Publications (5)7.59 Total impact
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Article: Progress report on the first sub-Saharan trial of newer versus older antihypertensive drugs in native black patients.
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ABSTRACT: BACKGROUND: The epidemic surge in hypertension in sub-Saharan Africa is not matched by clinical trials of antihypertensive agents in Black patients recruited in this area of the world. We mounted the Newer versus Older Antihypertensive agents in African Hypertensive patients (NOAAH) trial to compare, in native African patients, a single-pill combination of newer drugs, not involving a diuretic, with a combination of older drugs including a diuretic. METHODS: Patients aged 30 to 69 years with uncomplicated hypertension (140 to 179/90 to 109 mmHg) and [less than or equal to]2 associated risk factors are eligible. After a four week run-in period off treatment, 180 patients have to be randomized to once daily bisoprolol/hydrochlorothiazide 5/6.25 mg (R) or amlodipine/valsartan 5/160 mg (E). To attain blood pressure <140/<90 mmHg during six months, the doses of bisoprolol and amlodipine should be increased to 10 mg/day with the possible addition of up to 2 g/day alpha-methyldopa. RESULTS: At the time of writing of this progress report, of 206 patients enrolled in the run-in period, 140 had been randomized. At randomization, the R and E groups were similar (P [greater than or equal to]0.11) with respect to mean age (50.7 years), body mass index (28.2 kg/m2), blood pressure (153.9/91.5 mmHg) and the proportions of women (53.6%) and treatment naive patients (72.7%). After randomization, in the R and E groups combined, blood pressure dropped by 18.2/10.1 mmHg, 19.4/11.2 mmHg, 22.4/12.2 mmHg and 25.8/15.2 mmHg at weeks two (n = 122), four (n = 109), eight (n = 57), and 12 (n = 49), respectively. The control rate was >65% already at two weeks. At 12 weeks, 12 patients (24.5%) had progressed to the higher dose of R or E and/or had alpha-methyldopa added. Cohort analyses of 49 patients up to 12 weeks were confirmatory. Only two patients dropped out of the study. CONCLUSIONS: NOAAH (NCT01030458) demonstrated that blood pressure control can be achieved fast in Black patients born and living in Africa with a simple regimen consisting of a single-pill combination of two antihypertensive agents. NOAAH proves that randomized clinical trials of cardiovascular drugs in the indigenous populations of sub-Saharan Africa are feasible.Trials 05/2012; 13(1):59. · 2.02 Impact Factor -
Article: Rationale and design of the Newer Versus Older Antihypertensive Agents in African Hypertensive Patients (NOAAH) trial.
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ABSTRACT: Sub-Saharan Africa experiences an epidemic surge in hypertension. Studies in African Americans led to the recommendation to initiate antihypertensive treatment in Blacks with a diuretic or a low-dose fixed combination including a diuretic. We mounted the Newer versus Older Antihypertensive Agents in African Hypertensive Patients (NOAAH) trial to compare in native African patients a fixed combination of newer drugs, not involving a diuretic, with a combination of older drugs including a diuretic. Patients aged 30-69 years with uncomplicated hypertension (140-179/90-109 mmHg) and two or fewer associated risk factors are eligible. After a 4-week run-in period off treatment, 180 patients will be randomized to once daily bisoprolol/hydrochlorothiazide 5/6.25 mg or amlodipine/valsartan 5/160 mg. To attain and maintain blood pressure below 140/90 mmHg during 6 months of follow-up, the doses of bisoprolol and amlodipine in the combination tablets will be increased to 10 mg/day with the possible addition of α-methyldopa or hydralazine. NOAAH is powered to demonstrate a 5-mmHg between-group difference in sitting systolic pressure with a two-sided p-value of 0.01 and 90% power. NOAAH is investigator-led and complies with the Helsinki declaration. Six centers in four sub-Saharan countries started patient recruitment on September 1, 2010. On December 1, 195 patients were screened, 171 were enrolled, and 51 were randomized and followed up. The trial will be completed in the third quarter of 2011. NOAAH (NCT01030458) is the first randomized multicenter trial of antihypertensive medications in hypertensive patients born and living in sub-Saharan Africa.Blood pressure 04/2011; 20(5):256-66. · 1.26 Impact Factor -
Article: [Hypertension in the adult Congolese population of Southern Kivu: Results of the Vitaraa Study].
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ABSTRACT: To assess the prevalence of cardiovascular risk factors in adult urban and rural Congolese subjects. We obtained anthropometric data and information on life habits and medical history in 699 people ≥ 20 years, 444 in an urban, 255 in a rural setting. We determined the body mass index and recorded two blood pressure measurements that were averaged for analysis. Hypertension was BP ≥ 140/90mmHg, awareness and/or use of antihypertensive treatment. Diabetes mellitus was self-reported diagnosis or a casual glycemia ≥ 200mg/dL. We assessed the probability of hypertension in stepwise multiple logistic analysis, and awareness, and control of hypertension. We found higher (P<0.001) prevalence in the urban than the rural subjects for hypertension (41.4% vs 38.1%), diabetes (4.9% vs 3.2%), overweight/obesity (37.6% vs 16.5%), abdominal obesity (30.9% vs 12.9%), use of alcohol (45% vs 17.6%) and smoking (11.6% vs 1.2%). Hypertension was associated (P<0.05) to aging in 51.3%, overweight/obesity in 54.5%, diabetes in 69%, abdominal obesity in 63.8%, low physical activity in 42.4%, to stress in urban environment in 43.2% and professional position (executives: 53.2%, workers: 38.6%). Of these hypertensive subjects, 57.5% were unaware, 30.5% were treated, with control achieved in only 13.6% (17.4% women vs 6.9% men; P<0.01). In the logistic model, the probability of hypertension increased with age (OR for age>55 years: 2.35; P<0.001), overweight/obesity (2.22; P<0.001) and diabetes mellitus (2.67; P<0.05). Our results indicate a heavy burden of uncontrolled risk factors in the Congolese population the potential complications of which run at a high mortality rate. They highlight the need for reasonable prevention measures at the population level.La Presse Médicale 03/2011; 40(6):e315-23. · 0.67 Impact Factor -
Article: [Hypertension, insulin resistance and chronic kidney disease in type 2 diabetes patients from South Kivu, DR Congo].
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ABSTRACT: To assess the frequency and determinants of high blood pressure (HBP) in a group of type 2 black diabetics living in the east of Democratic Republic of Congo. Methodology: The medical records of 98 diabetic patients followed at the General Reference Hospital in Bukavu between 2005 and 2007 were collected and analyzed. Hypertension was defined as blood pressure≥140/90mmHg. Insulin sensitivity (HOMA S; %) was determined with the HOMA model, with insulin resistance (IR) representing HOMA S(-1) and defined from HOMA S values<50%). Patients were phenotyped regarding their cardiometabolic profile using metabolic syndrome criteria (minus that for HBP). The probability of hypertension was assessed by multiple logistic regression. There was an overall high prevalence of HBP (59.6%) and of chronic kidney disease (66%) contrasting with a low frequency of insulin resistance (5.2%) and obesity (18.6%). In addition, hypertension was not associated with insulin resistance [regression of SBP by % S: regression coefficient, 0.007 (-0.090-0.104) mmHg; correlation coefficient, 0.00; p = 0.89], [regression of DBP by % S: -0.004 (-0.053-0.045) mmHg; 0.00; 0.87]. There was no significant difference in prevalence of metabolic syndrome changed between hypertensive and normotensive patients [38.6% versus 33.3%, p = 0.60]. In multivariate analysis, overweight [OR adjusted = 3.20 (95%: 1.19-8.61), p = 0.02] and CKD [2.49 (0,98-6.34; 0.05] were found as major determinants of hypertension. The metabolic syndrome is poorly predictive of an absolute decrease in insulin sensitivity in a type 2 diabetes population, in which the prevalence of hypertension was high, and that of insulin resistance low. Overweight independently of insulin resistance and chronic kidney disease common in type 2 diabetes in Sub-Saharan Africa in which the disease is poorly controlled may play a major role in the determinism of hypertension.Néphrologie & Thérapeutique 11/2010; 6(6):520-5. · 0.47 Impact Factor -
Article: In-hospital mortality among black patients admitted for hypertension-related disorders in Mbuji Mayi, Congo.
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ABSTRACT: As a consequence of hypertension, sub-Saharan Africa faces an epidemic of cardiovascular disease. We assessed in-hospital mortality among patients admitted for hypertension-related diseases to two city hospitals in Mbuji Mayi, Congo. On admission, we obtained anthropometric measurements, blood pressure, information on cardiovascular risk factors, and on the awareness and treatment of hypertension. We modeled the probability of death, using stepwise logistic regression. Of 401 consecutive patients (mean age, 54.3 years; 129 women), 118 (29.4 %) were unaware of their hypertension. Among 283 aware patients (70.6%), 126 (44.5%) were untreated. Systolic/diastolic blood pressure on admission averaged 178/106 mm Hg. In addition to hypertension, 390 patients (97.3%) had other cardiovascular risk factors, including a creatinine clearance below 60 ml/min/1.73 m(2) in 47 subjects (11.7%). Over 15 days (median) of hospitalization, 89 deaths (22.2%) occurred. The multivariable-adjusted probability of death increased with systolic blood pressure (odds ratio (95% confidence interval) for +10 mm Hg, 1.43 (1.15-1.77); P < 0.01), body mass index (+5 kg/m(2), 2.40 (1.39-4.17); P < 0.01), being aware vs. unaware of hypertension (3.17 (1.52-6.61); P < 0.01), and being untreated (2.33 (1.12-4.76); P < 0.05), but it decreased with age (+10 years, 0.65 (0.46-0.92); P < 0.05) and higher creatinine clearance (+10 ml/min/1.73 m(2), 0.71 (0.61-0.82); P < 0.001). The in-hospital mortality among African patients hospitalized for hypertension-related disorders in a Congolese provincial capital city is over 20%. These findings underscore that screening and treatment for hypertension and the prevention of cardiovascular disease should be placed much higher on the political agenda in sub-Saharan Africa.American Journal of Hypertension 03/2009; 22(6):643-8. · 3.18 Impact Factor
Top co-authors
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Institutions
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2011
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Leuven University College
Leuven, VLG, Belgium
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2009
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University of Kinshasa
Kinshasa, Ville de Kinshasa, Congo Democratic Republic
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