Determinants of prognosis among black Africans with hypertensive heart failure

One hundred and seven consecutive Black Africans hypertensive heart failure patients made of 52 Gambians and 55 Nigerians (51 males + 56 females) aged 53.6 +/- 12.1 years were followed-up for 12 months or till death. One-year survival curve was determined using Kaplan-Meiers method. The survivors and the deceased were compared using univariate and multivariate analysis. Mean blood pressures were 180.4 +/- 28.2 mmHg (range: 130-250 mmHg) systolic and 117.0 +/- 12.9 mmHg (range: 100-160 mmHg) diastolic. Duration of hypertension ranged from 0.5 to 23 years. The rate of undetected hypertension was 44%. Overall one-year survival rate was 71%. Twenty two percent of deaths occurred within the first 3 months of HHF. One-year survival rate among the survivors of this period was 89.4%. A strong negative correlation existed between cumulative survival and the duration of heart failure (y = 0.9812, x(2) = 0.1173, R = 0.965). Compared to the survivors, the deceased had significantly higher systolic blood pressure (191.9 +/- 32.2 mmHg versus 175.1 +/- 25.2 mmHg; P < 0.05), diastolic blood pressure (123.7 +/- 15.8mmHg versus 114.3 +/- 10.3 mmHg; P < 0.05), cardiothoracic index (69.2 +/- 3.9% versus 66.2 +/- 4.2%; P < 0.05) and serum creatinine (148.6 +/- 42.2 umol/L versus 113.8 +/- 36.4 umol/L; P < 0.05). Compared to the patients aged 40 or more years, patients aged below 40 years had significantly lower one-year survival rate (41.7% versus 74.1%; P < 0.05). One-year survival rate was significantly higher among patients on captopril medication than those without (75% versus 52.6%; P < 0.05). However, only serum creatinine had statistically differing values between the deceased and survivors (df = 1 SS = 10272, F = 7.60, p = 0.007). Basic clinical and biochemical parameters could therefore be useful prognostic markers in hypertensive heart failure.