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[Pulse pressure monitoring in hypertensive black Africans]
1Institut de Cardiologie d'Abidjan, Abibjan, Côte d'Ivoire. koninchristophe @yahoo.fr
Insights
High pulse pressure is common in hypertensive Black Africans, with poor control. Dual therapy including a diuretic improved management and reduced myocardial complications.
Area of Science:
- Cardiology
- Public Health
- Hypertension Research
Background:
- Pulse pressure exceeding 60 mmHg is a recognized cardiovascular risk factor.
- Limited data exists on pulse pressure characteristics in sub-Saharan African populations.
- Arterial hypertension management requires understanding specific risk factors within diverse ethnic groups.
Purpose of the Study:
- To determine the prevalence of high pulse pressure (PP > 60 mmHg) in Black Africans with hypertension.
- To investigate correlations between high pulse pressure and cardiovascular risk factors.
- To assess the impact of high pulse pressure on target organs and treatment efficacy.
Main Methods:
- A 10-year observational study involving 640 hypertensive Black African patients.
- Data collection included baseline assessments and follow-ups at 1, 3, 6, and 12 months.
- Evaluations focused on pulse pressure, cardiovascular risk factors, target organ damage, and treatment response.
Main Results:
- A high pulse pressure prevalence of 60% was observed at baseline.
- Factors associated with high pulse pressure included age over 50, female gender, and diabetes.
- Pulse pressure control was suboptimal; dual therapy with a diuretic demonstrated superior efficacy in reducing pulse pressure.
Conclusions:
- Hypertensive Black Africans exhibit a high prevalence of elevated pulse pressure.
- Effective management of pulse pressure remains a challenge, though combination therapy with diuretics shows promise.
- Elevated pulse pressure is linked to significant myocardial complications in this population.
Aim:
A pulse pressure above 60 mmHg in hypertensive subjects is an independent cardiovascular risk factor. There are few data on pulse pressure in sub-Saharan Africa. The aim of this study was to describe the pulse pressure in black Africans with arterial hypertension.
Methods:
A 10-year study was carried out on 640 hypertensive sub-Saharan African subjects at the outpatient department of the Abidjan Heart Institute. The primary endpoint was to determine the prevalence of a high pulse pressure, the correlation between pulse pressure and cardiovascular risk factors, the impact of pulse pressure on target organs, and the variation in pulse pressure while on treatment during follow up. Evaluations were made at the start of the study, and in the first, third, sixth and twelfth months of follow up. The mean age was 56.2 years and 56% were female.
Results:
The prevalence of a high pulse pressure in our patients was 60% at the start of the study. The factors contributing to a high pulse pressure were age over 50 years (75.3 vs 24.7%, p < 0001), gender (60 vs 40%, p = 0.02), and diabetes (76.7 vs 23.3%, p = 0.0006). Smoking, obesity and dyslipidaemia were not related to an elevation in pulse pressure. The control of pulse pressure was poor during monitoring. Only 17.8% of patients had their pulse pressure lowered below 60 mmHg between the first and fifth consultations. A high pulse pressure was a predictor of future myocardial complications but few target organs were significantly affected. Dual therapy with a diuretic was more effective in controlling the pulse pressure, with a reduction rate of 22% during follow up (19.2 mmHg), against a rate reduction of 11% (8.4 mmHg) in patients without a dual diuretic.
Conclusion:
The prevalence of pulse pressure above 60 mmHg was higher in hypertensive black Africans. Their control was poor, but dual therapy with a diuretic was more effective. Myocardial consequences were significant.
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