Dried Blood Spot Biomarkers of Oxidative Stress and Inflammation Associated with Blood Pressure in Rural Senegalese Women with Incident Hypertension

Blood biomarkers of oxidative stress and inflammation have been associated with increased risk of hypertension development; yet their application in sub-Saharan Africa has been limited due to the lack of blood collection facilities. In this study, we evaluated the usefulness of dried blood spots (DBS), a more feasible alternative to venous blood, in rural sub-Saharan residents. We recruited 342 women with incident hypertension from rural Senegal, and measured C-reactive protein (CRP) and malondialdehyde (MDA) in DBS and concurrent blood pressure (BP) at baseline and 1-year follow-up. Associations of DBS biomarkers with current levels of and 1-year changes in BP were examined after adjusting for demographic, medical, and socioeconomic covariates. DBS concentrations of MDA were significantly associated with concurrent systolic BP (SBP) (p < 0.05), while DBS baseline concentrations of CRP were associated with longitudinal changes in SBP between baseline and follow-up. Compared to participants with baseline CRP < 1 mg/L, those with CRP of 1–3 mg/L and 3–10 mg/L had 2.11 mmHg (95%CI: −2.79 to 7.02 mmHg) and 4.68 mmHg (95%CI: 0.01 to 9.36 mmHg) increases in SBP at follow-up, respectively. The results support the use of DBS biomarkers for hypertension prevention and control, especially in settings with limited clinical resources.

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P6369Prevalence of severe hypertension in a sub-Saharan African community

European Heart Journal ◽

10.1093/eurheartj/ehz746.0965 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

B Gaye ◽

A L Janeczek ◽

X Jouven ◽

D Luu ◽

E Marijon ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Rural Areas ◽

Severe Hypertension ◽

Blood Pressure Measurement ◽

Target Organ Damage ◽

Sub Saharan Africa ◽

Global Health Initiative ◽

Increased Risk ◽

Sub Saharan

Abstract Background Individuals with SH have high 10-year risk of cardiovascular disease, especially when additional risk factors or target organ damage are present. Though some data from in-hospital or selected populations are available, there are no studies reporting community-level prevalence of Severe Hypertension (SH) in sub-Saharan Africa. Purpose Using a cross-sectional design in Abidjan (Ivory Coast), we assessed prevalence of Severe Hypertension among adults. Methods Study participants were recruited within the framework of The Heart Fund's global health initiative. Data were collected in August 2016 from 6 randomly selected sites, ensuring representativeness of both urban and rural areas. Blood pressure (BP) was measured twice, 10 minutes apart, after optimal resting time. Blood pressure measurement were standardized between sites and SH was defined as systolic blood pressure ≥180 and/or diastolic blood pressure ≥110 mmHg at both readings. Demographics and data on cardiovascular history/risk factors were collected in the field. Ethics approval for the study was obtained from the National Ethical Committee of Côte d'Ivoire and written informed consent was obtained from all adult patients. Results Among 1,785 subjects examined, 1,182 aged between 18 and 75 years were included in this analysis. The prevalence of SH was 14.1% (12.5% females vs 17.0% males; P=0.03) (Figure). Among participants with severe hypertension, 28.9% were either undiagnosed or untreated. Alarmingly, subjects at high cardiovascular risk (age ≥60 years and/or obese) had even higher prevalence of overall SH (29.6% and 24.9%, respectively) as well as undiagnosed/untreated SH (29.4% and 24.6%). SH prevalence was almost double in urban compared to rural areas (17.0% vs. 9.2%, P=0.02); however, conversely, undiagnosed/untreated SH was significantly higher in rural areas (50.4% vs 21.9%). Compared to normal bodyweight, those who were overweight and obese had a 1.95-fold (95% CI, 1.30–2.93; P<0.001)and 4.24-fold (95% CI, 2.68–6.74; P<0.001)increased odds of SH (adjusting for age and sex), respectively. Similarly, participants ≥60 years had a 6.04-fold (95% CI, 3.93–9.36; P<0.001)increased risk of undiagnosed SH compared to under 50 years. Finally, men had higher odds of SH compared to women (OR 1.71, 95% CI, 1.19–2.47; P=0.004). Figure 1 Conclusion(s) Our community-based study revealed very high prevalence of SH among adults in Abidjan area, with almost one out of every seven having SH. This underscores SH as a growing public health problemin sub-Saharan Africa.More concerning, a significant (almost one third) proportion of them were either undiagnosed or untreated.

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High Blood Pressure Confirmed with 24-Hour Ambulatory Blood Pressure Monitoring in Tanzanian Adolescents Enrolling in a Cohort Study

10.21203/rs.3.rs-123312/v1 ◽

2020 ◽

Author(s):

Mussa Nsanya ◽

Philip Ayieko ◽

Ramadhan Hashim ◽

Ezekiel Mgema ◽

Daniel Fitzgerald ◽

...

Keyword(s):

Blood Pressure ◽

Cohort Study ◽

Public Schools ◽

High Blood Pressure ◽

Cardiovascular Health ◽

Blood Pressure Monitoring ◽

Sub Saharan Africa ◽

White Coat Hypertension ◽

Sub Saharan

Abstract Prevalence estimates for high blood pressure (BP) among adolescents in sub-Saharan Africa vary widely and most studies have relied on attended automated office BP (AOBP) measurements. We aimed to estimate prevalence of high BP using unattended AOBP followed by 24-Hour ambulatory BP monitoring (24-Hour ABPM) for confirmation and to determine factors associated with confirmed high BP. Between April and August 2018, 500 adolescents aged 11 to 15 years were enrolled from three randomly selected public schools in Mwanza city (Tanzania) to participate in a 2-year prospective cohort study. We obtained three consecutive unattended AOBP measurements. Follow-up AOBP measurements were obtained in participants with high BP at initial measurements. Participants whose follow-up measurements remained high underwent 24-Hour ABPM. Of all 500 participants, 36.6% had high BP using first AOBP measurement; 25.6% using average of the second and third AOBP measurements and 10.2% using average of follow-up AOBP measurements and were eligible for 24-Hour ABPM. Only 13(2.6%) had confirmed high BP and they had no unique distinguishing characteristic. White coat hypertension is common among adolescents in Africa. Cardiovascular health promotion in Africa can be done through school-based screening for high BP among adolescents using one unattended AOBP

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Abstract MP021: Glycated Hemoglobin and Risk of Incident Hypertension in the Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽

10.1161/circ.125.suppl_10.amp021 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Julie K Bower ◽

Lawrence J Appel ◽

Kunihiro Matsushita ◽

J. H Young ◽

Alvaro Alonso ◽

...

Keyword(s):

Blood Pressure ◽

Glycated Hemoglobin ◽

Diabetes Diagnosis ◽

Atherosclerosis Risk In Communities ◽

Incident Hypertension ◽

Increased Risk ◽

Atherosclerosis Risk ◽

Aric Study ◽

Shared Risk

Introduction: Diabetes and hypertension often co-occur and have shared risk factors. While hypertension is known to predict diabetes, hyperglycemia may also be independently associated with incident hypertension. We investigated glycated hemoglobin (HbA1c) as a predictor of incident hypertension in individuals in the Atherosclerosis Risk in Communities (ARIC) cohort. Methods: We conducted a prospective analysis of 9,603 middle-aged participants in the ARIC Study without hypertension at baseline. Using Cox proportional hazards models, we estimated the association between HbA1c at baseline and incident hypertension by two definitions: (1) self-reported hypertension during a maximum of 18 years of follow-up; and (2) measured blood pressure or hypertension medication use recorded at clinic visits for a maximum of 9 years of follow-up. Results: We observed 4,800 self-reported hypertension cases and 1,670 visit-based cases. Higher baseline HbA1c was associated with increased risk of hypertension and was robust to adjustment for a comprehensive list of confounders that included two measures of adiposity (body mass index and waist-hip ratio). Compared to nondiabetic adults with HbA1c <5.7%, HbA1c in the pre-diabetic range (5.7–6.4%) was independently associated with incident self-reported hypertension (HR 1.25, 95% CI: 1.16–1.34) and visit-detected hypertension (HR 1.18, 95% CI: 1.04–1.34). The HR per 1-% point higher HbA1c was 1.11 (1.06–1.16) among those with no history of diabetes and 1.06 (1.01–1.11) among those with diagnosed diabetes; the continuous associations between HbA1c and incidence of self-reported hypertension for individuals without diabetes are illustrated in the Figure. Conclusions: The association of HbA1c with incident hypertension suggests that elevated levels of circulating glucose may independently contribute to cardiovascular risk through higher blood pressure. Persons with elevated HbA1c, even without a prior diabetes diagnosis, are at increased risk of developing hypertension.

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Community-based prevalence of rheumatic heart disease in rural Ethiopia: Five-year follow-up

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0009830 ◽

2021 ◽

Vol 15 (10) ◽

pp. e0009830

Author(s):

Tadesse Gemechu ◽

Eldryd H. O. Parry ◽

Magdi H. Yacoub ◽

David I. W. Phillips ◽

Susy Kotit

Keyword(s):

Heart Disease ◽

Rheumatic Heart Disease ◽

Sub Saharan Africa ◽

Community Based ◽

Increased Risk ◽

The Family ◽

Sub Saharan ◽

Penicillin Prophylaxis ◽

Rheumatic Heart

Background As little is known about the prevalence and clinical progression of subclinical (latent) rheumatic heart disease (RHD) in sub-Saharan Africa, we report the results of a 5 year follow-up of a community based, echocardiographic study of the disease, originally carried out in a rural area around Jimma, Ethiopia. Methods Individuals with evidence of RHD detected during the baseline study as well as controls and their family members were screened with a short questionnaire together with transthoracic echocardiography. Results Of 56 individuals with RHD (37 definite and 19 borderline) in the original study, 36 (26 definite and 10 borderline) were successfully located 57.3 (range 44.9–70.7) months later. At follow-up two thirds of the definite cases still had definite disease; while a third had regressed. Approximately equal numbers of the borderline cases had progressed and regressed. Features of RHD had appeared in 5 of the 60 controls. There was an increased risk of RHD in the family relatives of borderline and definite cases (3.8 and 4.0 times respectively), notably among siblings. Compliance with penicillin prophylaxis was very poor. Conclusions We show the persistence of echocardiographically demonstrable RHD in a rural sub-Saharan population. Both progression and regression of the disease were found; however, the majority of the individuals who had definite features of RHD had evidence of continuing RHD lesions five years later. There was an increased risk of RHD in the family relatives of borderline and definite cases, notably among siblings. The findings highlight the problems faced in addressing the problem of RHD in the rural areas of sub-Saharan Africa. They add to the evidence that community-based interventions for RHD will be required, together with appropriate ways of identifying active disease, achieving adequate penicillin prophylaxis and developing vaccines for primary prevention.

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Abstract MP13: N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP) and Risk of Hypertension in the Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽

10.1161/circ.129.suppl_1.mp13 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Julie K Bower ◽

Mariana Lazo ◽

Jonathan Rubin ◽

Kunihiro Matsushita ◽

Ron C Hoogeveen ◽

...

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Medication Use ◽

Community Based ◽

Incident Hypertension ◽

Increased Risk ◽

Aric Study

Introduction: Increased plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration reflects cardiac overload and is used to diagnose and stage congestive heart failure. While NT-proBNP exhibits beneficial effects on the cardiovascular system via vasodilatation and diuresis, increased amounts of circulating NT-proBNP also promote release of norepinephrine, which is known to affect blood pressure. Cross-sectional studies report positive associations of NT-pro-BNP with blood pressure, but the prospective association of increased NT-proBNP with risk of hypertension is not well characterized. Thus, the study aim was to evaluate the association of NT-proBNP with incident hypertension in the community-based ARIC Study. Methods: We conducted a prospective cohort analysis of 3,849 participants aged 53-75 years with measured NT-proBNP at ARIC Visit 4 (1996-98) and normal blood pressure; participants with a history of hypertension (medication use or measured BP ≥140/90 mmHg), cardiovascular disease, or heart failure at baseline were excluded. Incident hypertension was defined based on diagnosis or antihypertensive medication use reported during annual follow-up. Results: During a median follow-up of 9 years, there were 2,157 new hypertension cases. There was a significant independent positive association between NT-proBNP levels and risk of hypertension. A 10% increased risk of hypertension was observed per log-unit increase in NT-proBNP (Table). This association was similar among individuals who were normotensive and pre-hypertensive at baseline [HR (95 % CI): 1.08 (1.01-1.15) and 1.11 (1.00-1.24), respectively]. Participants in the highest quartile for NT-proBNP were at 26% increased risk compared to those in the lowest quartile. Conclusions: NT-proBNP is positively associated with incident hypertension in this community-based cohort of middle-aged and older adults. In spite of the vasodilatory effects of increased NT-proBNP, elevated levels predict the development of hypertension.

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Resting Heart Rate predicts all-cause mortality in sub-Saharan African Patients with Heart Failure: Insight from the Douala Heart failure registry (Do-HF)

10.1101/2020.11.24.20237701 ◽

2020 ◽

Author(s):

Anastase Dzudie ◽

Blaise Barche ◽

Sidick Mouliom ◽

Ariane Nouko ◽

Fogue Raissa ◽

...

Keyword(s):

Heart Failure ◽

Heart Rate ◽

Cox Regression ◽

Sub Saharan Africa ◽

Resting Heart Rate ◽

Cox Regression Analysis ◽

Increased Risk ◽

All Cause Mortality ◽

Sub Saharan

AbstractBackgroundHigher resting heart rate (HR) is associated with mortality amongst Caucasians with heart failure (HF), but its significance has yet to be established in sub-Saharan Africans in whom HF differs in terms of characteristics and etiologies.ObjectivesWe assessed the association of HR with all-cause mortality in patients with HF in sub-Saharan Africa.MethodsThe Douala HF registry (Do–HF) is an ongoing prospective data collection on patients with HF receiving care at four cardiac referral services in Douala, Cameroon. Patients included in this report were followed-up for 12 months from their index admission, for all-cause mortality. We used Cox-regression analysis to study the association of HR with all-cause mortality during follow-up.ResultsOf 347 patients included, 343 (98.8%) completed follow-up. The mean age was 64±14 years, 176 (50.7%) were female, and median admission HR was 85 bpm. During a median follow-up of 12 months, 78 (22.7%) patients died. Mortality increased steadily with HR increase and ranged from 12.2% in the lower quartile of HR (≤69 bpm) to 34.1% in the upper quartile of HR (>100 bpm). Hazard ratio of 12-month death per 10 bpm higher heart rate was 1.16 (1.04–1.29), with consistent effects across most subgroups, but a higher effect in participants with hypertension vs those without (interaction p=0.044).ConclusionHeart rate was independently associated with increased risk of all-cause mortality in this study, particularly among participants with hypertension. The implication of this finding for risk prediction or reduction should be actively investigated.

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Sex-Specific Associations between Blood Pressure and Risk of Atrial Fibrillation Subtypes in the Tromsø Study

Journal of Clinical Medicine ◽

10.3390/jcm10071514 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1514

Author(s):

Hilde Espnes ◽

Jocasta Ball ◽

Maja-Lisa Løchen ◽

Tom Wilsgaard ◽

Inger Njølstad ◽

...

Keyword(s):

Atrial Fibrillation ◽

Blood Pressure ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Pressure Management ◽

Reference Models ◽

Proportional Hazards Regression ◽

Hazard Ratios ◽

Increased Risk

The aim of this study was to explore sex-specific associations between systolic blood pressure (SBP), hypertension, and the risk of incident atrial fibrillation (AF) subtypes, including paroxysmal, persistent, and permanent AF, in a general population. A total of 13,137 women and 11,667 men who participated in the fourth survey of the Tromsø Study (1994–1995) were followed up for incident AF until the end of 2016. Cox proportional hazards regression analysis was conducted using fractional polynomials for SBP to provide sex- and AF-subtype-specific hazard ratios (HRs) for SBP. An SBP of 120 mmHg was used as the reference. Models were adjusted for other cardiovascular risk factors. Over a mean follow-up of 17.6 ± 6.6 years, incident AF occurred in 914 (7.0%) women (501 with paroxysmal/persistent AF and 413 with permanent AF) and 1104 (9.5%) men (606 with paroxysmal/persistent AF and 498 with permanent AF). In women, an SBP of 180 mmHg was associated with an HR of 2.10 (95% confidence interval [CI] 1.60–2.76) for paroxysmal/persistent AF and an HR of 1.80 (95% CI 1.33–2.44) for permanent AF. In men, an SBP of 180 mmHg was associated with an HR of 1.90 (95% CI 1.46–2.46) for paroxysmal/persistent AF, while there was no association with the risk of permanent AF. In conclusion, increasing SBP was associated with an increased risk of both paroxysmal/persistent AF and permanent AF in women, but only paroxysmal/persistent AF in men. Our findings highlight the importance of sex-specific risk stratification and optimizing blood pressure management for the prevention of AF subtypes in clinical practice.

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Predictors of lost to follow up from antiretroviral therapy among adults in sub-Saharan Africa: a systematic review and meta-analysis

Infectious Diseases of Poverty ◽

10.1186/s40249-021-00822-7 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Hafte Kahsay Kebede ◽

Lillian Mwanri ◽

Paul Ward ◽

Hailay Abrha Gesesew

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Meta Analysis ◽

Sub Saharan Africa ◽

Hiv Care ◽

Care Services ◽

Validity Assessment ◽

Sub Saharan ◽

Lost To Follow Up

Abstract Background It is known that ‘drop out’ from human immunodeficiency virus (HIV) treatment, the so called lost-to-follow-up (LTFU) occurs to persons enrolled in HIV care services. However, in sub-Saharan Africa (SSA), the risk factors for the LTFU are not well understood. Methods We performed a systematic review and meta-analysis of risk factors for LTFU among adults living with HIV in SSA. A systematic search of literature using identified keywords and index terms was conducted across five databases: MEDLINE, PubMed, CINAHL, Scopus, and Web of Science. We included quantitative studies published in English from 2002 to 2019. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for methodological validity assessment and data extraction. Mantel Haenszel method using Revman-5 software was used for meta-analysis. We demonstrated the meta-analytic measure of association using pooled odds ratio (OR), 95% confidence interval (CI) and heterogeneity using I2 tests. Results Thirty studies met the search criteria and were included in the meta-analysis. Predictors of LTFU were: demographic factors including being: (i) a male (OR = 1.2, 95% CI 1.1–1.3, I2 = 59%), (ii) between 15 and 35 years old (OR = 1.3, 95% CI 1.1–1.3, I2 = 0%), (iii) unmarried (OR = 1.2, 95% CI 1.2–1.3, I2 = 21%), (iv) a rural dweller (OR = 2.01, 95% CI 1.5–2.7, I2 = 40%), (v) unemployed (OR = 1.2, 95% CI 1.04–1.4, I2 = 58%); (vi) diagnosed with behavioral factors including illegal drug use(OR = 13.5, 95% CI 7.2–25.5, I2 = 60%), alcohol drinking (OR = 2.9, 95% CI 1.9–4.4, I2 = 39%), and tobacco smoking (OR = 2.6, 95% CI 1.6–4.3, I2 = 74%); and clinical diagnosis of mental illness (OR = 3.4, 95% CI 2.2–5.2, I2 = 1%), bed ridden or ambulatory functional status (OR = 2.2, 95% CI 1.5–3.1, I2 = 74%), low CD4 count in the last visit (OR = 1.4, 95% CI 1.1–1.9, I2 = 75%), tuberculosis co-infection (OR = 1.2, 95% CI 1.02–1.4, I2 = 66%) and a history of opportunistic infections (OR = 2.5, 95% CI 1.7–2.8, I2 = 75%). Conclusions The current review identifies demographic, behavioral and clinical factors to be determinants of LTFU. We recommend strengthening of HIV care services in SSA targeting the aforementioned group of patients. Trial registration Protocol: the PROSPERO Registration Number is CRD42018114418

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Persistence of mRNA indicative of Plasmodium falciparum ring-stage parasites 42 days after artemisinin and non-artemisinin combination therapy in naturally infected Malians

Malaria Journal ◽

10.1186/s12936-020-03576-z ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Almahamoudou Mahamar ◽

Kjerstin Lanke ◽

Wouter Graumans ◽

Halimatou Diawara ◽

Koualy Sanogo ◽

...

Keyword(s):

Combination Therapy ◽

Artemisinin Combination Therapy ◽

Parasite Prevalence ◽

Sub Saharan Africa ◽

Ring Stage ◽

Qrt Pcr ◽

Sub Saharan ◽

Stage Parasite ◽

Ring Stage Parasite

Abstract Background Malaria control in sub-Saharan Africa relies upon prompt case management with artemisinin-based combination therapy (ACT). Ring-stage parasite mRNA, measured by sbp1 quantitative reverse-transcriptase PCR (qRT-PCR), was previously reported to persist after ACT treatment and hypothesized to reflect temporary arrest of the growth of ring-stage parasites (dormancy) following exposure to artemisinins. Here, the persistence of ring-stage parasitaemia following ACT and non-ACT treatment was examined. Methods Samples were used from naturally infected Malian gametocyte carriers who received dihydroartemisinin–piperaquine (DP) or sulfadoxine–pyrimethamine (SP–AQ) with or without gametocytocidal drugs. Gametocytes and ring-stage parasites were quantified by qRT-PCR during 42 days of follow-up. Results At baseline, 89% (64/73) of participants had measurable ring-stage parasite mRNA. Following treatment, the proportion of ring-stage parasite-positive individuals and estimated densities declined for all four treatment groups. Ring-stage parasite prevalence and density was generally lower in arms that received DP compared to SP–AQ. This finding was most apparent days 1, 2, and 42 of follow-up (p < 0.01). Gametocytocidal drugs did not influence ring-stage parasite persistence. Ring-stage parasite density estimates on days 14 and 28 after initiation of treatment were higher among individuals who subsequently experienced recurrent parasitaemia compared to those who remained free of parasites until day 42 after initiation of treatment (pday 14 = 0.011 and pday 28 = 0.068). No association of ring-stage persistence with gametocyte carriage was observed. Conclusions The current findings of lower ring-stage persistence after ACT without an effect of gametocytocidal partner drugs affirms the use of sbp1 as ring-stage marker. Lower persistence of ring-stage mRNA after ACT treatment suggests the marker may not reflect dormant parasites whilst it was predictive of re-appearance of parasitaemia.

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