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Item Predictors and prognoses of new onset post-stroke anxiety at one year in black Africans(Elsevier Inc., 2020) Ojagbemi, A.; Akinyemi, J.; Owolabi, M.; Akinyemi, R.; Arulogun, O.; Gebregziabher, M.; Akpa, O.; Olaniyan, O.; Salako, B.; Ovbiagele, B.Background: There is relatively limited information on the risk factors and outcome of new onset Post stroke Anxiety (PSA) in Low- and Middle-Income Countries. We estimated incidence, cumulative incidence, risk factors and outcome of new onset anxiety in the first year of stroke among African stroke survivors. Methods: We analyzed the dataset of a completed clinical trial comprising patients enrolled to test an intervention designed to improve one-year blood pressure control among recent ( one month) stroke survivors in Nigeria. Anxiety was measured using the Hospital Anxiety and Depression Scale. Outcomes were assessed using the modified Rankin Scale (mRS), Community screening instrument for dementia (CSID) and Health Related Quality of Life in Stroke Patients (HRQOLISP-26). Results: Among 322 stroke survivors who were free of anxiety at baseline, we found a one-year cumulative incidence of 34% (95% CI = 28.6 39.3). Rates were 36.2% (95% CI =29.6 42.7) for men and 29.2% (95% CI =19.9 38.3) for women. In multivariate Cox regression analyses, haemorrhagic stroke type was associated with higher risk of new onset PSA (Hazard Ratio=1.52, 95% CI =1.01 2.29). New onset PSA was independently associated with cognitive [(mean difference (MD) in CSID scores=1.1, 95% C.I=0.2, 1.9)] and motor decline (MD in mRS scores= 0.2, 95% C.I= 0.4, 0.02), as well as poorer quality of life overtime (MD in total HRQOLISP-26 scores=3.6, 95% C.I=1.0, 6.2). Conclusion: One in 3 stroke survivors in Nigeria had PSA at one year. Clinicians in SSA should pay special attention to survivors of haemorrhagic stroke as they are at higher risk of incident anxiety and therefore its consequences.Item Regional Patterns and Association between Obesity and Hypertension in Africa evidence from the H3 Africa CHAIR Study(Wolters Kluwer Health, Inc., 2020) Akpa, O. M.; Made, F.; Ojo, A.; Ovbiagele, B.; Adu, D.; Motala, A. A.; Mayosi, B. M.; Adebamowo, S. N.; Engel, M. E.; Tayo, B.; Rotimi, C.; Salako, B.; Akinyemi, R.; Gebregziabher, M.; Sarfo, F.; Wahab, K.; Agongo, G.; Alberts, M.Abstract—Hypertension and obesity are the most important modifiable risk factors for cardiovascular diseases, but their association is not well characterized in Africa. We investigated regional patterns and association of obesity with hypertension among 30044 continental Africans. We harmonized data on hypertension (defined as previous diagnosis/ use of antihypertensive drugs or blood pressure [BP]≥140/90 mmHg/BP≥130/80 mmHg) and obesity from 30 044 individuals in the Cardiovascular H3Africa Innovation Resource across 13 African countries. We analyzed data from population-based controls and the Entire Harmonized Dataset. Age-adjusted and crude proportions of hypertension were compared regionally, across sex, and between hypertension definitions. Logit generalized estimating equation was used to determine the independent association of obesity with hypertension (P value<5%)Participants were 56% women; with mean age 48.5±12.0 years. Crude proportions of hypertension (at BP≥140/90 mmHg) were 47.9% (95% CI, 47.4–48.5) for Entire Harmonized Dataset and 42.0% (41.1–42.7) for population-based controls and were significantly higher for the 130/80 mmHg threshold at 59.3% (58.7–59.9) in population-based controls. The age-adjusted proportion of hypertension at BP≥140/90 mmHg was the highest among men (33.8% [32.1–35.6]), in western Africa (34.7% [33.3–36.2]), and in obese individuals (43.6%; 40.3–47.2). Obesity was independently associated with hypertension in population-based controls (adjusted odds ratio, 2.5 [2.3–2.7]) and odds of hypertension in obesity increased with increasing age from 2.0 (1.7–2.3) in younger age to 8.8 (7.4–10.3) in older age. Hypertension is common across multiple countries in Africa with 11.9% to 51.7% having BP≥140/90 mmHg and 39.5% to 69.4% with BP≥130/80 mmHg. Obese Africans were more than twice as likely to be hypertensive and the odds increased with increasing age. (Hypertension. 2020;75:00-00. DOI: 10.1161/HYPERTENSIONAHA.119.14147.)Item Unraveling the risk factors for spontaneous intra cerebral hemorrhage among West Africans(American Academy of Neurology., 2020) Sarfo, F. S.; Ovbiagele, B.; Gebregziabher, M.; Akpa, O.; Akpalu, A.; Wahab, K.; Ogbole, G.; Akinyemi, R.; Obiako, R.; Komolafe, M.; Owolabi, L.; Lackland, D.; Arnett, D.; Tiwari, H.; Markus, H. S.; Akinyemi, J.; Oguntade, A.; Fawale, B."Abstract Objective To characterize risk factors for spontaneous intra cerebral hemorrhage (sICH) occurrence and severity among West Africans. Methods The Stroke Investigative Research and Educational Network (SIREN) study is a multicenter case control study involving 15 sites in Ghana and Nigeria. Patients were adults ≥18 years old with CT confirmed sICH with age-, sex-, and ethnicity-matched stroke-free community controls. Standard instruments were used to assess vascular, lifestyle, and psychosocial factors. Factors associated with sICH and its severity were assessed using conditional logistic regression to estimate odds ratios (ORs) and population-attributable risks (PARs) with 95% confidence intervals (CIs) for factors. Results Of 2,944 adjudicated stroke cases, 854 were intra cerebral hemorrhage (ICH). Mean age of patients with ICH was 54.7 ± 13.9 years, with a male preponderance (63.1%), and 77.3% were non lobar. Etiologic subtypes of sICH included hypertension (80.9%), structural vascular anomalies (4.0%), cerebral amyloid angiopathy (0.7%), systemic illnesses (0.5%), medication-related (0.4%), and undetermined (13.7%). Eight factors independently associated with sICH occurrence by decreasing order of PAR with their adjusted OR (95% CI) were hypertension, 66.63 (20.78–213.72); dyslipidemia, 2.95 (1.84–4.74); meat consumption, 1.55 (1.01–2.38); family history of CVD, 2.22 (1.41–3.50); non consumption of green vegetables, 3.61 (2.07–6.31); diabetes mellitus, 2.11 (1.29–3.46); stress, 1.68 (1.03–2.77); and current tobacco use, 14.27 (2.09–97.47). Factors associated with severe sICH using an NIH Stroke Scale score >15 with adjusted OR (95% CI) were non consumption of leafy green vegetables, 2.03 (1.43–2.88); systolic blood pressure for each mm Hg rise, 1.01 (1.00–1.01); presence of midline shift, 1.54 (1.11–2.13); lobar ICH, 1.72 (1.16–2.55); and supratentorial bleeds, 2.17 (1.06–4.46). Conclusions Population-level control of the dominant factors will substantially mitigate the burden of sICH in West Africa.