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Background: The current pandemic of coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has shown epidemiological and clinical characteristics that appear worsened in hypertensive patients. The morbidity and mortality of the disease among hypertensive patients in Africa have yet to be well described., Methods: In this retrospective cohort study all confirmed COVID-19 adult patients (≥18 years of age) in Lagos between February 27 to July 62,020 were included. Demographic, clinical and outcome data were extracted from electronic medical records of patients admitted at the COVID-19 isolation centers in Lagos. Outcomes included dying, being discharged after recovery or being evacuated/transferred. Descriptive statistics considered proportions, means and medians. The Chi-square and Fisher's exact tests were used in determining associations between variables. Kaplan-Meier survival analysis and Cox regression were performed to quantify the risk of worse outcomes among hypertensives with COVID-19 and adjust for confounders. P-value ≤0.05 was considered statistically significant., Results: A total of 2075 adults with COVID-19 were included in this study. The prevalence of hypertension, the most common comorbidity, was 17.8% followed by diabetes (7.2%) and asthma (2.0%). Overall mortality was 4.2% while mortality among the hypertensives was 13.7%. Severe symptoms and mortality were significantly higher among the hypertensives and survival rates were significantly lowered by the presence of additional comorbidity to 50% from 91% for those with hypertension alone and from 98% for all other patients (P < 0.001). After adjustment for confounders (age and sex), severe COVID-19and death were higher for hypertensives {severe/critical illness: HR = 2.41, P = 0.001, 95%CI = 1.4-4.0, death: HR = 2.30, P = 0.001, 95%CI = 1.2-4.6, for those with hypertension only} {severe/critical illness: HR = 3.76, P = 0.001, 95%CI = 2.1-6.4, death: crude HR = 6.63, P = 0.001, 95%CI = 3.4-1.6, for those with additional comorbidities}. Hypertension posed an increased risk of severe morbidity (approx. 4-fold) and death (approx. 7-fold) from COVID-19 in the presence of multiple comorbidities., Conclusion: The potential morbidity and mortality risks of hypertension especially with other comorbidities in COVID-19 could help direct efforts towards prevention and prognostication. This provides the rationale for improving preventive caution for people with hypertension and other comorbidities and prioritizing them for future antiviral interventions., (© 2021. The Author(s).)

Background: Heart failure (HF) is a major cause of cardiovascular admissions and hypertensive heart failure (HHF) is the most common cause of HF admissions in sub-Saharan Africa, Nigeria inclusive. Right ventricular (RV) dysfunction is being increasingly recognized in HF and found to be an independent predictor of adverse outcomes in HF. This study aimed to determine the prevalence of RV systolic dysfunction in HHF by several echocardiographic parameters., Methodology: One hundred subjects with HHF were recruited consecutively into the study along with 50 age and sex-matched controls. All study participants gave written informed consent, and had a full physical examination, blood investigations, 12-lead electrocardiogram, and transthoracic echocardiography. RV systolic function was assessed in all subjects using different methods based on the American Society of Echocardiography guidelines for echocardiographic assessment of the right heart in adults. This included tricuspid annular plane systolic excursion (TAPSE), RV myocardial performance index (MPI), and RV systolic excursion velocity by tissue Doppler (S')., Results: RV systolic dysfunction was found in 53% of subjects with HHF by TAPSE, 56% by RV MPI, and 48% by tissue Doppler systolic excursion S'. RV systolic dysfunction increased with reducing left ventricular ejection fraction (LVEF) in subjects with HHF., Conclusion: A high proportion of subjects with HHF were found to have RV systolic functional abnormalities using TAPSE, RV MPI, and RV S'. Prevalence of RV systolic dysfunction increased with reducing LVEF., Competing Interests: Disclosure The authors report no conflicts of interest in this work. OA Oketona and OT Oketona are a married couple.

Background: Left ventricular hypertrophy is independently associated with increased incidence of cardiovascular disease, cardiovascular and all cause mortality. In a relatively healthy hypertensive adult population, type II diabetes is associated with higher left ventricular mass, concentric left ventricular geometry and lower myocardial function independent of age, sex, body size, and arterial blood pressure., Objective: The study is to investigate left ventricular geometry in Nigerians with Type II Diabetes mellitus., Methods: The study design was cross-sectional and it comprised 75 consecutive patients with type II diabetes mellitus with or without hypertension. Using a structured pre-evaluated questionnaire, the demographic and clinical data were obtained. All subjects had two dimensional (2D) and 2D derived M-mode echocardiography using Sonoline G60s Ultrasound imaging system with 4.2 MHZ transducer equipped with simultaneous ECG tracing., Results: A total of 75 consecutive type II diabetic patients with or without hypertension were recruited into the study. There were 18 (24.0%) hypertensive-diabetic and 12 (16.0%) normotensive-diabetic males and Thirty-four (45.3%) hypertensive-diabetic and 11 (14.0%) normotensive-diabetic were females. Hypertensive-diabetic males had significantly higher left ventricular mass compared to normotensive-diabetic counterpart 207.05 +/- 41.5g and 156.00 +/- 27.1g P = 0.001. Similarly, left ventricular mass index was found to be higher in hypertensive-diabetic males than their normotensive-diabetic counterpart 114.50 +/- 29.2g/m2 and 92.28 +/- 20.5g/m2 P = 0.014. Hypertensive-diabetic female significantly had higher LVM compared to the normotensive-diabetics 196.06 +/- 41.5g and 161.54 +/- 31.6g P = 0.016. Left ventricular mass index was also found to be higher in hypertensive-diabetic female than their normotensive counterpart 118.52 +/- 27.8g/m2 and 95.75 +/- 23.0g/m2 P = 0.019. Hypertensive-diabetics had predominantly concentric left ventricular hypertrophy compared to the normotensive-diabetics 36 (69.2. %) and 5 (21.7%) P = 0.001., Conclusion: The study reported that hypertensive-diabetics have predominantly concentric left ventricular hypertrophy, higher left ventricular mass and left ventricular mass index compared to normotensive-diabetic. Female hypertensive-diabetic had predominantly concentric left ventricular hypertrophy, while male hypertensive-diabetic and normotensive-diabetic had predominantly concentric left ventricular remodelling.

Background: Left ventricular hypertrophy (LVH) is an independent risk factor for adverse cardiac outcomes in hypertensive patients., Objective: This study is designed to assess the cardiovascular responses to treadmill exercise among Nigerian hypertensives with echocardiographically proven LVH., Materials and Methods: Fifty hypertensive patients with LVH (27 males and 23 females) between 30 and 65 years of age were studied in Nigeria. 50 hypertensive patients without LVH and 50 normal subjects who were age and sex matched served as controls. All patients and control subjects underwent M-mode, 2-D and Doppler ECHO-studies and the Bruce protocol treadmill exercise test., Results: The study showed that the estimated maximal oxygen consumption (MVO2) in MET reduced progressively from 8.39 ± 1.26 (normotensive control) to 7.62 ± 1.33 (hypertensive without LVH), 6.27 ± 0.99 (hypertensive with LVH) (P<0.0001ANOVA). The duration of exercise (s) was also reduced in that order from 455.4 ± 79.1 to 411.6 ±8 2.3, 315.8 ± 75.6 respectively (P<0.0001). The systolic blood pressure (SBP) and pressure rate product (PRP) during maximal exercise were also increased in hypertensives with LVH and hypertensive without LVH when compared to normotensive controls. The hypertensives with LVH and hypertensives without LVH also showed significant limitation to heart rate increase with exercise compared to normotensive controls (P<0.003)., Conclusion: This study demonstrated significant impairment of exercise capacity in hypertensives with or without LVH compared to normotensive subjects. Both earlier recognition and improved understanding of LVH may lead to more effective therapeutic strategies for this cardiovascular risk factor.

This descriptive cross-sectional survey was conducted among all the female traders in Sango market, Ibadan in, April 2003. The aim of the study was to identify the common health problems of women traders in Sango and their work conditions. The most commonly reported health problems were muscular and joint pains by 105 (37.4%), 95 (33.8%) had symptoms suggestive of malaria and 66 (23.5%) had chronic low back pain. The prevalence of muscular and joint pain was highest among respondents aged > 60yrs (p=0.023), and among those who spent eight to ten hours per day in the market (p=0.200). On examination 56 (19.9%) were hypertensive, 88 (31.3%) and 97 (16.7%) were overweight and obese respectively. The prevalence of hypertension was associated with increasing age and obesity (p=0.000). The common health problems among these female traders were muscular and joint pain, symptoms suggestive of malaria, chronic low back pain and hypertension. It is recommended that appropriate health interventions be instituted to address these problems.

132 Nigerians with Non Insulin -dependent diabetes mellitus (NIDDM) were divided into two groups (NIDDM) patients with hypertension and those without) and their clinico-laboratory parameters were studied and analyzed. Their mean age (SD) was 59.5+/-9 years. Body mass index (BMI) was 25.2+/-3.5 kg/m2 and the duration of DM was 6.9+/-6 years. The prevalence of hypertension was 55(41.6%) No significant difference were observed in the age, sex ratio and BMI of both groups but the duration of DM showed a statistical difference between the two groups. However, laboratory parameters such as fasting blood glucose, serum urea, creatinine clearance and degree of proteinuria all showed statistically significant difference between the hypertensive and normotensive groups. Also the hypertensive diabetic group were observed to have more end organ damage i.e peripheral neuropathy, diabetic retinopathy and diabetic nephropathy than the normotensive diabetics. We conclude that, hypertension in NIDDM patients has prognostic implications and so more aggressive efforts be made in detecting and controlling hypertension in DM patients.

Fifty-one native Nigerian patients with mild to moderate essential hypertension received Lisinopril ('Zestril') in doses of 10 mg to 40 mg once daily. All patients received an initial dose of 10 mg, which was titrated up to a maximum of 40 mg if normotensive diastolic blood pressure had not been achieved. Reduction in mean diastolic blood pressure, when compared with baseline data, was significant (p < 0.001) following 16 weeks of treatment. Of the 46 evaluable patients, 32 (70%) had their blood pressure controlled (i.e. diastolic blood pressure < or = 90 Hg). Lisinopril ('Zestril') was well tolerated, with 27% of patients reporting adverse reactions of which cough was the most common. In conclusion, this study shows that Lisinopril ('Zestril"), when administered to Nigerian patients, is a clinically effective and well-tolerated for mild to Customer to supply Mss.

Hypertension is established as one of the major risk factors for congestive heart failure, renal failure, cerebrovascular accident and coronary artery disease. Left ventricular hypertrophy (LVH) is an adaptive response to the increased afterload in hypertension, and therefore serves to normalize wall stress. However, LVH has been established as an independent risk factor for adverse cardiovascular events and death in hypertension. For this reason, considerable attention has been directed towards a better understanding of LVH as a risk factor. As recognition of the risk associated with LVH has grown, investigators have increasingly focused attention on improving methods for the detection of LVH, assessing its effects on cardiac function, defining its relationship with myocardial ischaemia and sudden death, evaluating the role of antihypertensive treatment in the regression of LVH and assessing whether such regression is beneficial in the long term.

Objective: The efficacy, safety, tolerability and speed of onset of the hypotensive action of the combination of oral enalapril (10 mg) prazosin (1 mg) and hydrochlorothiazide (50 mg) has been assessed in 12 Nigerians with severe hypertension (Diastolic BP > or = 115 mmHg)., Patients: The ages of the patients ranged from 30-60 years, and the serum creatinine from 52-732 mumol.l-1. The initial blood pressure was 200/130 mmHg., Results: The combination significantly reduced systolic and diastolic blood pressure respectively. The hypotensive action appeared within 0.5 h and led to a fall in BP to 175/120 mmHg, and the peak action occurred at 4 h, when the BP was 138/99 mmHg, and it persisted upto 24 h (160/101 mmHg). Despite the significant fall in blood pressure, no reflex tachycardia was observed. Transient dizziness was seen in 2 patients, but otherwise all claimed improvement in clinical status and a clearer sensorium., Conclusion: The combination may be a useful oral treatment for the rapid control of severe hypertension in Blacks.

Echocardiography has demonstrated that regression of left ventricular hypertrophy (LVH) can occur following control of blood pressure, although the role of individual drugs in promoting this regression remains less clear. Since LVH in hypertension is an adaptive response to the increased afterload, and therefore serves to normalize wall stress, it is important to establish the effects of hypertrophy regression on cardiac function. Assessment of these effects, however, is complicated by the contributions of alteration in loading conditions and drug therapy to left ventricular function. Since systolic function is normal in LVH, it is not surprising that regression leads to no significant change in commonly measured indices of contractile function. Abnormalities of diastolic function, on the other hand, occur as a consequence of both hypertension and LVH, and reversal of these abnormalities might, therefore, be expected to lead to an improvement in diastolic function. This is indeed the case, although not in all reported studies. Only recently has information emerged on the effects of regression of LVH on function when blood pressure is allowed to return to its pretreatment level following discontinuation of antihypertensive therapy. Such trials, although requiring careful monitoring, are the only way of providing information on the effects of regression itself on left ventricular function. The implications of LVH regression and its attendant changes in function remain to be determined.

The purpose of this study was to determine the effect of parental socioeconomic status on blood pressures of Nigerian school children. The weight, height, blood pressure and heart rate of 807 school children in Ile-Ife, Nigeria were measured. The subjects' ages ranged between 8 and 20 years. The subjects were classified into three (lower, middle and upper) groups based on the socioeconomic status of their parents. The findings revealed that parental socioeconomic status has no effect on the systolic and diastolic pressure, heart rate, rate pressure product and pulse pressure of Nigerian children. We found the 95th centile blood pressure to be 133/92 mm Hg. If the 95th centile is considered the diagnostic criteria for hypertension, then Nigerian children with sustained blood pressure in excess of 133/92 mm Hg should be investigated.

Left ventricular hypertrophy is an ominous prognostic factor for all the cardiovascular complications of hypertension. Treatment has undoubtedly improved the outlook, particularly in patients with congestive cardiac failure. It has recently been shown that the hypertrophy process itself can be regressed by control of hypertension. The principal factor of importance in this regression process is the fall in blood pressure. Although experimental studies suggest that the renin-angiotensin-aldosterone (RAA) system and the sympathetic nervous system (SNS) both play a role in regression, clinical studies in this regard are suggestive but not conclusive. Left ventricular function appears well preserved with the control of blood pressure and parallel reduction in pressure and left ventricular mass is likely to have no adverse effect on myocardial perfusion. The implications of regression of hypertrophy and the patient's long term prognosis have not yet been determined.

Cardiovascular responses to treadmill exercise were studied using the Bruce protocol in 40 patients with essential hypertension (20 males; 20 females) and 36 normotensive controls (20 males; 16 females) with similar age, level of habitual physical activity, smoking and alcohol habits. Maximal heart rate (MHR) was significantly lower in hypertensives than normotensives but there was no significant difference when treated were compared with untreated male hypertensives. Rest -maximal change in heart rate (delta HR) was lower in hypertensives than normotensives (males P less than 0.02). The blood pressure (BP) response was significantly higher in hypertensives than normotensives and in untreated than treated hypertensive males. The delta SBP was not significantly different in hypertensives and normotensives. The mean PRP max was significantly higher in male hypertensives than normotensives, lower in treated vs untreated male hypertensives; similar in treated hypertensives and normotensives and also in female hypertensives (mainly a treated group) compared with controls. The cardiovascular responses to exercise in the hypertensive population studied were significantly different from normotensives. The benefit of treatment of hypertensives is further emphasized by the reduction in blood pressure response to exercise and the reduced myocardial oxygen consumption during maximal exercise.

Hypertension is an important and common risk factor for cardiovascular morbidity and mortality in Africans. In Africans, hypertension carries a more dismal prognosis for target organ damage. We therefore studied the influence of blood pressure on treadmill exercise performance in normotensives, hypertensives and patients with hypertensive heart failure, matched for age and sex. The spectrum of response was a progressive diminution of the systolic rise in blood pressure during exercise, exercise-induced tachycardia, exercise time, and maximal oxygen intake. There was an increase in functional aerobic impairment with a rank order from normotensives to WHO I hypertensives, then WHO II, with a non-linear extreme rise with the onset of heart failure. The results indicate that impaired exercise performance in African hypertensives occurs with the onset of ventricular hypertrophy, and that this is accentuated by the neuroendocrine response in congestive heart failure.

Olumide A Akinyele, Michael O Balogun, Rasaaq A Adebayo, Oladiipo A Olanipekun, Anthony O Akintomide, Oyeronke T Williams, Obafemi S Adesanya Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun State, NigeriaCorrespondence: Olumide A AkinyeleCardiology Unit, Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife PMB 5538, NigeriaEmail mideakinyele@gmail.comBackground: Masquerading bundle branch block (MBBB) is a rare and important electrocardiographic pattern. It consists of right bundle branch block (RBBB) in precordial leads and left bundle branch block (LBBB) in limb leads. It indicates advanced conduction system abnormality usually associated with severe underlying heart disease. MBBB is associated with poor prognosis. MBBB patients are at increased risk of complete atrioventricular (AV) block. To our knowledge, there is no previous published report of MBBB in heart failure in Nigeria.Aim: To present a case of an African patient with heart failure and masquerading bundle branch block, a rare and important finding on 12-lead electrocardiogram.Objective: To highlight the electrocardiographic feature of masquerading bundle branch block in a heart failure patient in our environment and the need for early recognition and close monitoring.Patient and Methods: A 65-year-old man, known hypertensive and asthmatic, who presented with cough productive of whitish frothy sputum, bilateral leg swelling, and difficulty in breathing of 3 weeks duration. There was associated paroxysmal nocturnal dyspnea, orthopnea, and early satiety. No central chest pain on exertion or at rest.Results: The 12-lead electrocardiography (ECG) showed precordial type MBBB with right bundle branch block in V1 and LBBB without deep and wide S waves in leads V5 and V6. Echocardiography confirmed heart failure with reduced ejection fraction of 19%, grade 3 diastolic dysfunction with E/A velocity ratio of 2.31, E/e’ of 29.7. Chest X-ray revealed unfolded aorta and cardiomegaly with cardio-thoracic ratio (CTR) of 65%. Patient was stabilized on anti-failure drugs and is being followed up.Conclusion: We have reported electrocardiographic feature of MBBB in an African patient with heart failure. Early recognition of this rare electrocardiographic pattern, close monitoring and follow-up of these patients is important because of its association with poor prognosis.Keywords: masquerading bundle branch block, left bundle branch block, right bundle branch block, heart failure, hypertension, electrocardiography, atrioventricular block

Background: Left ventricular hypertrophy (LVH) is an independent cardiac risk factor in hypertensives and the structural classification of left ventricular (LV) geometry provides additional prognostic information. Ambulatory blood pressure (ABP) monitoring has been shown to be superior to office blood pressure (BP) in relation to hypertension LVH. We investigated ambulatory BP variables in relation to LV geometric patterns in Nigerian hypertensives. Materials and Methods: A total of 130 patients (males = 96, females = 34) with hypertension had their 24-hours ambulatory BP and trans-thoracic 2D/M- mode echocardiography. Data were analyzed with SPSS 13.0. P < 0.05 was considered statistically significant. Results: The mean age of the patients was 54.08±11.88 years. The prevalence rate of abnormal LV geometry was 48.4%. Mean ambulatory Systolic BP (day time, night time and 24-hour-average) was significantly higher in patients with LVH compared with those without LVH. Day-night systolic and diastolic BP decay (i.e. percentage nocturnal decline in BP) was also significantly lower in LVH group than in the group without LVH. Patients with eccentric LVH had abnormal day time mean ambulatory systolic BP, night time mean ambulatory systolic BP, elevated day time and night time systolic BP loads, as well as non-dipping diastolic BP pattern. Significant correlates of LV mass index in this study population were mean ambulatory systolic BP (day time: r = 0.355, P = 0.004; night time: r = 0.343, P = 0.005; 24- hour average: r = 0.358, P = 0.004) and day-night decay (systolic: r = -0.388, P = 0.007; diastolic: r = -0.290, P = 0.022) as well as 24-hour systolic BP variability. Conclusion: The presence of LVH in hypertension was associated with higher mean ambulatory systolic BP and lower percentage nocturnal decline in systolic and diastolic BP than its absence which appeared to be worse in patients with eccentric LV geometry when compared with other geometric patterns. [ABSTRACT FROM AUTHOR]