FACULTY OF CLINICAL SCIENCES
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Item Guidelines for the Management of Hypertension in Nigeria(Nigerian Association of Nephrology, 2020) Kadiri, S.; Arogundade, F. A.; Arije, A.; Omotoso, A.; Onwubere, B.; Aderibigbe, A.; Isah, A.; Mbakwem, A.; Salako, B.; Isezuo, S.; Ogun, S.; Sani, M.; Ulasi, I.; Familoni, O.; Ogbera, A.; Ogah, O.; Ademola, A. D.; Opadeyi, A.; Asinobi, A.Background: Hypertension, defined as blood pressure > 140/90 mmHg, has assumed greater public health importance in Nigeria in the last 2 decades. Many reports put the adult prevalence rates at 20-40%, with some major ones specifically reporting 27.8% and 28.9%. Low detection and reporting rates, inadequate investigation and treatment rates all combine to increase the burden. The guidelines provide updated information. Recommendations: The traditional risk factors, with the addition of high income and education status, are highlighted. Recommendations regarding the use of devices and the setting, including home and ambulatory, in the measurement of the blood pressure, are updated. The importance of total cardiovascular risk assessment and risk stratification, employed in initiating and guiding therapy, is emphasized. Lifestyle modifications are prescribed for all; they are described with estimates of BP responses and with a greater reference to local conditions. Attention is drawn to the early use of medicine therapy in those with high CV risk and multi-medicine therapy in those with BP > 160/100 mmHg. The use of single pill combinations, wherever feasible, is recommended, and the prediction is made of most patients eventually requiring multi-medicine therapy. Considerations of cost, availability, tolerance and patient-specific factors influence the choice of medicines, and although any of the several medicine classes could be used for initial therapy, thiazide and thiazide-like diuretics and calcium channel blockers are recommended for single or dual-medicine therapy. Alternatively, any of these and any of angiotensin converting enzyme inhibitor, angiotensin receptor blocker, centrally acting agent, beta-blocker or alphablocker could be used for combination therapy. Effective and recommended combinations and a list of the commonly available medicines in Nigeria are listed. Aspirin for secondary prevention and statin therapy should be used as required. The goal of treatment is commonly <140/90 mmHg, but could be lower in patients with diabetes, chronic kidney disease. Patient counselling, follow-up and treatment monitoring are emphasised. Outlines of treatment in special groups or situations including diabetes, chronic kidney disease, haemoglobinopathies, HIV-infection, paediatric patients, patients with sexual dysfunction, resistant hypertension, hypertension emergency, community control and prevention are provided.Item Factors associated with medication nonadherence among hypertensives in Ghana and Nigeria(Hindawi Publishing Corporation, 2015) Boima, V.; Ademola, A. D.; Odusola, A. O.; Agyekum, F.; Nwafor, C. E.; Cole, H.; Salako, B. L.; Ogedegbe, G.; Tayo, B. O.Background. Blood pressure (BP) control is poor among hypertensives in many parts of sub-Saharan Africa. A potentially modifiable factor for control of BP is medication non-adherence (MNA); our study therefore aimed to determine factors associated withMNA among hypertensives in Ghana and Nigeria. Methodology. We conducted a multicenter cross-sectional study. Patients were recruited from Korle-Bu Hospital (𝑛 = 120), Ghana; and University of Port Harcourt Teaching Hospital, (𝑛 = 73) Apapa General Hospital Lagos (𝑛 = 79) and University College Hospital Ibadan (𝑛 = 85), Nigeria. Results. 357 hypertensive patients (42.6% males) participated. MNA was found in 66.7%. Adherence showed correlation with depression (𝑟 = −0.208, 𝑃 < 0.001), concern about medications (𝑟 = −0.0347, 𝑃 = 0.002), and knowledge of hypertension (𝑟 = 0.14, 𝑃 = 0.006). MNA was associated with formal education (𝑃 = 0.001) and use of herbal preparation (𝑃 = 0.014). MNA was found in 61.7% of uninsured participants versus 73.1% of insured participants (𝑃 = 0.032). Poor BP control was observed in 69.7% and there was significant association between MNA and poor BP control (𝑃 = 0.006). Conclusion. MNA is high among hypertensives in Ghana and Nigeria and is associated with depression, concern about hypertensive medications, formal education, and use of herbal preparations. The negative association between health insurance and MNA suggests interplay of other factors and needs further investigation.Item Association between depression and hypertension in the Ibadan Study of Ageing. African(2020) Ajayi, S.O.; Oladeji, B.; Abiona, T.; Gureje, O.Introduction: The elderly population is growing all over the world with attendant increase in occurrence of comorbid conditions. Using data from a longitudinal study of community-dwelling elderly persons in Nigeria, we explored the prevalence and corelates of hypertension and depression as well as the factors associated with the comorbidity of these two conditions. Methods: The Ibadan Study of Ageing, a longitudinal community-based cohort study conducted between 2003 and 2009 on the profile and determinants of successful ageing. A multistage cluster random sampling was used to select a cohort of elderly participants from across eight contiguous Yoruba speaking states in Nigeria- Ekiti, Kogi, Kwara, Lagos, Ogun, Ondo, Osun, and Oyo. Participants (non-institutionalized elderly, aged 65 years or over) were assessed at 4 time points: baseline(2003/2004) and annually from 2007 (wave 1), 2008 (wave 2 and 2009 (wave 3). Data was collected in face-to-face interviews; depression was assessed using the World Mental Health initiative version of the Composite International Diagnostic Interview (CIDI), social engagement was assessed using an adapted World Health Organization Disability Assessment Schedule WHODAS) and functional disability using activities of daily living (ADL) and instrumental activities of daily living (IADL). Hypertension was defined according to the Joint National Committee-7(JNC7) recommendations as systolic blood pressure of 140 mmHg and above, diastolic blood pressure of 90mmHg. This current study is based on cross-sectional data from the wave 1(2007) assessment. Results: Of the 1597 participants, 58% were females and 42% were 70 years and older. The mean age was 74.2 years (SD ±7.8). Nine hundred and ninety-eight (62.5%) participants had hypertension while 177 (10.6%) met the criteria for major depression while comorbid depression and hypertension was present in 122 (7.1%). The comorbidity of hypertension and depression was significantly associated with gender (higher in women) (p=0.001), insomnia (p=0.001), lack of family participation (p=0.001), lack of community participation (p=0.002), and experiencing a negative life event in the past year (p=0.003). In a multivariate analysis, lack of participation in family activities was associated with an increased risk of co-morbidity between hypertension and depression (OR 4.51, p=0.000, CI 2.14-9.50). Conclusions: These findings suggest that the comorbidity of depression and hypertension could potentially be minimized by modifying social risk factors such as keeping the elderly involved in family and community life participation by promoting their involvement in recreational and volunteer activities as well as social gatherings.Item Increased urinary sodium excretion is associated with systolic blood pressure in first degree relatives of hypertensive patients in Ibadan, Southwestern Nigeria.(2018) Ajayi, S.O.; Adebiyi, A.; Kadiri, S.Introduction: Understanding the risk factors of hypertension has led to a better understanding of the pathogenesis, prevention and reduction in morbidity of hypertension. It is well known that offsprings of hypertensive parents have an increased risk of developing hypertension. It is therefore necessary to explore the physiological differences between normotensive patients with and without a positive family history of hypertension with respect to their urinary excretion of sodium. Methods: This study was carried out at the University College Hospital, Ibadan Nigeria, to determine if normotensive patients with a positive family history of hypertension are different with respect to their urinary excretion of electrolytes and blood pressure. It examined the relationship between 24-hour urinary excretion of sodium, chloride and potassium, urea and creatinine and blood pressure in subjects with and without family history of hypertension. It was a case-control study of sixty-two subjects: normotensive patients’ first degree relatives of primary hypertensive patients and normotensive patients without positive family history. Results: The mean (SD) systolic blood pressures for subjects with and without family history of hypertension were significantly different: 120.0(22.25) and 105.0(17.50) respectively, (p=0.001). The mean arterial blood pressures were significantly different: 86.4(10.2) mmHg and 80.1(8.1) mmHg respectively (p=0.010). The mean (SD) 24-hour urinary excretion of sodium for normotensive patients with and without positive family history of hypertension were 180.5 (45.50) mEq/L, and 156.0(36.25) mEq/L respectively. Systolic blood pressure and 24-hour urinary excretion of sodium was also higher in normotensive subjects with a positive family history of hypertension. Conclusion: Systolic blood pressure and twenty-four hour urinary excretion of sodium were higher in normotensive subjects with a positive family history of hypertension than in those without a family history of hypertension.Item Pattern of prescription of anti-hypertensive medications in a tertiary health care facility in Abuja, Nigeria.(2013) Ojji D.B.; Ajayi S.O.; Mamven M.H.; Alfa J.; Albertino D.Introduction: Marked changes have been made in the pharmacotherapy of hypertension over the years. In sub-Saharan Africa, hypertension pharmacotherapy is often thought to include only thiazide diuretics, beta blockers and centrally acting medications and, it is unclear if and how often calcium channel blockers, angiotensin converting enzyme inhibitors and angiotensin receptor blockers are used. Objective: To examine the anti-hypertensive prescription pattern in a tertiary health centre in Nigeria to determine how it conforms to current guidelines. Method: 590 newly diagnosed hypertensive patients presenting at the Cardiology Unit of University of Abuja Teaching Hospital over a three-year period were studied. Result: Calcium channel blockers were the most frequently prescribed anti-hypertensive medications (66.9% of all cases) and centrally acting medications were prescribed in only 5.01% of cases. Single-pill combination either alone or in combination with other antihypertensive medications were prescribed in 17.3% cases. Of these, calcium channel blocker-based combinations constituted the most frequently used multiple drug combinations. 94.6% of the patients required more than one medication for blood pressure control. Conclusion: Anti-hypertensive pharmacotherapy in Abuja, Nigeria, compares favorably with the current recommendations in the prescription pattern of anti-hypertensive medications. (Ethn Dis. 2013;23[4]:480–483)Item Prevalence of metabolic syndrome among hypertensive subjects in abuja, Nigeria(2012) Ojji D.B.; Ajayi, S.O.; Mamven, M.H.; Alabi P.Background: It is well known that factors like high blood pressure, hyperglycemia, dyslipidemia, obesity and hyperuricemia tend to cluster together giving rise to what is called metabolic syndrome. In spite of the high prevalence of hypertension in Nigeria, there is a dearth of data describing the prevalence of metabolic syndrome in Nigerian hypertensive patients. We therefore set out to look at the prevalence of metabolic syndrome in hypertensive patients presenting to the cardiology clinic of a tertiary institution in Abuja, Nigeria. Methods: Metabolic syndrome was defined in patients according to the World Health Organisation’s definition. Results: Of the 362 patients studied, 56.9% were male and 43.1% were female. The mean age was 51.80 6 11.63 years, mean duration of hypertension was 8.90 6 3.95 years, mean body mass index was 29.36 6 6.12 kg/m2 and mean arterial blood pressure was 110.28 6 18.17 mm Hg. Overall, 13.0% of the study population had metabolic syndrome; 16.7% of females and 10.2% of males. Conclusion: The prevalence of metabolic syndrome among hypertensive patients in Abuja, Nigeria is comparable to rates observed in some general populations in Europe. This might imply the epidemiological transition in disease pattern already being experienced in many parts of sub-Saharan Africa.Item Variability in the relationship between serum creatinine and creatinine clearance in hypertensives and normotensives with normal renal function(2000) Kadiri, S.; Ajayi, S.O.Variabilities exist in the relationship between serum creatinine (Se-C) and creatinine clearance (CCr) due to the influences of age, muscle mass and gender on creatinine production. We studied this variability in a group of hypertensives (n = 62, 30 male, age 44 ± 7 years) and normotensives (n = 90, 47 male, age 42 ± 1 0 years) with normal renal function (Se-C< 0.01) and females (84 ± 19mL/min Vs 96 ± 19mL/min, P < 0.01). Crude CCr was significantly higher in men than women (.P < 0.05) in the whole group but not significantly in the normotensive or hypertensive subgroups. After adjustment, the differences diminished and became insignificant in the whole group. Some subgroups had identical mean Se-C values but different adjusted CCr. A particular Se-C value did not always indicate a particular CCr. Adjustment of CCr to 1.73 m2 BSA reduced the variability between Se-C and CCr and the difference between the genders. CCr showed significant difference in renal function between subgroups where Se-C did not.Item Bronchial asthma: a risk factor for hypertension?(2000) Salako, B.L.; Ajayi, S.O.Several attempts have been made to improve primary prevention of essential hypertension and many of these have been directed at avoiding the well known risk factors. Both asthma and hypertension are spastic disorders of smooth muscle, also asthmatics and hypertensives have been found to be salt sensitive. There is a suspicion that the similarities between these two diseases may predispose the individuals with one disease to the other, as pulmonary hypertension has been described during exercise- induced bronchoconstriction. We therefore, studied the blood pressure pattern during and after acute severe asthma (ASA) along with the frequency of hypertension in stable asthmatic patients. Two groups of patients were studied. Group 1 consisted of 12 patients with ASA (2 males, 10 females) with a mean age of 30 ± 9,9.years. The mean blood pressure during attack of ASA (147±16.9/ 100±8.2 mmHg) was higher than the mean BP (132±8.3/82±7 mmHg) 2 weeks after discharge from hospital without treatment in all patients (P < 0.05). Group 2 included 134 asthmatic subjects in stable state (54 males, 80 females) with a mean age of 45 ± 15 years and a range of 15-90 years. The overall frequency of hypertension was 37% with a proportion of 39% in males and 35% in females. Hypertension was defined as systolic blood pressure of £ 140mmHg and or diastolic blood pressure of £ 90mmHg. There was no difference between the frequency of attack of ASA in hypertensives (5.7 ±5.6 per year) and nonhypertensives (5.5 ± 3.8 per year), P < 0.05. We concluded that transient elevation of blood pressure may occur during ASA. The frequency of hypertension among asthmatics is quite high and concurrent family history of hypertension and frequency of attack of ASA did not seem to determine the status of blood pressure. Patients with asthma should have regular blood pressure check during follow-up visits.Item Hypertensive patient in the surgical ward - what the Surgeon should do(2004) Akute, O. 0; Olubowale, 0. 0|; Aghahowa, M. E; Afolabi., A. 0Two cases of hypertension are presented to emphasize the need for the surgeons to pay adequate attention to these purely medical conditions that may have a devastating adverse effect on the outcome of surgery. The article also highlights the serious constraints that still characterize the management of these patients in this part of the world. The ideal situation is a multi-disciplinary approach involving the Surgeon, the Physician and the Anaesthetist. The surgeon must not confine himself to the technical aspect of the surgery alone. The hypertension must be controlled whether the patient presents with an elective or emergent surgical condition and anti-hypertensive medication must be continued up till the time ofsurgery and at times intra-operatively. It is not only unnecessary hut also potentially dangerous to withdraw anti-hypertensives before anaesthesia. The main goal of the surgically amenable secondary hypertension is to remove the cause ofter adequate control of the hypertension in preparation for surgery. Patient however must be made to understand that the hypertension may not be "cured" and the anti-hypertensive medication may have to be continued post-operatively particularly if the hypertension is long established before patient presents. Local and/or regional blocks are to be preferred to general anaesthesiafor peripheral lesions and even then it is still preferable to have the hypertension controlled.Item The challenges of single-short spinal anaesthesia for caesarean section in a morbidly obese patient: a case report(2005-10) Danladi, K. Y.; Sotunmbi, P. T.; Awolude, O. A.; Obisesan, K. A.An unusual case of morbid obesity, severe hypertension and twin gestation at 36weeks in an unbooked multigravid patient was presented for cesarean section. She was referred from a private clinic to the obstetric emergency unit of the University College Hospital, Ibadan with history of hypertension in pregnancy. She was a known hypertensive for ten years and her blood pressure was poorly controlled due to non-compliance with medications and medical check-up. She had been having progressive visual loss over the ten year period and had lost three, previous pregnancies. Following comprehensive clinical and radiological evaluation, she had a carefully planned single-shot spinal anaesthesia for cesarean delivery of a set of twin which was performed on a double operation table. She remained stable throughout the procedure and post operative period.