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Clinical and Echocardiographic Findings of Left Ventricular Diastolic Dysfunction Among Hypertensive Patients at Muhimbili National Hospital, Dar es Salaam

Sanga, T. S. (2012) Clinical and Echocardiographic Findings of Left Ventricular Diastolic Dysfunction Among Hypertensive Patients at Muhimbili National Hospital, Dar es Salaam. Masters thesis, Muhimbili University of Health and Allied Sciences.

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Abstract

Hypertension is the commonest of the cardiovascular risk factors, whose prevalence in Tanzania is high between 20-30%, among rural and urban residents respectively. Uncontrolled hypertension leads to a number of structural changes in the heart which eventually cumulates into interstitial fibrosis, myocardial wall thickness and functional alteration such as diastolic dysfunction. Diastolic dysfunction is thought to be responsible for as many as 74% of cases of HF in hypertensive patients. Despite this likelihood; it is rarely diagnosed in clinical practice except by default. Diastolic heart failure is common in sub-Saharan African hypertensive patients. However less is known about the prevalence of subclinical left ventricular (LV) diastolic dysfunction in asymptomatic and symptomatic hypertensive patients in Tanzania. To describe the clinical and echocardiographic features of Left ventricular diastolic dysfunction among hypertensive patients at Muhimbili National Hospital. LV geometry and diastolic function were assessed by echocardiography in 200 hypertensive patients attending Muhimbili National Hospital in Dar es Salaam, Tanzania. The demographic parameters including age, sex, and body surface area, systolic and diastolic blood pressure were taken. Patients were categorized into groups of in-patients and outpatients. Ethical clearance was sought from the Research and Publications Committee of MUHAS and permission to conduct the study was obtained from the Ethics committee department of MNH. Patients were enrolled after informed verbal and written consent. Data entry and analysis has been done using the SPSS windows version 16 Two hundred participants were recruited into the study during the study period. One hundred and eight (54%) were females.The mean age of the study population was 52±13.5 years, which varied from 23-86 years, with men being older than women, with higher body surface area and heights than women. xii LV diastolic dysfunction was found in 58.5 % of participants, 50% were in grade 1 diastolic dysfunction. The overall prevallence of left ventricular hypertrophy was 86% in this population of patients, concentric LVH dominated in both patient groups constituting 60.4% , eccentric hypertrophy was seen in 17.6% and concentric remodeling in 8%. Fourteen percent had normal left ventricular geometry. Concentric left ventricular geometry was the predominant geometry among the in-patients with diastolic dysfunction In-patient hypertensive group had statistically significant larger LV internal diameters and wall thicknesses, and they had higher LV mass as well as higher prevalence of LVH (all p<0.01. higher E/E’ ratio was independently found to be associated with in-patient status, adjusting for lower age, larger LA size, higher mitral valve A velocity and lower IVRT (multiple R2=0.26, p<0.001). Conclusion: The prevalence of diastolic dysfunction is high among this population of patients with hypertension . Concentric left ventricular hypetrophy is high among hypertensives in this population and is a predominant geometry in patients with diastolic dysfunction. Elevated left ventricular filling pressures were independetly associated with inpatient status. The higher prevalence of cardiac hypertrophy and left ventricular diastolic dysfunction among hypertensives in our study support the need for improved attainment of blood pressure goals in these patients. Aggressive Screening for end organ demage should be warranted in this population.

Item Type: Thesis (Masters)
Keywords: Clinical and Echocardiographic, Ventricular Diastolic Dysfuction, Hypertensive Patients,Hypertension,Myocardial, Diastolic heart, Dar es Salaam
Subjects: ?? NCD4 ??
Divisions: ?? muhas ??
Depositing User: Users 61 not found.
Date Deposited: 14 Aug 2013 06:52
Last Modified: 14 Aug 2013 06:52
URI: http://ihi.eprints.org/id/eprint/1519

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