7. PROPUESTA DE MEJORAMIENTO EDUCATIVO
7.4. ACTIVIDADES
1. The hospital based nature of the study. The findings in this study may not likely be reflective of the findings in the community as it was conducted in a tertiary hospital.
2. Some patients may not have fasted for twelve hours before their blood samples were collected thereby giving rise to false results.
5.11 Recommendations
1. Physicians should be encouraged to screen their hypertensive patients for dyslipidaemia and institute early management.
2. Severity of hypertension should be determined for patients at first presentation.
This will assist in knowing those at risk of coronary heart diseases.
3. All hypertensive patients whose lipid profiles have been assessed should have their mean atherogenic index (TC:HDL – C) ratio and coronary heart disease risk (HDL-C:TC) ratio calculated to know those who are at risk of cardiovascular risk.
4. Family physicians, as advocates and communicators, should organize and promote public health enlightenment programs/campaigns to educate the public on risk factors and management of hypertension.
5. Patient with dyslipidaemia should be treated and monitored. Lifestyle modification should be included as part of its management.
REFERENCES
1. Akinkugbe O O. Non – communicable diseases in Nigeria. The next epidemic. Nig.
J clin Practice 2000; 3:37-42.
2. Kadiri S, Walker O, Salako BL, Akinkugbe OO. Blood pressure, hypertension and correlates in Urbanized workers in Ibadan, Nigeria – a revisit J. Hum Hypertension 1999; 13:23-27.
3. Kadiri S. Current concepts in the management of hypertension. Dokita 1999;
26;93-96
4. Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel 111). JAMA 2001;285: 2486-2497.
5. Richard S, Safeer MD, Prabha S. Cholesterol Treatment Guidelines update Am Fam Physician 2002; 65:871-880.
6. The Seventh Report of The Joint National Committee on Prevalence, Detection, Evaluation and Treatment of High Blood Pressure. JNC7 report. JAMA 2003.
42(6): 1206- 1212.
7. Papadakis JA, Ganotakis ES, Jagroop IA. Effect of hypertension and its treatment on lipid, Lipoprotein, fibrinogen and bilirubin levels in patients referred for hyperlipidaemia, Am J Hypertens 1999; 12:673-681
8. Laragh GH Laragh’s lessons in pathophysiology and Clinical Pearl for treating hypertension. Am J Hypertens 2001; 14: 491. 503.
9. European Society of Hypertension- European society of Cardiology Guidelines for management of Arterial Hypertension. Guideline Committee. Journal of Hypertension 2003; 2:1011-1053
10. Maldonado-simo Ml. Diet and arterial hypertension. Rev. Enterm 1999. 21:13-16.
11. Perreault S, Dorais M, Conpal L, Paradis G. Grover SA. Impact of treating hyperlipidaemia or hypertension to reduce the risk of death from coronary heart disease. CMAJ 999. 160; 1449 –1455
12. Wolze M, Cutler J, Rocella EJ. Statement from the National High Blood Pressure Education Program. Prevalence of Hypertension. Am J Hypertens 2000, 13:103-104
13. Halperin RO, Sesso HD, Ma J. Dyslipidaemia and The Risk of Incident of Hypertension in Men. Hypertension 2006; 47:45-50.
14. Khot UN, Khot MB, Bujerot T. Prevalence of conventional risk factors in patients with coronary heart disease JAMA 2003; 290:595-604.
15. Rubins HB, Robins SJ, Collins D, Fye CL, Anderson JW, Elam MB, et al.
Gemfibrozil for the secondary prevention of coronary heart disease in men with
low level of high-density lipoprotein cholesterol. Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study Group. N Engl J Med 1999; 341:
410 – 418.
16. Oghagbon EK, Okesina AB, Adebisi SA. Awareness of atherosclerosis risk factor in Nigeria. Journal of the Royal Society for Promotion of Health. 2004: 124(4): 180-183.
17. Dean GS.Epidemiology of Dyslipidaemia and Economic Burden on the Healthcare System. AMJ. Mang care.2007:13:68-71
18. World Heath Organization. Quantifying selected major risks to health. The World Health Report 2002-Reducing Risks, promoting Healthy life.Chapter4: World Health Organization.2002:47-97.
19. Thom T, Haasen N, Rosamond W. Heart disease and Stroke statistics.2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.Circulation2006:113:85-151.
20. Fredrickson DS, Leva RI, Less RS. Fat Transport in Lipoproteins – an integrated approach to mechanisms and disorders N Eng J Med 1967; 276: 34-42.
21. Linda CG. Graw-Hill. M Lipids and Lipoprotenis. Lange’s outline review of Clinical Chemistry. 2001; 102: 27-50.
22. Grundy SM, Bazzarre T, Cleeman J, D Agostino RB Houston – Miller N. Prevention Conference V: beyond secondary prevention. Identifying the high-risk patient for primary prevention. Medical Office assessment. Writing Group1. Circulation 2000;
101: E3 -E11.
23. American Diabetes Association. Management of dyslipidaemia in adults with diabetes. American Diabetes Association: Clinical Practice Recommendations 2000. Diabetes care 2000:23 (suppl.1):557-560.
24. Pinkowish MD. CVD in Patient with diabetes. Patient care 2000; 34:50-72
25. Fodor JG Frohlich JJ, Genest J, Mc Pherson PR. Working Group on Hypercholesterolemia and other dyslipidaemias. Recommendations for the management and treatment of dyslipidaemia: report of the working Group on Hypercholesterolemia and other dyslipidaemias. AMA 2000; 162 (10) 1441-1447 26. Kris – Etherton PM, Haris WS, Appel LJ. American Heart Association Nutrition
Committee. Fish Consumption, fish Oil, Omega 3 fatty acids and cardiovascular disease. Circulation 2002, 66: 2747-2757.
27. Flestche GF. How to implement physical activity in primary and secondary prevention of coronary heart disease. Circulation 1999:96;355-357
28. MRC/BHF. Heart protection study of cholesterol – lowering with simvastin in 20,536 high-risk individuals: a randomized placebo controlled trial. Lancet 2002;
360:7-22
29. Schwartz GG, Olsson AG, Ezekowitz MD Ganz P, Oliver MF, Waters D.
Myocardial Ischaemia Reduction with Aggressive cholesterol lowering (MIRACL).
Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial. JAMA 2001; 285 (131):1711-1718.
30. Tracy R. P. Inflammation in Cardiovascular disease. Circulation. 1998, 97: 2000 31. Ross R. Atherosclerosis. An inflammatory disease. N. Engl. J. Med. 1999;
340:115- 126.
32. Opadijo OO, Akande AA. Jimoh K. Prevalence of coronary heart disease risk factors in Nigerians with systemic hypertension. Afr J Med Sci: 2004; 33 (2);’ 121-125
33. Agboola –Abu CF, Onabolu. Plasma Lipid Levels in patients attending Igbinedion Hospital and Medical Research Centre, Okada, Edo State, Nigeria. NMJ 2000.
38:1-5.
34. Okesina AB, Oparinde DB, Akindoyin KA, Oghagbon EK, Opadijo OG, Erasmus BT. Prevalence of some risk factors of coronary heart disease in a rural Nigerian population. East Afr. J. Med. 1999 76 (4) 212-216.
35. Yekeen LA, Sanusi RA, Ketiku AO. Prevalence of obesity and high levels of cholesterol in hypertension. African Journal of Biomedical research. 2003: 6:129-132.
36. Adedeji OO. Oniton AC. Plasma Lipids in Nigerian Hypertensives Afr. J. Med. Sci.
1999. 19: 281-284.
37. Oghagbon Ek, Okesina AB, Opadijo OG. Plasma Lipids pattern in hypertensives on treatment in Ilorin, Nigeria. Nigerian Medical Practitioner. 2006. 49(1): 3-6.
38. Oghagbon Ek; Okesina AB. Pattern of some risk factors for cardiovasclar disease in untreated Nigerian hypertensive patients. West Afr J Med 2006; 25 (3):190-194.
39. Benjamin A, Joseph W. Acheampong J. Dyslipidaemia in Outpatient at General Hospital in Kumasi Ghana Cross – Sectional Study. Croat. Med J. 2003: 44(5):
576-578.
40. Michael L, David S. Rebecca J. Prevalence of comorbid Hypertension and Dyslipidaemia and Associated cardiovascular Disease. Am J. Manag. Care 2004.
10:926 – 932.
41. O’mearu JG, Kardiasi S., Armon JJ, Brown CA, Boerwinkle E, Turner ST. Ethnic and sex difference in the prevalence, treatment and control of dyslipidaemia among hypertensive adults in the GENEOS study. Arch intern Med. 2004. 164(12):
1313 -1318.
42. Poala P and Neil. R. Levels of dyslipidaemia and improvement in its management in England: Results from the Health survey for England, 2003. Blackwell Synergy:
Clin. Endocrinol. 64(3): 292 – 298.
43. US Preventive services Task Force Screening for Lipid disorder in Adults.
Recommendation and Rationale. Am J Prev Med 2001: 20(3): 37 – 76.
44. Gordon H. Hypertensive vascular disease In: Eugene Braunwald et al eds Harrison’s principles of internal medicine. 15th Edn. McGraw – New York, 2000.
1414-1430.
45. World Health Organization, International Society on Hypertension Writing Group.
2003 World Health Organization Writing Group 2003 World Health Organization (WHO) / International Society of Hypertension (ISH) Statement on management of hypertension. J hypertens. 2003:21:1983-1992.
46. Guidelines Sub-Committee. 1999 World Health Organization – International Society of Hyperpertion guidelines for the management of hypertension J Hypertens 1999:17:151-183.
47. Onwubere BJC,Ike SO.Prevalence of hypertension and its complications among medical admissions at the University of Nigeria Teaching Hospital Enugu. Nigeria J Int. Med. 2003 (11):17-40
48. Mabudeje AF. WHO-ISH Guidelines for the management of hypertension complication in Africa: The Nigerian experience. Clin. Exptl. Hypertension: 1999:21 (5-6) 671-681.
49. Edwards R, Unwin N. Hypertension prevalence and Care in an Urban and Rural area of Tanzania. J. Hypertens. 2000 Feb. 18 (2): 145-52.
50. 2003 European Society of Cardiology. Guidelines for the management of Arterial hypertension. Guidelines Committee Journal of Hypertension 2003, 2:1011-1053 51. Wolf – Maier k, cooper RS, Banegas JR, et al. Hypertension Prevalence and blood
pressure levels in 6 European countries, Canada, and the United States. JAMA 2003; 289(18): 236-39
52. Wilson PW, Kannel WB, Silbershatz H. Clustering of metabolic factors and coronary heart disease. Arch Intern Med 1999; 159 (10): 1104-1109.
53. Ford ES, Mordad AH, Giles WH. Serum Total Cholesterol Concentrations and Awareness, Treatment and Control of Hypercholesterolemia Among US Adults.
Findings from the National Examination Survey 1999 to 2000. Circulation 2003.
107: 2185 – 2189.
54. Thomas F, Bean K, Guizel E. Combined effects of systolic blood pressure and serum cholesterol on cardiovascular mortality in young (<55 years) men and women. Eur Heart 2002; 23(7): 528-35.
55. Kannel W.B. Fifty years of Framingham study contributions to understanding hypertension. J Hum Hypertens 2000: 14(2):83-90
56. Neal B, Mac Mahon S, Chapman N. Blood Pressure Lowering Treatment Trial lists Collaboration. Effect of ACE inhibitors, calcium antagomists, and other blood –
pressure lowering drugs: results of prospectively designed overviews of randomized trials Lancet 2000; 355 (2946): 1955-64.
57. Chapman RH, Benner JS, Petrilla AA. Adherence with concomitant antihypertensive and Lipid – lowering Therapy. Circulation 2003; 108 (17): 756-7.
58. The 2006 Census of the Federal Republic of Nigeria. The National Population Commission 2006.
59. Public Relations and Information Unit. Two decades of service to humanity and health care delivery. University of Benin Teaching Hospital. Information handbook and 20th Anniversary. 1st Ed. Benin City: 1993.
60. Ethical Principles for the guidance of Physicians in Medical Research. The Declaration of Helsinki, Bulletin of WHO 2001; 4:79.
61. Araoye Olabisi Margaret: Subjects selection: Research methodology with statistics for heath and social sciences. First edition Ilorin: Nathadex Publishers. March 2003; Pp. 117-122.
62. Zak B. Cholesterol Methodologies: A review. Clin Chem. 1977, 23:120 1-1210 63. Klotzsch SG, MC-Namara JR. Triglyceride measurements: A review of methods
and interferences. Clin chem. 1990 36:1605-1613.
64. Warwick GR, Cheung MC, Albers JJ. Comparison of current methods for high density Lipoprotein quantitation. Clin Chem. 1979; 25:596-603.
65. Lopes – Virella MF, Stone P, Ellis E. Cholesterol determination in high density Lipoproteins separated by three different methods. Clin Chem. 1977, 23:88 2-88 66. Friedwald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low
density lipoprotein cholesterol without the use of the preparative ultracentrifuge Clin Chem. 1972. 18:499-504.
67. Youmbissi TJ, Djoumess S, Nouedoui C. Profile Lipidique d’un Groupe d hypertendus Cameriounais nor Africans. Medicine d’ Afrique Noire 2001, 31:114-118.
68. Mgonda YM, Ramaiya KL, Swai ABM, George KM, Alberti M. Insulin resistance and hypertension in non-obese Africans in Tanzania. Hypertension 1998; 31:114-118.
69. Singh RB, Rastogi V, Ghosh S. Serum cholesterol and coronary artery disease in Population with low cholesterol levels. The Indian Paradox. Int J Cardiol 1998:
65:81-90
70. Berger GMB. Marais A.D. Diagnosis, Management and Prevention of the Common Dyslipidaemias in South Africa - Clinical Guideline. South African Medical Journal.
2000; 90:164-178
71. Olusi SO, Prabhak S. Biochemical risk factors for myocardial infarction among South Asian immigrants and Arabs. Annual Saudi Med 1999:19:147-149.
72. Onat A, Hergene G, Uzunlar B. Determination of HDL Cholesterol and its predication of coronary disease among Turks. Arch Turk Soc cardiol, 2003: 31:
9.16.
73. Elena V. Puala W. Nora L. Trends in high levels of low density lipoprotein cholesterol in the United States. 1999-2006. JAMA, 2009. 302 (19): 2104-2110.
74. Clarice D, Millicent H, Karen A, Frederick C, Robert G, Michael H, Body Mass Index and the prevalence of Hypertension and Dyslipidaemia. Obesity Research.
2000: (8) 605 – 619.
75. Mufunda J. Correlates of Blood pressure in an Urban Zimbabwean Population and comparison to other populations of African Origin. Journal of Human Hypertension.
2000: 14 (1): 65-73.
76. Steyn K, Gaziano T, Bradsha WD, Laubscher R, Fouries JM. Hypertension in South African Adults. Results from the Demographic and Health Survey. Journal of Hypertension. 2001; 19:1717-1725.
77. Steyn K, Foune J.M, Sheppard J. The lipid profile of South Africa attending general practitioner: The Cholesterol Monitor. South African Medical Journal. 1999. 28 1569-1975.
78. Cappuccio. FP. Prevention of Hypertension in a Black African Population.
Prevention of Hypertension and stroke in Africa.Lancet.2000;356:677-678
79. Kruger HS, Venter C.S, Vorster H.H, Margetts B.M. Physical Inactivity is the Major determinant of Obesity in black Women in the North West Province, South Africa.
The THUSA Study. Nutrition. 2002; 18: 4 22-27.
80. Grundy SM, Pasternal R, Greenland P, Smith S, Fuster V. Assessment of Cardiovascular risk by use of multiple –risk –factor assessment equation a statement for health care professionals from the American Heart Association and the American College of Cardiolgy. Circulation 1999, 100 (13) 81-92
APPENDIX I
CONSENT TO PARTICIPATE IN THE STUDY OF PREVALENCE AND PATTERN OF DYILISPIDASMIA AMONG ADULT HYPERTENSIVES IN THE GENERAL PRACTICE CLINIC OF UNIVERSITY OF BENIN TEACHING PRACTICE HOSPITAL,
1. I am Dr Cosmas Ebomwonyi, a Senior Registrar in the department of Family Medicine interested in the study of prevalence and pattern of dyslipidaemia among adult hypertensives in General practice Clinic of UBTH. It has been noted in literature that dyslipidaemia is now prevalent among hypertensive patients. We need the current prevalence of dyslipidaemia among hypertensives in Nigeria to guide in its management and prevention cardiovascular disease complications.
This is the reason for this study.
2. I will need your consent for the administration of this questionnaire which is solely for the purpose of medical research and your response will be kept very confidential. I will need to collect blood samples from you to carry out this study.
The test is free.
3. Kindly indicate your willingness to participate by signing below.
Refusal to provide consent will not count against you or your care at this facility in any way.
Thank you for your co-operation.
ATTESTATION
I have read and understood the above and give my consent.
_________________ ________________
Sign Date
Witness:
__________________ _________________
Sign Date
APPENDIX II
DATA COLLECTION INSTRUMENTS