OA Akintomide’s research while affiliated with Obafemi Awolowo University Teaching Hospital and other places

Objectives: This study evaluated left ventricular function, using echocardiographic methods, in Nigerian DIABETICS with additional aim of assessing the effect of coexisting hypertension. Design: A descriptive cross sectional study Setting: Hospital based study Subjects: Ninety five subjects aged 30-60 years comprising 31 hypertensive DIABETICS, 30 normotensive DIABETICS, and 34 age- and sex- matched non DIABETIC non hypertensive subjects as control. Main Outcome measures: All subjects had transthoracic 2D/Mmode and Doppler flow echocardiography performed to determine left ventricular systolic and diastolic functions. Results: Age and sex of the subjects were comparable. Duration of DIABETICS for hypertensive diabetics and normotensive diabetics were 36.78 ±31.26 months and 36.12 ± 47.50 months respectively. Mean fasting blood glucose was significantly higher in the normotensive diabetics (8.94 ± 2.13 mmol/L) than hypertensive diabetics (6.04 ± 2.01 mmol/L); p=0.038. There was stepwise reduction in Left Ventricular Ejection Fraction(LVEF) from normal controls (71.77 ± 8.26 %) to normotensive diabetics (65.34 ± 9.75 %) and hypertensive diabetics (64.29 ±10.99 %); p= 0.005. The diabetic subjects had impaired LV diastolic function, as shown by their significantly longer Isovolumic relaxation time (IVRT) and deceleration time and lower transmitral E: A ratio compared with controls. No statistically significant difference existed in these indices of LV diastolic function between the normotensive and hypertensive diabetics, though hypertensive diabetics had higher LVMI than the normotensive diabetics. Conclusion: Left ventricular function is impaired in diabetics. This may be independent of coexisting hypertension, though presence of hypertension appears to worsen it.

Left ventricular hypertrophy (LVH) is an independent cardiac risk factor in hypertensives and the structural classification of left ventricular (LV) geometry provides additional prognostic information. Ambulatory blood pressure (ABP) monitoring has been shown to be superior to office blood pressure (BP) in relation to hypertension LVH. We investigated ambulatory BP variables in relation to LV geometric patterns in Nigerian hypertensives. A total of 130 patients (males = 96, females = 34) with hypertension had their 24-hours ambulatory BP and trans-thoracic 2D/M- mode echocardiography. Data were analyzed with SPSS 13.0. P < 0.05 was considered statistically significant. The mean age of the patients was 54.08±11.88 years. The prevalence rate of abnormal LV geometry was 48.4%. Mean ambulatory Systolic BP (day time, night time and 24-hour-average) was significantly higher in patients with LVH compared with those without LVH. Day-night systolic and diastolic BP decay (i.e. percentage nocturnal decline in BP) was also significantly lower in LVH group than in the group without LVH. Patients with eccentric LVH had abnormal day time mean ambulatory systolic BP, night time mean ambulatory systolic BP, elevated day time and night time systolic BP loads, as well as non-dipping diastolic BP pattern. Significant correlates of LV mass index in this study population were mean ambulatory systolic BP (day time: r = 0.355, P = 0.004; night time: r = 0.343, P = 0.005; 24- hour average: r = 0.358, P = 0.004) and day-night decay (systolic: r = -0.388, P = 0.007; diastolic: r = -0.290, P = 0.022) as well as 24-hour systolic BP variability. The presence of LVH in hypertension was associated with higher mean ambulatory systolic BP and lower percentage nocturnal decline in systolic and diastolic BP than its absence which appeared to be worse in patients with eccentric LV geometry when compared with other geometric patterns.

This study evaluated normotensive diabetic patients' blood pressure response to graded exercise and their echocardiographic pattern of left ventricular geometry. A descriptive, cross-sectional, hospital-based study was carried out on 30 normotensive type 2 diabetic patients and 34 controls, aged 30 to 60 years. The outcome measures were to determine the exercise-related variable, blood pressure response, and left ventricular geometry by means of echocardiography. Nineteen (29.7%) and 11 (17.2%) normotensive diabetic subjects had normal left ventricular geometry and concentric left ventricular remodelling, respectively. None of the subjects had concentric or eccentric left ventricular hypertrophy. On this basis, the normotensive diabetic subjects were divided to two groups: G1 (normal) and G2 (concentric left ventricular remodelling). The groups had comparable mean age, body mass index (BMI), fasting blood glucose (FBG) and two-hour post-prandial blood glucose values, and heart rate, systolic (SBP) and diastolic blood pressure (DBP) at rest. G2 patients had higher mean duration of diabetes than G1 subjects (69.0 +/- 9.48 vs 18.7 +/- 8.7 months; p = 0.007). Peak systolic blood pressure was significantly higher in G2 than G1 subjects (213.6 +/- 20.1 vs 200.0 +/- 15.3 mmHg; p = 0.04). Although there was no statistically significant difference in the left ventricular (LV) mass index between the groups, G2 patients had significantly higher relative wall thicknesses than G1 patients (0.53 +/- 0.03 vs 0.41 +/- 0.04; p < 0.001). Normotensive diabetic subjects with concentric left ventricular remodelling have increased blood pressure reactivity to exercise. It is probable, as suggested in earlier studies, that increased blood pressure reactivity to exercise is an indicator of target-organ damage, particularly in normotensive diabetics.