Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

To review studies on hypertension in Nigeria over the past five decades in terms of prevalence, awareness and treatment and complications. Following our search on Pubmed, African Journals Online and the World Health Organization Global cardiovascular infobase, 1060 related references were identified out of which 43 were found to be relevant for this review. The overall prevalence of hypertension in Nigeria ranges from 8%-46.4% depending on the study target population, type of measurement and cut-off value used for defining hypertension. The prevalence is similar in men and women (7.9%-50.2% vs 3.5%-68.8%, respectively) and in the urban (8.1%-42.0%) and rural setting (13.5%-46.4%).The pooled prevalence increased from 8.6% from the only study during the period from 1970-1979 to 22.5% (2000-2011). Awareness, treatment and control of hypertension were generally low with attendant high burden of hypertension related complications. In order to improve outcomes of cardiovascular disease in Africans, public health education to improve awareness of hypertension is required. Further epidemiological studies on hypertension are required to adequately understand and characterize the impact of hypertension in society.

https://www.hedu-africa.org/uploads/files/Blood_pressure,_prevalence_of_hypertension_and_hypertension.pdf

Blood pressure, prevalence of hypertension and hypertension related complications in Nigerian Africans: A review.

Background: The burden of hypertension is high in Africa, and due to rapid population growth and ageing, the exact
burden on the continent is still far from being known. We aimed to estimate the prevalence and awareness rates of
hypertension in Africa based on the cut off ‘‘$140/90 mm Hg’’.
Methods: We conducted a systematic search of Medline, EMBASE and Global Health. Search date was set from January 1980
to December 2013. We included population-based studies on hypertension, conducted among people aged $15 years and
providing numerical estimates on the prevalence of hypertension in Africa. Overall pooled prevalence of hypertension in
mixed, rural and urban settings in Africa were estimated from reported crude prevalence rates. A meta-regression
epidemiological modelling, using United Nations population demographics for the years 1990, 2000, 2010 and 2030, was
applied to determine the prevalence rates and number of cases of hypertension in Africa separately for these four years.
Results: Our search returned 7680 publications, 92 of which met the selection criteria. The overall pooled prevalence of
hypertension in Africa was 19.7% in 1990, 27.4% in 2000 and 30.8% in 2010, each with a pooled awareness rate (expressed
as percentage of hypertensive cases) of 16.9%, 29.2% and 33.7%, respectively. From the modelling, over 54.6 million cases of
hypertension were estimated in 1990, 92.3 million cases in 2000, 130.2 million cases in 2010, and a projected increase to
216.8 million cases of hypertension by 2030; each with an age-adjusted prevalence of 19.1% (13.9, 25.5), 24.3% (23.3, 31.6),
25.9% (23.5, 34.0), and 25.3% (24.3, 39.7), respectively.
Conclusion: Our findings suggest the prevalence of hypertension is increasing in Africa, and many hypertensive individuals
are not aware of their condition. We hope this research will prompt appropriate policy response towards improving the
awareness, control and overall management of hypertension in Africa

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Estimating the prevalence and awareness rates of hypertension in Africa: a systematic analysis

From a global perspective, the large and diverse African population is disproportionately affected by cardiovascular disease (CVD). The historical balance between communicable and noncommunicable pathways to CVD in different African regions is dependent on external factors over the life course and at a societal level. The future risk of noncommunicable forms of CVD (predominantly driven by increased rates of hypertension, smoking, and obesity) is a growing public health concern. The incidence of previously rare forms of CVD such as coronary artery disease will increase, in concert with historically prevalent forms of disease, such as rheumatic heart disease, that are yet to be optimally prevented or treated. The success of any strategies designed to reduce the evolving and increasing burden of CVD across the heterogeneous communities living on the African continent will be dependent upon accurate and up-to-date epidemiological data on the cardiovascular profile of every major populace and region. In this Review, we provide a contemporary picture of the epidemiology of CVD in Africa, highlight key regional discrepancies among populations, and emphasize what is currently known and, more importantly, what is still unknown about the CVD burden among the >1 billion people living on the continent.

/pdf/cardiovascular-disease-in-africa-epidemiological-profile-and-3dsba4eser.pdf

Cardiovascular disease in Africa: epidemiological profile and challenges

Background:Hypertension is a leading cause of morbidity and mortality in Africa, and Nigeria, the most populous country in the continent, hugely contributes to this burden.Objective:To provide an improved estimate of the prevalence and number of cases of hypertension in Nigeria based on the cut-off

An estimate of the prevalence of hypertension in Nigeria: a systematic review and meta-analysis

Aim: With increasing urbanization of lifestyle, cardiovascular morbidity and mortality have been on the increase in Africans. Studies on cardiovascular risk factors in rural communities in South East Nigeria are scarce. This study focused on hypertension and obesity in adult Nigerians dwelling in a rural setting in Eastern Nigeria. Materials and Methods: A total of 218 participants from the rural community were recruited into the study. A questionnaire was used to assess prior knowledge of their weight and blood pressure status as well as drug history for those found to have hypertension. Each participant's blood pressure was measured and any value ≥140/90 mmHg was regarded as high blood pressure (HBP). Their heights and weights were measured and their body mass indices (BMI) calculated using the standard formula of BMI = Weight in Kg/Height in m 2 ; BMI ≥30 Kg/m 2 was referred to as global obesity. Their waist circumferences (WC) were also measured and any value ≥102 cm for males and ≥88 cm for females was regarded as abdominal obesity. Results: The general prevalence of HBP in the rural community was 44.5%. The prevalence of HBP increased as age increased and awareness about HBP was low (15.2%). Females were more aware than the males. The prevalence of HBP was higher in males (49.3%) compared with their female counterparts (42.3%), whereas the females had a higher prevalence of all forms of obesity (abdominal: 36.2%, global: 14.8%) compared with the males (abdominal: 14.5%, global: 10.1%). Higher BMI was associated with higher systolic and diastolic BP values. Hypertensive participants had higher BMI and WC than those who had normal BP. Conclusion: The prevalence of both hypertension and obesity seems to be increasing in rural communities in Nigeria and thus, the available prevalence documented in previous studies for rural communities may no longer represent the current trend. Awareness of the participants about these major cardiovascular risk factors is still very low. Higher BMI was associated with higher values of both systolic and diastolic BP.

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Evaluation of blood pressure and indices of obesity in a typical rural community in eastern Nigeria.

Abnormalities in serum lipid and lipoprotein levels are recognized major modifiable cardiovascular disease and essential hypertension risk factors. The objective of this study was to examine the serum lipid patterns of newly diagnosed hypertensive patients attending a tertiary healthcare centre in South East Nigeria. Methods. Two hundred and fifty newly diagnosed adult hypertensive patients and an equal number of age- and sex-matched controls without hypertension were consecutively recruited from the Medical and General Outpatient Clinics of Nnamdi Azikiwe University Teaching Hospital, Nnewi. Result. 126 males and 124 females were in each of the two groups. Mean age was comparable in both groups. Hypertensives had significantly higher mean systolic blood pressure, diastolic blood pressure, body mass index, waist circumference, waist-hip ratio, and fasting blood sugar than the controls. The mean TC, TG, and LDL-C were significantly higher among the hypertensives. The mean HDL-C was comparable; P = 0.8. Among the hypertensive subjects, there was statistically significant positive correlation between BMI and TC; LDL-C and TG; WC and TG; FBS and TC; LDL-C and TG. HDL-C showed a statistically significant inverse correlation with WHR in hypertensives. Conclusion. This study showed that lipid abnormalities are highly prevalent among newly diagnosed hypertensives in South-East Nigeria.

/pdf/serum-lipid-profile-of-newly-diagnosed-hypertensive-patients-4ieb75qi03.pdf

Serum lipid profile of newly diagnosed hypertensive patients in nnewi, South-East Nigeria.

AIntroduction: Cardiovascular disease (CVD) is one of the top killer diseases in the world sparing neither developed or developing countries. The study was carried out to determine the pattern of cardiovascular admissions at Nnamdi Azikiwe University Teaching Hospital Nnewi South East Nigeria. Methods: The study was a retrospective study covering the period January 2007 to December 2009. SPSS version 13 software was used to analyze data. Results: 537 (15%) patients were admitted into the study out of 3546 patients {females 1756 and 1790} admitted into medical wards. 322 (60%) of study population were males and 215 (40%) females. 359(67.5%) were discharged, 170 (32%) died and 8 (0.5%) were discharged against medical advice. The majority of the deaths 105(61.8%), were in patients with CVA. Most of the deaths (111 or 65.3%) occurred within the first seven days of admission. The mean age of the population was 60.7 years ±15.9 with a range of 18 to 110 years. The length of stay in hospital ranged between 1 and 140 days with a mean of 13.5 ± 13.9 days and a median of 10 days. 33 of the subjects were single, 406 were married, 94 were widowed (11 males and 83 females) and 4 were divorced. 46.7% (251) were admitted for CVA and 30.9% (166) for heart failure. Cardiomyopathy/valvular heart diseases (clinical diagnosis due to absence of echocardiography) constituted 3.9%, hypertension 20.5% and pre-existing hypertension with uremia 1.9%. Conclusion: The study has shown that cardiovascular disease contributed significantly to medical admissions the elderly accounting for a significant proportion. There is thus the need for intensification of primary preventive strategies for cardiovascular diseases.

Pattern of cardiovascular admissions at Nnamdi Azikiwe University Teaching Hospital Nnewi, South East Nigeria.

Medical students in Nigeria must complete an intensive six-year program with few or no holidays or recreational periods. Therefore, it is not surprising that academic stress is commonly experienced by Nigerian medical students during the course of their training.There is substantial evidence that ac

Academic stress and cardiovascular health.

Substantial evidence indicates that mental stress has adverse effects on serum lipid levels and cardiovascular health. This study examined the effects of final medical degree examinations (mental stress) on serum lipid and lipoprotein cardiovascular risk factors in African medical students. Twenty-seven healthy male and female medical students had lipids, lipoproteins, urea and uric acid assessments before and during final year examination. The results showed that black African medical students had adverse lipoprotein changes characterized by reduction in the levels of high density lipoprotein-cholesterol (HDLC) and HDLC/total cholesterol (TC) ratio [coronary heart disease (CHD) risk predictor index] during examinations, while mean urea level decreased from the baseline. These findings provide an opportunity for better planning of the nutritional requirements (vis-a-vis increase in protein intake) for medical students during examinations. They will also guide academic curriculum planners on how to work out strategies to reduce mental stress and its associated metabolic disturbances among the students during examinatinos, throughout the period of their medical training. In all, these findings will add to our knowledge of the numerous factors that may affect lipid and lipoprotein changes in African subjects.

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GI Ahaneku

Papers

Evaluation of blood pressure and indices of obesity in a typical rural community in eastern Nigeria.

Serum lipid profile of newly diagnosed hypertensive patients in nnewi, South-East Nigeria.

Pattern of cardiovascular admissions at Nnamdi Azikiwe University Teaching Hospital Nnewi, South East Nigeria.

Academic stress and cardiovascular health.

Lipid and Lipoprotein Cardiovascular Risk Factor Responses to Episodic Academic Stress