Cardiovascular Journal of Africa: Vol 29 No 3 (May/Junel 2018)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 3, May/June 2018 200 AFRICA
combination drugs will be best for African patients and even
for different ethnic groups, will be completed in June 2018.
The results, as well as the availability and cost effectiveness of
drugs, will be taken into account when drafting the treatment
protocols.’
‘We expect the CREOLE trial to show that a diuretic and
a calcium channel blocker (CCB) will be the most effective
anti-hypertensive drugs for black patients, but we don’t know
yet what combination will be best: a CCB and a diuretic, or
a CCB plus angiotensin converting enzyme inhibitor (ACEI),
or a diuretic plus an ACEI. If we get this information, it
will be a big leap forward. We would like to reproduce the
CREOLE trial in South Asia and the Far East, to determine
which two drugs are the best for each ethnic group.’
• High-quality generic anti-hypertensive drugs will be produced
and delivered cost effectively by non-profit-making compa-
nies. These efforts will hopefully lead to more countries in
Africa joining the initiative. Currently only 25% of countries
in Africa have a government policy and guidelines to treat and
reduce the burden of hypertension,’ Poulter said.
*Certificate Course in Management of Hypertension (CCMH) is a joint certi-
fication programme currently being run in India. It is offered by the Public
Health Foundation of India (PHFI), International Society of Hypertension
(ISH), British and Irish Hypertension Society (BIHS) and Centre for Chronic
Disease Control (CCDC). CCMH is a 10-month course, which is currently
being offered at 40 regional training centres across India.
Marí Hudson
References
1. Dzudie A, Rayner B, Ojji D, Schutte AE, TwagirumukizaM, Damasceno
A, et al., on behalf of the PASCAR task force on hypertensiom.
Roadmap to achieve 25% hypertension control in Africa by 2025.
Cardiovasc J Afr 2017; 28(4): 261–272.
2. Barasa FA. CREOLE trial (Comparison of Three Combination
Therapies in Lowering Blood Pressure in Black Africans. http://www.
hypertension%20the%20same%20-%20Felix%20BARASA.pdf.
New high-sensitivity troponin test reduces heart attack risk
The newer high-sensitivity troponin test discovers smaller
amounts of heart-specific proteins, troponins, than the
older troponin test and therefore identifies more myocardial
infarction patients than before. A study from Karolinska
Institutet in Sweden now reports that the risk of a future
heart attack is lower in patients diagnosed with the new test.
A blood test that measures the presence of heart-specific
proteins called troponins is used by emergency clinics to
diagnose myocardial infarction in patients with chest pain.
For the past few years a newer laboratory method has
been used at most hospitals in Sweden that is 10n times
more sensitive than the conventional troponin test. The
high-sensitivity troponin test can discover heart attacks
earlier so that treatment can commence, which is thought
to improve the patient’s prognosis. ‘But there is a lack
of larger studies examining whether the high-sensitivity
troponin test is of any significance for patients with newly
diagnosed myocardial infarction in terms of survival or
the risk of another heart attack,’ says study leader Dr
Martin Holzmann, associate professor of epidemiology at
Karolinska Institutet’s Department of Medicine in Solna and
physician at Karolinska University Hospital.
The study included all patients in Sweden who had had
their first heart attack between 2009 and 2013. This gave a
study population of almost 88 000 patients, 40 000 of whom
had been diagnosed using the high-sensitivity troponin test
and just over 47 000 using the conventional troponin test.
The researchers found that 5% more myocardial
infarctions were being diagnosed in hospitals that used the
high-sensitivity troponin test. A year after the heart attack
was registered there was no difference in mortality rate
between the two groups, although the number of new heart
attacks was lower in the group that had been diagnosed using
the high-sensitivity troponin test.
‘This surprised us,’ says Holzmann. ‘We didn’t think that
the more sensitive test would affect the risk of future heart
attacks.’
The use of coronary angiography and balloon angioplasty
was 16 and 13% more common, respectively, in the patients
diagnosed with the high-sensitivity troponin test. In the
USA, where the new test was not approved until 2017, there
are fears that the more sensitive methods can entail a large
increase in the number of examinations with no benefit to
the patients.
‘The increase we observed in our study was less than
expected, which means that the high-sensitivity troponin
test has enabled doctors to single out the patients who
benefit from such intervention. We found no differences in
medication between the two groups, so the differences in
prognosis with fewer new heart attacks could be attributed to
the fact that more coronary angiography and balloon dilation
procedures have been performed on the right patients,’ says
Holzmann, who also believes that the study supports the idea
that the handful of hospitals in Sweden that still do not use
the high-sensitivity troponin test should start to do so.
Source: Medical Brief 2018