l’hypertension artérielle
(60.9%), l’hypercholestérolémie (29.7%), le tabagisme (29.4%) et le
diabète (24.3%). Les présentations cliniques étaient majoritairement
des SCA avec sus-décalage persistant de ST à Troponine I positive
(78.4%), suivis des SCA sans sus-décalage de ST à Troponine I néga-
tive (15.5%) et des SCAsans sus-décalage de ST à Troponine I positive
(6.1%). La revascularisation coronaire était réalisée par thrombolyse et
par angioplastie chez respectivement 3.7% et 11.2% des patients. La
mortalité hospitalière globale était de 6.7%.
Interpretation: La prise en charge précoce par les méthodes de revas-
cularisations coronaires notamment l’angioplastie reste l’enjeu majeur
pour améliorer le pronostic des syndromes coronariens aigus.
AMBULATORY BLOOD PRESSURE MEASUREMENT IN
CAMEROON: HIGH PREVALENCE OF WHITE COAT
HYPERTENSION AND INFLUENCE OF BODY MASS
INDEX
Noah T*, Dzudie A, Ndjebet J, Wawo EG, Kengne AP, Blackett Ngu K
Department of Internal Medicine, Faculty of Health Sciences,
University of Buea, Buea, Cameroon
Introduction: Identifying white coat hypertension (WCH) may avoid
inappropriate commitment of individuals to lifelong and costly blood
pressure (BP) lowering medications. We assessed the prevalence and
determinants of WCH in urban clinical settings in Cameroon.
Subjects and methods: Participants were a consecutive sample of
adults, who underwent ambulatory BP measurements (ABPM) for
the diagnosis of hypertension and evaluation of treatment in three
referral cardiac clinics in the cities of Yaoundé and Douala, between
January 2006 and July 2011. WCH was defined as a clinic systolic
(or diastolic) BP ≥140 (90) mmHg together with an average daytime
ambulatory systolic (diastolic) BP <135 (85) mmHg.
Results: Of the 500 participants included, 188 (37.6%) were women,
230 (46%) were non-smokers and 53 (10.6%) had diabetes mellitus.
The mean age was 51.6 ± 10.2 years. The ABPM readings were
higher in men than in women (p<0.05). The prevalence of WCH
was 26.4% overall, 39.3% in women and 22.4% in men (p =0.01). In
multivariable analysis, body mass index (BMI) was the only signifi-
cant determinant of WCH (odds ratio 1.15 (95% confidence interval:
1.00–1.43), p <0.05).
Interpretation: The prevalence of WCH was high in our study popu-
lation and was correlated only with BMI. Accurate measurement of
BP and appropriate diagnosis of hypertension using ABPM in this
setting may help limiting the consequences of overestimating hyper-
tension severity on individuals, families and health systems.
A STUDY OF AWARENESS OF THE WARNING AGAINST
SMOKING, PERCEPTION OF TOBACCO USE AND TOBAC-
CO CONTROL MEASURES AMONG RESIDENTS OF ABIA
STATE, SOUTH EAST NIGERIA
Ogah OS*, Onyeonoro UU, Madukwe OO, Chukwuonye II,
Akhimien M, Ukaegbu A
Department of Medicine, University College Hospital, Ibadan,
Nigeria
Introduction: As part of global efforts to control tobacco use, in
Nigeria tobacco control is primarily through health education on the
harmful effects of tobacco, disseminated primarily through the media
and cigarette packs. The goal of the health education is to influ-
ence perceptions of tobacco use, thereby discouraging smokers and
would-be smokers from smoking. This study is aimed at ascertaining
the level of awareness of the warning against smoking, perception of
tobacco use and tobacco control measures among residents of Abia
State, south east Nigeria.
Subjects and methods: It is a cross-sectional, population-based
survey of 2 983 respondents (aged 18 years and above) selected
by multistaged sampling technique. Responses were elicited using
an interviewer-administered questionnaire on sociodemographic
characteristics, awareness of warning against tobacco use, sources
of information, perception of harmful effecs of tobacco and tobacco
control measures.
Results: About 88% of the respondents were aware of warnings
against tobacco use; the most common source of information was
media adverts (50.7%). Awareness of warning against tobacco use
was found to be associated with sociodemographic characteristics,
history of smoking, exposure to smoke at home and in public places,
and perception of tobacco use. Similarly, more than 90% of subjects
believed that smoking is harmful to health and also expressed their
support for the law banning smoking in public places.
Interpretation: The study revealed a high level of awareness of the
warnings against tobacco use, positive perceptions about the harm-
ful effects tobacco and tobacco control measures among the study
population, thereby presenting an opportunity for initiating more
robust policies, programmes and interventions for tobacco control
in the state.