Intraventricular conduction blocks and microalbuminuria in Nigerians with essential hypertension

Öz

Objective: The objective of this study was to examine the prevalence and pattern of intraventricular conduction blocks in adult Nigerians with newly diagnosed essential hypertension and to determine the relationship between microalbuminuria and intraventricular conduction blocks. Methods: It was a cross-sectional study with nested case control. Ninety six patients were consecutively enrolled and compared with age- and sex-matched ninety six healthy normotensive individuals. Pre-tested questionnaire was used for data collection. The data collected was doubly entry into SPSS 20.0 software and analysed. P value < 0.05 was accepted as significance. Results: There were 52 (54.2%) male and 46 (45.8%) female hypertensive patients. Twenty one patients (21.9%) had intraventricular conduction blocks compared with 4 (4.2%) among the normotensive controls (21.9% versus 4.2%, P = 0.001) and left anterior fascicular block was the most frequent (38.1%). The prevalence of microalbuminuria was 32.3% in the hypertensive patients. Intraventricular blocks were significantly more common in hypertensive patients with microalbuminuria than in those without it (32.3% versus 16.9%, P=0.01). Conclusion: This study reveals that there is a high prevalence of intraventricular conduction blocks in adult Nigerians with newly diagnosed essential hypertension and left anterior fascicular block is the most common type. It also shows that the subset of hypertensive patients with microalbuminuria is more likely to have intraventricular blocks than those without it.

Anahtar Kelimeler

• Hypertension, Intraventricular conduction blocks, Microalbuminuria

Esansiyel Hipertansiyonu olan Nijeryalılarda İntraventriküler İletim Blokları ve Mikroalbüminüri

Öz

Kaynakça

1. Kearney PM, Whelton M, Reynolds K, Whelton PK, He J. Worldwide prevalence of hypertension: a systematic review. J Hypertens 2004; 22(1):11–19 Kearney PM, Whelton M, Reynolds K, et al. Global burden of hypertension: analysis of worldwide data. Lancet 2005; 365(9455):217–223 Adedoyin RA, Mbada CE, Balogun MO, et al. Prevalence and pattern of hypertension in a semiurban community in Nigeria. Eur J Cardiovasc
2. Prev Rehabil 2008, 15(6):683-687 Ofuya Z: The incidence of hypertension among a select population of adults in the Niger
3. Delta region of Nigeria. Southeast Asian J Trop Med Public Health 2007; 38(5):947-949 Oladipo B, Akinkungbe. Current epidemiology of hypertension in Nigeria. Archives of Ibadan Medicine 2001; 1(1): 4- 8 Oladapo OO, Salako L, Sodiq O, et al. A prevalence of cardiometabolic risk factors among a rural Yoruba south-western Nigerian population: a population-based survey. Cardiovasc J Afr. 2010
4. Jan-Feb; 21(1):26-31. Aje A, Adebiyi AA, Falase AO. Hypertensive heart disease in Africa. S A Heart 2009; 6:42-51 Mensah GA, Barkley NL, Cooper RS.
5. Spectrum of hypertensive target organ damage in Africa: a review of published studies. J Hum Hypertens 1994; 8: 799-808 Opadijo OG, Omotoso ABO, Araoye MA.
6. Prognostic significance of intraventricular conduction blocks in adult Nigerians with hypertensive heart disease. N J M 2000; 9(4): 130133 Mullins CB, Atkins JM, Prognosis and management of ventricular conduction block in acute myocardial infarction. Mod Concepts
7. Cardiovasc Dis 1976; 45(10): 129-133 Dubois C, Pierard LA, Smeets JP, et al.
8. Short and long term prognostic importance of complete bundle branch block complicating acute myocardial infarction. Clin Cardiol 1988; 11: 292296 Kahn S, Frishman WH, Weissman S, et al.

9. Left ventricular hypertrophy on electrocardiogram: prognostic implications from a 10-year cohort study of older subjects: a report from the Bronx Longitudinal Aging Study. J Am Geriatr Soc 1996; 44(5): 524-9 Busari O, Opadijo G, Olarewaju T, et al.
10. Electrocardiographic correlates of microalbuminuria in adult Nigerians with essential hypertension. Cardiol J 2010; 17(3): 281-287 Chandrashekhar Y, Kalita HC, Anand IS.
11. Left anterior fascicular block: an ischaemia response during threadmill testing. Br Heart J 1991; 65(1): 51-52
12. Ma FS, Ma J, Tang K, et al.. Left posterior fascicular block: a new endpoint of ablation for verapamil sensitive idiopathic ventricular tachyarrhythmia. Chin Med J 2006; 119(5): 367372
13. Chobaman AU, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure: JNC 7 report. JAMA 2003; 289: 2560-2572 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens 2003; 1983-1992
14. Michels WM. Grootendorst DC. Verduijn M, et al. Performance of the Cockcroft-Gault, MDRD, and New CKD-EPI Formulas in Relation to GFR, Age, and Body Size. CJASN 2010; 5 (6): 1003-1009
15. Surawicz B, Childers R, Deal BJ, et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part III: intraventricular conduction disturbances: a scientific statement from the AHA Electrocardiographic AND Arrythmias Committee, Council on Clinical Cardiology: the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol 2009; 53: 976 Marti-Almor J, Cladellas M, Bazan V, et al. Long term mortality predictors in patients with chronic bifascicular block. Europace 2009; 11: 1201-1207
16. Smith S, Hayes WL. Prognosis of complete left bundle branch block. Am Heart J 1995; 70: 157-159 Araoye
17. Tiu SC, Lee SS, Cheng MW. Comparison of six commercial techniques in the measurement of microalbuminuria in diabetic patients. Diabetes Care 1993; 16: 616-620
18. Omotoso ABO, Opadijo OG, Araoye MA. Intraventricular conduction blocks in adult Nigerians with hypertensive heart disease. Cardiologie Tropicale 1999; 29(113): 9-12 Cole TO, Falase AO. Fascicular conduction blocks and their relationship to complete heart block in Nigerians. Cardiology 1975: 60: 236-246
19. Fadayomi MO, Stephens MR. Left anterior hemiblock in adult Africans. Euro J Cardiol 1978; 7(1): 35-39
20. Elizari MV, Acunzo RS, Ferreiro M. Heart blocks revisited. Circulation 2007; 115: 1154
21. Horwitz S, Lupi E, Hayes J, et al. Electrocardiographic criteria for the diagnosis of left anterior fascicular block, left atrial deviation and delayed intraventricular conduction. Chest 1975; 68(3): 317-320
22. Kwbertus HE, Demoulin JC. The left hemiblock: significance, prognosis and treatment. Schweiz Med Wochenschr 1982; 112(45): 15791584 Busari OA, Opadijo OG, Omotoso AB.
23. Microalbuminuria and hypertensive retinopathy among newly diagnosed nondiabetic hypertensive adult Nigerians. Niger J Clin Pract 2011;14:436-9 Busari OA, Opadijo OG, Olarewaju TO.
24. Microalbuminuria and its relations with serum lipid abnormalities in adult Nigerians with newly diagnosed hypertension. Annals of African Medicine 2010; 9 (2): 62-67 Klausen K, Borch-Johnsen K, FeldtRasmussen Bo, et al. Very low levels of microalbuminuria are associated with increased risk of coronary heart disease and death irrespective of renal function, hypertension and diabetes mellitus. Circulation 2004; 110: 32-35
25. Flowers NC. Left bundle branch block: a continuously evolving concept. J Am Coll Cardiol 1987;9:684–697
26. Eriksson P, Wilhelmsen L, Rosengren A. Bundle-branch block in middle-aged men: risk of complications and death over 28 years. The Primary Prevention Study in Go¨teborg, Sweden. European Heart Journal 2005; 2: 2300–2306
27. Toquero J, Geelen P, Goethals M, et al. What is first, left bundle branch block or left ventricular dysfunction? J Cardiovasc Electrophysiol 2001; 12:1425–1428