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Prof Elijah Nyainda Ogola was  the chaiman of the department of clinical medicine at the university of Nairobi. He is a clinical cardiologist. His main research interest is the emergence of cardiovascular risk factors in Africa

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Publications


2016

Conteh, S, OGOLA EN, Oyoo GO, Gitura BM, Achieng L.  2016.  Echocardiographic abnormalities in systemic lupus erythematosus patients at Kenyatta National Hospital. African Journal of Rheumatology. 3(3):19. AbstractWebsite

Background: The cardiovascular system is frequently affected in patients with Systemic Lupus Erythematosus (SLE). Involvement of the pericardium, endocardium, myocardium, coronary and pulmonary vessels has been found in several clinical and autopsy studies in patients with SLE; most of which can be detected by noninvasive two dimensional and Doppler echocardiography. More than half of SLE patients experience clinical cardiovascular manifestation during the course of the disease and cardiovascular complications are among the leading causes of morbidity and mortality in patients with SLE.
Objective: To determine the prevalence and spectrum of cardiac abnormalities; determined by echocardiography in SLE patients at Kenyatta National Hospital (KNH).
Methods: This was a cross-sectional descriptive study of SLE patients attending clinic at KNH. A targeted history and physical examination and a detailed trans-thoracic echocardiography were performed for all patients. The independent variables included; age, sex, duration of disease and medications. The echocardiogram outcome variables included; pericardial effusion, thickening and calcification, systolic and diastolic dysfunction, mitral valve thickening, stenosis and regurgitation, aortic valve thickening, stenosis and regurgitation, and pulmonary hypertension.
Results: Sixty three SLE patients participated in the study, the mean age was 36.7 years, with a female to male ration of 20:1 and a meadian duration of disease of 36 months. Over 70% of participants were on at least 2 disease modifying medication. The overall prevalence of echocardiographic abnormalities was 88.9%, the major drivers of this high prevalence being pericardial and valvular thickening. The single moast common cardiac lesion was pericardial thickening at 77.8%. The mitral valve was the most commonly affected valve with 69.8% and 30.2% having mitral thickening and regurgitation respectively. Aortic valve thickening and regurgitation was found in 25.4% and 6.3% of participants respectively. Diastolic dysfunction was found in 50.8% of participants and was found to be associated with older age at diagnosis. Pulmonary hypertension was found in 22.2% of participants.
Conclusion: The study demonstrates a high prevalence of cardiac abnormalities among SLE patients despite being on disease modifying medications. Even though the majority of these abnormalities comprised of clinically insignificant pericardial and valvular thickening, the prevalence of valvular insufficiency and pulmonary hypertension are substantially high and relatively higher than the prevalence seen in other studies in the case of pulmonary hypertension.

2015

Kubo, MN, Kayima JK, Were AJ, McLigeyo SO, Ogola EN.  2015.  Factors Associated with Uncontrolled Hypertension among Renal Transplant Recipients Attending Nephrology Clinics in Nairobi, Kenya. Journal of transplantation. Abstract

Objective.To determine the factors associated with poor blood pressure control among renal transplant recipients in a resource limited setting.Methods.Across- ectionalstudywascarriedoutonrenaltransplantrecipientsattheKenyattaNationalHospital. Sociodemographicdetails,blood pressure,urine albumin: creatinine ratio,andadherenceusingtheMMAS-8questionnairewere noted.Independentfactorsassociatedwithuncontrolledhypertensionweredeterminedusinglogisticregressionanalysis.Results. 85 subjects were evaluated. Mean age was 42.4 (SD ± 12.2) years, with a male:female ratio of 1.9:1. Fifty-five patients (64.7%) had uncontrolled hypertension (BP ≥ 130/80mmHg). On univariate analysis, male sex (OR 3.7, 95% CI 1.4–9.5,

2014

Genga, EK, Otieno CF, OGOLA EN, Maritim MC.  2014.  Assessment of the Perceived Quality of Life of Non insulin Dependent D iabetic patients attending t he Diabetes Clinic in Kenyatta National H ospital. Abstract

BACKGROUND: Diabetes Mellitus is a common and demanding health related problem that has a wide effect on every day’s life of the patients. It can have a profound effect on quality of life in terms of social and psychological well-being as well as physical ill-health. It is one of the most psychologically demanding of the chronic diseases; with psychosocial factors pertinent to nearly every aspect of the disease and its treatment.
OBJECTIVE: To Assess the perceived Health-related quality of life of diabetic patients not on insulin therapy using the WHOQoL-Bref (World Health Organization Quality of Life – Brief).
STUDY DESIGN: This was a cross-sectional study.
STUDY SITE: The study was conducted on patients attending the Diabetic clinic at Kenyatta National Hospital.
RESULTS: Study recruited 139 patients with type2 diabetes not on insulin therapy. The study population was predominantly female (61%) , majority were 40-60yrs, having had diabetes for less than 5yrs, 75% having more than one complication. Most (75%) of the study participants were poorly controlled with HbA1C mean score of 8.04% .Majority of the study participants( 84%) achieved a good score on the HRQoL scale using the WHOQoL-Bref tool. The determinants of HRQoL in our study were: age of study participants, duration of diabetes, presence of complications and income related factors. Age of the study subjects had significant association only in the social domain of HRQoL with a p-value of 0.037. Level of income had a significant association with overall HRQoL score (p-value of 0.029), psychological domain (p value of 0.023) and in the social domain (p-value of 0.029). Health care financing was significantly associated with psychological domain (p-value 0.006) and environmental domain (p-value 0f 0.04) and overall score (p-value 0.011). There was an association between employment status and HRQoL. Having a job improved the scores in physical domain (p-value of 0.013) and social domain (p value of 0.020). Duration with diabetes had significant association with physical domain where the p value was 0.007. The HRQoL of the study subjects was associated significantly with the number of complications. Indeed the association of complications with the HRQoL involved physical domain (p-value of <0.0001) and psychological domain (p-value of 0.041) which directly impacted on the overall total score (p value of 0.041).
CONCLUSION: The results of this study show that diabetes affected HRQoL of our study participants. There is a need for interventions programs to improve glycemic control and inclusion of HRQoL assessment as part of patients on follow up. Age and duration of disease are not modifiable but complications can be reduced by better health care initiaves. Income-related factors can be modifiable through poverty alleviation and pooled health care financing.

Fogoum, AL, Atteh NI, Atteh NI, Ndongo BC, Wami B, Nouedoui C, Muna WFT.  2014.  Elijah N. Ogola Elijah N. Ogola OP78 Observance médicamenteuse chez les patients diabétiques suivis au Centre National d'Hypertension et de Diabétologie de l'Hôpital Central de Yaoundé (CNHD-HCY). Diabetes Research and Clinical Practice. 103 AbstractWebsite

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Ogola, EN, Machira BW, Joshi MD, Njeru E.  2014.  PM325 Cardivascular risk factors in young adult university students in Nairobi, Kenya. Global Heart. 9(1) AbstractWebsite

Cardiovascular diseases (CVD) are rapidly increasing in Africa due to epidemiologic transition. Many risk factors are acquired in chidhood and early adulthood. University students are exposed to multiple lifestyle influences. Understanding the dynamics of risk factors in this population provides a platform for early intervention.

A, D, D O, E O.  2014.  Development of the roadmap and guidelines for the prevention and management of high blood pressure in Africa: Proceedings of the PASCAR Hypertension Task Force meeting, 27 October 2014.. : Proceedings of the PASCAR Hypertension Task Force meeting. Abstract

Africa has one of the fastest growing economies in the world. The economic changes are associated with a health transition characterised by a rise in cardiovascular risk factors and complications, which tend to affect the African population at their age of maximum productivity. Recent data from Africa have highlighted the increasing importance of high blood pressure in this region of the world. This condition is largely underdiagnosed and poorly treated, and therefore leads to stroke, renal and heart failure, and death. Henceforth, African countries are taking steps to develop relevant policies and programmes to address the issue of blood pressure and other cardiovascular risk factors in response to a call by the World Health Organisation (WHO) to reduce premature deaths from non-communicable diseases (NCDs) by 25% by the year 2025 (25 × 25). The World Heart Federation (WHF) has developed a roadmap for global implementation of the prevention and management of raised blood pressure using a health system approach to help realise the 25 × 25 goal set by the WHO. As the leading continental organisation of cardiovascular professionals, the Pan-African Society of Cardiology (PASCAR) aims to contextualise the roadmap framework of the WHF to the African continent through the PASCAR Taskforce on Hypertension. The Taskforce held a workshop in Kenya on 27 October 2014 to discuss a process by which effective prevention and control of hypertension in Africa may be achieved. It was agreed that a set of clinical guidelines for the management of hypertension are needed in Africa. The ultimate goal of this work is to develop a roadmap for implementation of the prevention and management of hypertension in Africa under the auspices of the WHF.

2013

Kirui, F, Oyoo GO, OGOLA EN, Amayo EO.  2013.  Elijah N. Ogola Elijah N. Ogola Cardiovascular risk factors in patients with Rheumatoid Arthritis at Kenyatta National Hospital. African Journal of Rheumatology. 1(1) Abstract

Background: Rheumatoid arthritis is associated with excessive cardiovascular morbidity and mortality. This is predominantly due to accelerated coronary artery and cerebrovascular atherosclerosis. Traditional cardiovascular risk factors as well as extra articular disease have been associated with occurrence of myocardial infarction.
Objective: To identify cardiovascular risk factors in patients with rheumatoid arthritis at Kenyatta National Hospital and compare with healthy controls.
Design: This was a comparative cross sectional survey.
Setting: Kenyatta National Hospital medical outpatient clinic. The study population were patients with rheumatoid arthritis and the controls were individuals without RA age and sex matched staff of KNH. All those who consented were enrolled and a clinical evaluation was done as per the study protocol.
Results: One hundred patients with RA were screened out of which 80 were enrolled. The prevalence of hypertension among RA patients was 41.3%, diabetes 6.3%, dyslipidemia 71.3%, smoking 5%, obesity 22.5%, abnormal WHR 33.8%, family history of sudden death 5%, no family history of stroke or heart attack was reported. In the control group one hundred and five were screened and twenty five were excluded. The prevalence of hypertension was 22.5%, diabetes 5%, dyslipidemia 73.8%, smoking 2.5%, obesity 32.5%, abnormal WHR 33.8% family history of sudden death 10%, stroke 1.3% no history of heart attack was reported. Eighty percent of patients with RA were on at least one DMARD, 57.5% were on steroids and 37.5% were on NSAIDS.
Conclusion: There was a high prevalence of hypertension among RA patients (41.3%) than in the controls (22.5%) and this was statistically significant (OR 2.42 (95 CI 1.22-4.81) P = 0.017). Hypertension was also significantly associated with the use of DMARDS OR 2.189 (95% CI 1.111-4.312) P= 0.022 and steroids OR 2.06(95% CI 1.008-4.207) P= 0.022. No significant difference between patients with RA and controls in other risk factors including diabetes, dyslipidemia, smoking, obesity, abnormal waist hip ratio and family history of cardiovascular events was found.
Recommendations: Clinicians should keenly look out for hypertension in patients with RA for early identification and if necessary aggressive management of hypertension. Screening of cardiovascular risk factors in patients with RA should be done routinely and a larger study with normal controls from the general population should be undertaken in order to measure this cardiovascular risk factors and cardiovascular disease in this population.

Key words: Cardiovascular, rheumatoid arthritis, Kenyatta National Hospital

2012

OGOLA, EN, Ahmed AH, JOSHI MD, Amayo EO, NJERU E.  2012.  African Journal of Rheumatology. Journal of Hypertension. AbstractWebsite

Background: Hypertension, a major risk factor for cardiovascular disease is rapidly attaining epidemic portions in Africa and is strongly associated with urbanisation. We studied a population of Kenyans of Somali ethnicity; traditionally a semi nomadic pastoralist community but who have settled in local urban centres and thereby subject to lifestyle influences of urbanisation. This represents a unique position in the epidemiological transition.

Methods: A cross-sectional community survey carried out in Garissa town, the administrative centre for North Eastern Province, with a population of 196,062. Utilising cluster sampling 2200 adults were recruited. WHO STEPS questionnaire was followed by measurement of BP; height and weight for BMI; waist and hip circumference. Non fasting blood specimens were taken for random blood sugar and total cholesterol.

Results: Data for 1823 subjects, 702 males, 1121 females were complete and analysed. Mean age was 38.5 (range 18-96 years), 82% less than 50 years. Hypertension prevalence was 12.6% (95% CI 11.1-14.2%) and increased with age reaching 38.5 % in over 65years; with a 61% detection rate. Concurrent risk factors were: diabetes 3.7% (2.9-4.7); Overweight 23.9% (21.9-25.9%), Obesity 12.6% (11.2-14.3%), Abdominal obesity (WHR)20.4% (18.5-22.3%), Smoking 5.2% (4.4-6.5%) and hypercholesterolemia 16.9%(11.0-24.3%). Male sex, increasing age, diabetes and over weight were independently associated with hypertension.

Discussion: Despite the young age, this unique and previously unstudied urban & semi-urban population has a high prevalence of hypertension and cardiovascular risk factors showing evidence of epidemiological transition to NCDs. There is opportunity for primary prevention.

2009

Nduiga, DK, Joshi M, OGOLA EN.  2009.  Demographic and clinical characteristics of ambulatory atrial fibrillation at Kenyatta National Hospital. Cardiovascular Journal of Africa:. :6-7.

2006

  2006.  Non communicable Diseases in Adults. , Nairobi: University of Nairobi
OGOLA, ESN.  2006.  The Drakensberg declaration on the control of rheumatic fever and rheumatic heart disease in Africa.. S Afr Med J. 2006 Mar;96(3 Pt 2):246. : Kisipan, M.L. AbstractWebsite

This paper reviews some research studies on tillage methods influencing soil and moisture conservation in the eastern African countries of Kenya, Tanzania, Malawi and Ethiopia during the past four decades. Most of these studies were conducted in marginal rainfall (semi arid ) areas and on shallow soils of various textures (sandy clay loam, sandy clay, clay and loam). The studies were meant to establish the effects of tillage and residue management practices on physico-chemical soil properties (i.e. structure, bulk density, soil moisture and organic matter contents), runoff and infiltration. This review emphasizes the importance of appropriate tillage and residue management methods (contour bunds and terraces, minimum tillage, tied ridging, mulching and conventional tillage) in providing soil conditions favourable for soil moisture conservation and subsequent crop performance and yield on smallholder farms.

2005

Otieno, CF, Vaghela V, Mwendwa FW, KAYIMA JK, OGOLA EN.  2005.  Cardiovascular risk factors in patients with type 2 diabetes mellitus in Kenya: levels of control attained at the outpatient diabetic clinic of Kenyatta National Hospital, Nairobi. East African Medical Journal Vol. . 82(12):S184-S190. AbstractWebsite

Objectives: To determine the proportion of specific cardiovascular risk factors in ambulatory patients with type 2 diabetes and the levels of control achieved in them.

Design: Prospective, cross-sectional study over a six month period.

Setting: Out-patient diabetic clinic of the Kenyatta National Hospital.

Subjects: Two hundred and eleven patients with type 2 diabetes.

Main outcome measures: Sociodemographic attributes, duration of diabetes, levels of glycaemia, body weight, blood pressure, fasting lipids and modes of treatment.

Results: A total of 211 patients were enrolled, 57.3% were females. The mean (SD) age for women was 54.45 (9.44) and that of men was 55.8 (9.02) years. About 77% of the study population were on oral glucose-lowering agents with or without insulin but less than 30% achieved HbA1c <7%; 15% were active cigarette smokers; about 50% were hypertensive with female predominance but 65% of them did not achieve desired blood pressure level inspite of treatment. Just over 50% had raised LDL-cholesterol and over 75% had raised total cholesterol but only three men were on statins without achieving desired targets. Body mass index above 30kg/m2 as a measure obesity was found in 32% of females and 16% males. Most of the study patients admitted use of Aspirin at certain times in the course of their diabetes.

Conclusion: The study showed that specific cardiovascular risk factors of hyperglycaemia, dyslipidaemia, hypertension and obesity were prevalent although not adequately controlled to targets. Statin use was extremely low in people who already needed them. Regular Aspirin use was infrequent because many patients did not quite understand its role in their diabetes treatment. It is recommended that a more pro-active approach in multifactorial address of cardiovascular risk factors be used in high-risk patients with type 2 diabetes to forestall future cardiovascular events.

Otieno, CF, Vaghela V, OGOLA EN, Amayo EO.  2005.  Patterns of homocysteine in Kenyans with type 2 diabetes without overt cardiovascular disease at Kenyatta National Hospital, Nairobi. East African medical journal. 82(12) AbstractWebsite

Background: Increased total homocysteine (tHcy) is an independent risk factor for cardiovascular disease. The measurement of tHcy in blood is therefore of potential great importance especially in patients with type 2 diabetes.

Objective: To determine the total homocysteine levels in ambulatory patients with type 2 diabetes. Design: Cross-sectional, prospective study.

Setting: Outpatient diabetic clinic of the Kenyatta National Hospital.

Subjects: Ambulatory patients with Type 2 diabetes without overt cardiovascular, renal, liver or other chronic disease.

Main outcome measures: Serum levels of tHcy, HbA1c, lipids and socio-demographic characteristics. Results: A total of 115 patients, 48% males, with type 2 diabetes were included in the study. The mean (sd) age of the males was 56.85(8.96) years and of the females was 55.68(8.93) years. The mean (sd) total serum homocysteine for males of 12.97(6.06) µmol/l was significantly higher than that of the females of 10.64(4.41) µmol/l. The cholesterol, glycated haemoglobin, the body mass index and blood pressure of the study subjects did not show any statistically significant influence on their homocysteine levels. However, increasing age and duration of diabetes showed a significant linear relationship with rising level of total serum homocysteine. Some study participants reported smoking habit but unreliably.

Conclusion: There was a significant proportion of the study patients with high levels of serum homocysteine, although most of them were of low to intermediate risk category. It may be prudent to assay homocysteine levels in patients with type 2 diabetes who are either older or have had diabetes for long duration for potential intervention.

Otieno, CF, Mwendwa FW, Vaghela V, OGOLA EN, Amayo EO.  2005.  Elijah N. Ogola Elijah N. Ogola Lipid profile of ambulatory patients with type 2 diabetes mellitus at Kenyatta National Hospital, Nairobi. East African Medical Journal Vol.. 82(12):S173-S179. AbstractWebsite

Background: Patients with type 2 diabetes are at high of cardiovascular events because they have abnormal lipid status compared to their non-diabetic counterparts.

Objective: To determine the quantitative lipid profile of ambulatory patients with type 2 diabetes mellitus. Design: Prospective, cross-sectional descriptive study.

Setting: Out-patient diabetic clinic of the Kenyatta National Hospital.

Subjects: Ambulatory patients with type 2 diabetes but without obvious cardiovascular, renal or foot complications.

Results: A total of 213 patients with type 2 diabetes were studied, 56.8% were females. The age range of the study population was 34 to 86 years, mean(sd) age of females was 54.45(9.4) years and that of males was 55.83(9.3) years. The mean body mass index (BMI) of females was 27.85(6.2) kg/m2 and 25.98(5.8) kg/m2 for males. The female subjects were more obese than the males in this study. Over 70% of the study participants had total cholesterol >4.2mmol/l, 43.8% and 57.6% of the females and males respectively had LDL-C >2.6 mmol/l , 25.6% of the females and 30% of the males had HDL-C < 1.00 mmol/l. Only a modest proportion of males (28.3%) and females (32.2%) had triglycerides >1.7 mmol/l. The LDL-C showed a significant positive correlation with age, duration of diabetes, fasting blood glucose, and total cholesterol but no correlation with glycated haemoglobin, body mass index, gender and the mode of glucose-lowering treatment.

Conclusion: There was significant proportion of quantitative dyslipidaemia in the study population especially with the Total - and LDL- cholesterols. Although treatment goals and lipid thresholds for cardiovascular risk in diabetes are not yet well-defined, even by the large randomized trials, high-risk patients with significant quantitative dyslipidaemia would require deliberate effort to correct the abnormal values to reduce the risk status. These high-risk patients without complications but already had significant dyslipidaemia, which enhances the risk of cardiovascular events, certainly required therapeutic intervention.

CF Otieno, V Vaghela, FWMJKKENO.  2005.  Cardiovascular risk factors in patients with type 2 diabetes mellitus in Kenya: levels of control attained at the outpatient diabetic clinic of Kenyatta National Hospital, Nairobi . East African Medical Journal. 82(12):184-190. Abstract

Objectives: To determine the proportion of specific cardiovascular risk factors in ambulatory patients with type 2 diabetes and the levels of control achieved in them.

Design: Prospective, cross-sectional study over a six month period.

Setting: Out-patient diabetic clinic of the Kenyatta National Hospital.

Subjects: Two hundred and eleven patients with type 2 diabetes.

Main outcome measures: Sociodemographic attributes, duration of diabetes, levels of glycaemia, body weight, blood pressure, fasting lipids and modes of treatment.

Results: A total of 211 patients were enrolled, 57.3% were females. The mean (SD) age for women was 54.45 (9.44) and that of men was 55.8 (9.02) years. About 77% of the study population were on oral glucose-lowering agents with or without insulin but less than 30% achieved HbA1c <7%; 15% were active cigarette smokers; about 50% were hypertensive with female predominance but 65% of them did not achieve desired blood pressure level inspite of treatment. Just over 50% had raised LDL-cholesterol and over 75% had raised total cholesterol but only three men were on statins without achieving desired targets. Body mass index above 30kg/m2 as a measure obesity was found in 32% of females and 16% males. Most of the study patients admitted use of Aspirin at certain times in the course of their diabetes.

Conclusion: The study showed that specific cardiovascular risk factors of hyperglycaemia, dyslipidaemia, hypertension and obesity were prevalent although not adequately controlled to targets. Statin use was extremely low in people who already needed them. Regular Aspirin use was infrequent because many patients did not quite understand its role in their diabetes treatment. It is recommended that a more pro-active approach in multifactorial address of cardiovascular risk factors be used in high-risk patients with type 2 diabetes to forestall future cardiovascular events.

East African Medical Journal Vol. 82(12) 2005: S184-S190

CF Otieno, V Vaghela, ENOEOA.  2005.  Patterns of homocysteine in Kenyans with type 2 diabetes without overt cardiovascular disease at Kenyatta National Hospital, Nairobi . East African Medical Journal. 82(12):180-183. Abstract

Background: Increased total homocysteine (tHcy) is an independent risk factor for cardiovascular disease. The measurement of tHcy in blood is therefore of potential great importance especially in patients with type 2 diabetes.

Objective: To determine the total homocysteine levels in ambulatory patients with type 2 diabetes. Design: Cross-sectional, prospective study.

Setting: Outpatient diabetic clinic of the Kenyatta National Hospital.

Subjects: Ambulatory patients with Type 2 diabetes without overt cardiovascular, renal, liver or other chronic disease.

Main outcome measures: Serum levels of tHcy, HbA1c, lipids and socio-demographic characteristics. Results: A total of 115 patients, 48% males, with type 2 diabetes were included in the study. The mean (sd) age of the males was 56.85(8.96) years and of the females was 55.68(8.93) years. The mean (sd) total serum homocysteine for males of 12.97(6.06) µmol/l was significantly higher than that of the females of 10.64(4.41) µmol/l. The cholesterol, glycated haemoglobin, the body mass index and blood pressure of the study subjects did not show any statistically significant influence on their homocysteine levels. However, increasing age and duration of diabetes showed a significant linear relationship with rising level of total serum homocysteine. Some study participants reported smoking habit but unreliably.

Conclusion: There was a significant proportion of the study patients with high levels of serum homocysteine, although most of them were of low to intermediate risk category. It may be prudent to assay homocysteine levels in patients with type 2 diabetes who are either older or have had diabetes for long duration for potential intervention.

East African Medical Journal Vol. 82(12) 2005: S180-S183

CF Otieno, FW Mwendwa, VENOEOAV.  2005.  Lipid profile of ambulatory patients with type 2 diabetes mellitus at Kenyatta National Hospital, Nairobi. East African Medical Journal. 82(12):173-179. Abstract

Background: Patients with type 2 diabetes are at high of cardiovascular events because they have abnormal lipid status compared to their non-diabetic counterparts.

Objective: To determine the quantitative lipid profile of ambulatory patients with type 2 diabetes mellitus. Design: Prospective, cross-sectional descriptive study.

Setting: Out-patient diabetic clinic of the Kenyatta National Hospital.

Subjects: Ambulatory patients with type 2 diabetes but without obvious cardiovascular, renal or foot complications.

Results: A total of 213 patients with type 2 diabetes were studied, 56.8% were females. The age range of the study population was 34 to 86 years, mean(sd) age of females was 54.45(9.4) years and that of males was 55.83(9.3) years. The mean body mass index (BMI) of females was 27.85(6.2) kg/m2 and 25.98(5.8) kg/m2 for males. The female subjects were more obese than the males in this study. Over 70% of the study participants had total cholesterol >4.2mmol/l, 43.8% and 57.6% of the females and males respectively had LDL-C >2.6 mmol/l , 25.6% of the females and 30% of the males had HDL-C < 1.00 mmol/l. Only a modest proportion of males (28.3%) and females (32.2%) had triglycerides >1.7 mmol/l. The LDL-C showed a significant positive correlation with age, duration of diabetes, fasting blood glucose, and total cholesterol but no correlation with glycated haemoglobin, body mass index, gender and the mode of glucose-lowering treatment.

Conclusion: There was significant proportion of quantitative dyslipidaemia in the study population especially with the Total - and LDL- cholesterols. Although treatment goals and lipid thresholds for cardiovascular risk in diabetes are not yet well-defined, even by the large randomized trials, high-risk patients with significant quantitative dyslipidaemia would require deliberate effort to correct the abnormal values to reduce the risk status. These high-risk patients without complications but already had significant dyslipidaemia, which enhances the risk of cardiovascular events, certainly required therapeutic intervention.

East African Medical Journal Vol. 82(12) 2005: S173-S179

FREDRICK, DROTIENOCF, N PROFOGOLAELIJAHS.  2005.  Lipid profile of ambulatory patients with type 2 diabetes mellitus at Kenyatta National Hospital, Nairobi. East Afr Med J. 2005 Dec;82(12 Suppl):S173-9.. East Afr Med J. 2005 Dec;82(12 Suppl):S173-9.. : Kisipan, M.L. Abstract
BACKGROUND: Patients with type 2 diabetes are at high of cardiovascular events because they have abnormal lipid status compared to their non-diabetic counterparts. OBJECTIVE: To determine the quantitative lipid profile of ambulatory patients with type 2 diabetes mellitus. DESIGN: Prospective, cross-sectional descriptive study. SETTING: Out-patient diabetic clinic of the Kenyatta National Hospital. SUBJECTS: Ambulatory patients with type 2 diabetes but without obvious cardiovascular, renal or foot complications. RESULTS: A total of 213 patients with type 2 diabetes were studied, 56.8% were females. The age range of the study population was 34 to 86 years, mean(sd) age of females was 54.45 (9.4) years and that of males was 55.83 (9.3) years. The mean body mass index (BMI) of females was 27.85 (6.2) kg/m2 and 25.98 (5.8) kg/m2 for males. The female subjects were more obese than the males in this study. Over 70% of the study participants had total cholesterol > 4.2 mmol/l, 43.8% and 57.6% of the females and males respectively had LDL-C > 2.6 mmol/l , 25.6% of the females and 30% of the males had HDL-C < 1.00 mmol/l. Only a modest proportion of males (28.3%) and females (32.2%) had triglycerides > 1.7 mmol/l. The LDL-C showed a significant positive correlation with age, duration of diabetes, fasting blood glucose, and total cholesterol but no correlation with glycated haemoglobin, body mass index, gender and the mode of glucose-lowering treatment. CONCLUSION: There was significant proportion of quantitative dyslipidaemia in the study population especially with the Total–and LDL- cholesterols. Although treatment goals and lipid thresholds for cardiovascular risk in diabetes are not yet well-defined, even by the large randomized trials, high-risk patients with significant quantitative dyslipidaemia would require deliberate effort to correct the abnormal values to reduce the risk status. These high-risk patients without complications but already had significant dyslipidaemia, which enhances the risk of cardiovascular events, certainly required therapeutic intervention.
OLONDE, PROFAMAYOERASTUS, N PROFOGOLAELIJAHS.  2005.  Otieno CF, Vaghela V, Ogola EN, Amayo EO. Patterns of homocysteine in Kenyans with type 2 diabetes without overt cardiovascular disease at Kenyatta National Hospital, Nairobi. East Afr Med J. 2005 Dec;82(12 Suppl):S180-3.. East Afr Med J. 2005 Dec;82(12 Suppl):S180-3.. : Kisipan, M.L. Abstract
BACKGROUND: Increased total homocysteine (tHcy) is an independent risk factor for cardiovascular disease. The measurement of tHcy in blood is therefore of potential great importance especially in patients with type 2 diabetes. OBJECTIVE: To determine the total homocysteine levels in ambulatory patients with type 2 diabetes. DESIGN: Cross-sectional, prospective study. SETTING: Outpatient diabetic clinic of the Kenyatta National Hospital. SUBJECTS: Ambulatory patients with Type 2 diabetes without overt cardiovascular, renal, liver or other chronic disease. MAIN OUTCOME MEASURES: Serum levels of tHcy, HbA1c, lipids and socio-demographic characteristics. RESULTS: A total of 115 patients, 48% males, with type 2 diabetes were included in the study. The mean (sd) age of the males was 56.85 (8.96) years and of the females was 55.68 (8.93) years. The mean (sd) total serum homocysteine for males of 12.97 (6.06) micromol/l was significantly higher than that of the females of 10.64 (4.41) micromol/l. The cholesterol, glycated haemoglobin, the body mass index and blood pressure of the study subjects did not show any statistically significant influence on their homocysteine levels. However, increasing age and duration of diabetes showed a significant linear relationship with rising level of total serum homocysteine. Some study participants reported smoking habit but unreliably. CONCLUSION: There was a significant proportion of the study patients with high levels of serum homocysteine, although most of them were of low to intermediate risk category. It may be prudent to assay homocysteine levels in patients with type 2 diabetes who are either older or have had diabetes for long duration for potential intervention.

2004

N, PROFOGOLAELIJAHS, DAVID PROFJOSHIMARK.  2004.  Cardiovascular risk factor profile of black Africans undergoing coronary angiography. Kamotho C,Ogola E N,Joshi M D,Gikonyo D. East Afr Med J.2004;81:82-86.. : Kisipan, M.L. Abstract
{ BACKGROUND: Coronary artery disease (CAD) is a growing epidemic on the African continent. It remains uncertain whether the risk factors identified as contributing to CAD in white populations contribute to a similar extent to CAD incidence in black populations. No data of the local population exists that is based on the coronary angiogram (CA). OBJECTIVES: To analyse the relationship of conventional cardiovascular risk factors with presence of CAD in black Africans. DESIGN: This was a dual-armed study, consisting of retrospective and prospective comparative arms. SUBJECTS: Black Africans who underwent coronary angiography. SETTING: Nairobi Hospital, Cathereterization laboratory. MAIN OUTCOME MEASURES: The conventional risk factors: age, male gender, hypertension, obesity, smoking, diabetes mellitus, dyslipidaemia, alcohol use and interventricular septum (IVS) hypertrophy, as a marker of LVH. RESULTS: One hundred and sixty nine patients fulfilled the inclusion criteria; 144 in the retrospective arm and 25 in the prospective. The larger retrospective arm showed that the group with CAD, compared to the normal group, was significantly older, with a higher mean age of 54.4 years compared to 49.8 years (P=0.005); had significantly more males, with a male to female ratio of 5.5:1 compared to 2.3:1 (P=0.045); had a very significantly larger proportion of diabetics (38.5% compared to 12%

2000

N, PROFOGOLAELIJAHS.  2000.  The urinary levels of catecholamines, aldosterone and cortisol in hypertensive East Africans: a pilot study.Ethn Dis. 2000 Autumn;10(3):357-63. Ethn Dis. 2000 Autumn;10(3):357-63.. : Kisipan, M.L. Abstract
This pilot project studies the prevalence of hypertension among unique social groups in Kenya, as well as the hormonal profiles accompanying the hypertensive and normotensive states in these populations. The purpose of this report is to enlarge and improve upon the statistical data currently available concerning the prevalence, etiology and prognosis of hypertensive disease in this region. In this study, the urinary concentrations of three vasoactive metabolites were measured in hypertensive and normotensive outpatients. The excretion values for the metabolites were ultimately tabulated as the quantity excreted per milligram of creatinine. The results demonstrate that the subjects with elevated blood pressures (>140/90 mm Hg) excreted double the concentrations (ng/mg creatinine) of cortisol and aldosterone excreted by normotensives. There were no apparent differences in urinary catecholamines between hypertensives and normotensives.

1999

N, PROFOGOLAELIJAHS, OTIENO PROFOGUTUELLY.  1999.  Oyoo GO, Ogola EN.Clinical and socio demographic aspects of congestive heart failure patients at Kenyatta National Hospital, Nairobi.East Afr Med J. 1999 Jan;76(1):23-7.. East Afr Med J. 1999 Jan;76(1):23-7.. : Kisipan, M.L. Abstract
socio-demographic determinants in patients admitted to Kenyatta National Hospital, Nairobi in congestive heart failure. DESIGN: Cross sectional descriptive study. SUBJECT: All patients aged thirteen years and above of either sex consecutively admitted with clinical diagnosis of congestive heart failure. SETTING: Kenyatta National Hospital (KNH), a national referral hospital. PATIENT EVALUATION: Detailed history including socio-demographic characteristics and physical examination was done. Patients underwent haematological and biochemistry tests followed by a chest x-ray, ECG and 2D Echo-doppler examination. Blood culture sensitivity was done when clinically indicated. RESULTS: Ninety one patients were studied, 44 males and 47 females. Almost 32% had rheumatic heart disease, 25.2% had cardiomyopathy, 17.6% hypertensive heart disease, 13.2% had pericardial disease while 2.2% had ischaemic heart disease. Three quarters of patients with hypertensive heart disease were above the age of 50 years, while 79% of patients with rheumatic heart disease were below the age of 30 years. Factors associated with patient deterioration leading to admission with congestive heart failure (CHF) included inadequate therapy (27.4%), arrhythmia (20.9%), respiratory infections (17.6%), anaemia (13.2%) and infective endocardiatis. Sixty two per cent of patients investigated were in New York Heart Association (NYHA) functional classification class IV, 31.9% in class III and 5.5% in class II. CONCLUSION: Congestive heart failure constitutes 3.3% of all medical admissions at KNH. Rheumatic heart disease is the commonest cause of congestive heart failure in our set-up while inadequate therapy, arrhythmias and respiratory infections are the three major causes of decompensation in our patients with cardiac disease.
N, PROFOGOLAELIJAHS, OMONDI DROYOOGEORGE.  1999.  Oyoo G O and Ogola E N Clinical and socio-demographic aspects of congestive heart failure patients at Kenyatta National Hospital, Nairobi, East African Medical Journal 1999; 76; 23-27. East African Medical Journal 1999; 76; 23-27. : Kisipan, M.L. Abstract
OBJECTIVE: To analyse the underlying aetiology, precipitating factors and certain socio-demographic determinants in patients admitted to Kenyatta National Hospital, Nairobi in congestive heart failure. DESIGN: Cross sectional descriptive study. SUBJECT: All patients aged thirteen years and above of either sex consecutively admitted with clinical diagnosis of congestive heart failure. SETTING: Kenyatta National Hospital (KNH), a national referral hospital. PATIENT EVALUATION: Detailed history including socio-demographic characteristics and physical examination was done. Patients underwent haematological and biochemistry tests followed by a chest x-ray, ECG and 2D Echo-doppler examination. Blood culture sensitivity was done when clinically indicated. RESULTS: Ninety one patients were studied, 44 males and 47 females. Almost 32% had rheumatic heart disease, 25.2% had cardiomyopathy, 17.6% hypertensive heart disease, 13.2% had pericardial disease while 2.2% had ischaemic heart disease. Three quarters of patients with hypertensive heart disease were above the age of 50 years, while 79% of patients with rheumatic heart disease were below the age of 30 years. Factors associated with patient deterioration leading to admission with congestive heart failure (CHF) included inadequate therapy (27.4%), arrhythmia (20.9%), respiratory infections (17.6%), anaemia (13.2%) and infective endocardiatis. Sixty two per cent of patients investigated were in New York Heart Association (NYHA) functional classification class IV, 31.9% in class III and 5.5% in class II. CONCLUSION: Congestive heart failure constitutes 3.3% of all medical admissions at KNH. Rheumatic heart disease is the commonest cause of congestive heart failure in our set-up while inadequate therapy, arrhythmias and respiratory infections are the three major causes of decompensation in our patients with cardiac disease.
N, PROFOGOLAELIJAHS, OMONDI DROYOOGEORGE.  1999.  Oyoo G.O OGOLA E.N, Clinical and sociodemographic aspects of congestive heart Failure Patients at Kenyatta National hospital. East Africa Med.J.70: 1999; 76:23-27.. East Africa Med.J.70: 1999; 76:23-27.. : Kisipan, M.L. Abstract
OBJECTIVE: To analyse the underlying aetiology, precipitating factors and certain socio-demographic determinants in patients admitted to Kenyatta National Hospital, Nairobi in congestive heart failure. DESIGN: Cross sectional descriptive study. SUBJECT: All patients aged thirteen years and above of either sex consecutively admitted with clinical diagnosis of congestive heart failure. SETTING: Kenyatta National Hospital (KNH), a national referral hospital. PATIENT EVALUATION: Detailed history including socio-demographic characteristics and physical examination was done. Patients underwent haematological and biochemistry tests followed by a chest x-ray, ECG and 2D Echo-doppler examination. Blood culture sensitivity was done when clinically indicated. RESULTS: Ninety one patients were studied, 44 males and 47 females. Almost 32% had rheumatic heart disease, 25.2% had cardiomyopathy, 17.6% hypertensive heart disease, 13.2% had pericardial disease while 2.2% had ischaemic heart disease. Three quarters of patients with hypertensive heart disease were above the age of 50 years, while 79% of patients with rheumatic heart disease were below the age of 30 years. Factors associated with patient deterioration leading to admission with congestive heart failure (CHF) included inadequate therapy (27.4%), arrhythmia (20.9%), respiratory infections (17.6%), anaemia (13.2%) and infective endocardiatis. Sixty two per cent of patients investigated were in New York Heart Association (NYHA) functional classification class IV, 31.9% in class III and 5.5% in class II. CONCLUSION: Congestive heart failure constitutes 3.3% of all medical admissions at KNH. Rheumatic heart disease is the commonest cause of congestive heart failure in our set-up while inadequate therapy, arrhythmias and respiratory infections are the three major causes of decompensation in our patients with cardiac disease.

1997

N, PROFOGOLAELIJAHS.  1997.  Lodenyo H.A, McLigeyo S.O OGOLA E.N.Cardiovascular disease in elderly patients at the Kenyatta national hospital. East Africa. J.741: 647,1997.. East Africa. J.741: 647,1997.. : Kisipan, M.L. Abstract
A prospective study to determine the prevalence and profile of cardiovascular disease in elderly patients admitted into the medical wards, Kenyatta National Hospital, was carried out between July 1991 and January 1992. Two hundred and two patients over 60 years of age were admitted into the medical wards over this period. This formed seven per cent of the total medical admissions. Two of these refused to take part in the study. Of the 200 elderly patients evaluated for cardiovascular disease, 146 (73%) were between 60 and 75 years of age with only 26 (13%) being over 85 years. Fifty seven per cent were males. Clinical evidence of cardiovascular disease was present in 79 (39.5%) of the patients evaluated. There was no sex difference in the prevalence of cardiovascular disease as judged from clinical evaluation (37.7% males versus 41.9% females, p > 0.05). Cardiovascular diseases in our medical in-patients at Kenyatta National Hospital are common and especially so with hypertension which plays an important role in the aetiology of congestive heart failure and cerebravascular accidents. Cardiac arrhythmias are also common though not necessarily symptomatic. Rheumatic heart disease and cardiomyopathies were uncommon in our study population. A community-based survey is needed to determine the true prevalence of cardiovascular diseases in the elderly and their contribution to morbidity in this sector of the population.

1995

N, PROFOGOLAELIJAHS, OTIENO PROFOGUTUELLY.  1995.  Ogola ES.Use of aspirin in preeclampsia.East Afr Med J. 1995 Nov;72(11):689.. East Afr Med J. 1995 Nov;72(11):689.. : Kisipan, M.L. Abstract
A prospective study to determine the prevalence and profile of cardiovascular disease in elderly patients admitted into the medical wards, Kenyatta National Hospital, was carried out between July 1991 and January 1992. Two hundred and two patients over 60 years of age were admitted into the medical wards over this period. This formed seven per cent of the total medical admissions. Two of these refused to take part in the study. Of the 200 elderly patients evaluated for cardiovascular disease, 146 (73%) were between 60 and 75 years of age with only 26 (13%) being over 85 years. Fifty seven per cent were males. Clinical evidence of cardiovascular disease was present in 79 (39.5%) of the patients evaluated. There was no sex difference in the prevalence of cardiovascular disease as judged from clinical evaluation (37.7% males versus 41.9% females, p > 0.05). Cardiovascular diseases in our medical in-patients at Kenyatta National Hospital are common and especially so with hypertension which plays an important role in the aetiology of congestive heart failure and cerebravascular accidents. Cardiac arrhythmias are also common though not necessarily symptomatic. Rheumatic heart disease and cardiomyopathies were uncommon in our study population. A community-based survey is needed to determine the true prevalence of cardiovascular diseases in the elderly and their contribution to morbidity in this sector of the population.
N, PROFOGOLAELIJAHS.  1995.  OGOLA E.N Use of aspirin in preeclampsia (Editorial) East Africa. Med J.11: 689,1995. East Africa. Med J.11: 689,1995. : Kisipan, M.L. Abstract
A prospective study to determine the prevalence and profile of cardiovascular disease in elderly patients admitted into the medical wards, Kenyatta National Hospital, was carried out between July 1991 and January 1992. Two hundred and two patients over 60 years of age were admitted into the medical wards over this period. This formed seven per cent of the total medical admissions. Two of these refused to take part in the study. Of the 200 elderly patients evaluated for cardiovascular disease, 146 (73%) were between 60 and 75 years of age with only 26 (13%) being over 85 years. Fifty seven per cent were males. Clinical evidence of cardiovascular disease was present in 79 (39.5%) of the patients evaluated. There was no sex difference in the prevalence of cardiovascular disease as judged from clinical evaluation (37.7% males versus 41.9% females, p > 0.05). Cardiovascular diseases in our medical in-patients at Kenyatta National Hospital are common and especially so with hypertension which plays an important role in the aetiology of congestive heart failure and cerebravascular accidents. Cardiac arrhythmias are also common though not necessarily symptomatic. Rheumatic heart disease and cardiomyopathies were uncommon in our study population. A community-based survey is needed to determine the true prevalence of cardiovascular diseases in the elderly and their contribution to morbidity in this sector of the population.

1994

N, PROFOGOLAELIJAHS.  1994.  OGOLA E.N Management of Hypertension in Africa East Africa. J.Med pract.4: 103,1994. East Africa. J.Med pract.4: 103,1994. : Kisipan, M.L. Abstract
A prospective study to determine the prevalence and profile of cardiovascular disease in elderly patients admitted into the medical wards, Kenyatta National Hospital, was carried out between July 1991 and January 1992. Two hundred and two patients over 60 years of age were admitted into the medical wards over this period. This formed seven per cent of the total medical admissions. Two of these refused to take part in the study. Of the 200 elderly patients evaluated for cardiovascular disease, 146 (73%) were between 60 and 75 years of age with only 26 (13%) being over 85 years. Fifty seven per cent were males. Clinical evidence of cardiovascular disease was present in 79 (39.5%) of the patients evaluated. There was no sex difference in the prevalence of cardiovascular disease as judged from clinical evaluation (37.7% males versus 41.9% females, p > 0.05). Cardiovascular diseases in our medical in-patients at Kenyatta National Hospital are common and especially so with hypertension which plays an important role in the aetiology of congestive heart failure and cerebravascular accidents. Cardiac arrhythmias are also common though not necessarily symptomatic. Rheumatic heart disease and cardiomyopathies were uncommon in our study population. A community-based survey is needed to determine the true prevalence of cardiovascular diseases in the elderly and their contribution to morbidity in this sector of the population.

1993

N, PROFOGOLAELIJAHS, OTIENO PROFOGUTUELLY.  1993.  Ogola EN, Yonga GO.Comparative study of the efficacy and tolerability of hydroflumethiazide versus propranolol in Africans with mild to moderate hypertension.East Afr Med J. 1993 May;70(5):277-9.. East Afr Med J. 1993 May;70(5):277-9.. : Kisipan, M.L. Abstract

Sixty patients with Diastolic Blood Pressure (DBP) of 100-110mmHg matched for age, sex and Bp levels were randomly assigned to propranolol 80mg daily or Hydroflumethiazide (HFM) 50mg daily. HFM causes a significant reduction in systolic blood pressure (SBP) and DBP within 4 weeks compared both with baseline and propranolol (SBP 143.7 +/- 12.3 vs 158.1 +/- 10.9mmHg, P < 0.05; DBP 92.0 +/- 4.5 vs 102.4 +/- 5.1mmHg, P < 0.05), (SBP 143.7 +/- 12.2 vs 152 +/- 11.0mmHg P < 0.05; DBP 92.0 +/- 4.5 vs 101.1 +/- 6.1mmHg, P < 0.05), respectively. Propranolol produced no significant difference from the baseline at 4 weeks (SBP 152.0 +/- H.0 vs 154.1 +/- 11.5mmHg NS; DBP 101.1 +/- 6.1 vs 102.2 +/- 5.6mmHg, NS). Reduction in BP by HFM was maintained after 8 and 12 weeks with further reduction but which did not achieve statistical significance. Increased dose of propranolol (160mg daily) after 4 weeks caused significant reduction in BP by 8 week (SBP 146.8 +/- 11.8 vs 152.0 +/- 11.0mmHg, P < 0.05; DBP 95.9 +/- 4.4 vs 101.1 +/- 6.1mmHg P < 0.05), which was maintained upto 12 weeks. The values however remained higher than in the HFM group. More patients in the HFM group achieved target BP (< 140/90), SBP 53.8% vs 29.6% P < 0.05, DBP 69.2% vs 14.8% P < 0.01. Incidence of side effects was similar and will be discussed. Thiazides are superior to B'blockers as initial monotherapy in black hypertensives.

N, PROFOGOLAELIJAHS, OTIENO PROFOGUTUELLY.  1993.  Yonga GO, Ogola EN, Orinda DA.Metabolic effects of propranolol and hydroflumethiazide treatment in Kenyans with mild to moderate essential hypertension.East Afr Med J. 1993 Nov;70(11):696-700.. East Afr Med J. 1993 Nov;70(11):696-700.. : Kisipan, M.L. Abstract
In a prospective single-blind comparative trial, sixty newly diagnosed mild to moderate hypertensives were randomly assigned to either propranolol or hydroflumethiazide monotherapy. Baseline fasting serum glucose lipid profiles, serum uric acid and potassium levels, were determined at the beginning of the trial. Repeat levels were determined at completion of twelve weeks of treatment. Propranolol treatment significantly reduced HDL-cholesterol (p < 0.02) and increased both VLDL and total serum triglycerides (p < 0.01). Hydroflumethiazide significantly increased total and LDL-chole-sterol, fasting serum glucose and uric acid levels (p < 0.01); potassium levels were significantly lowered (p < 0.01). Treatment with either propranolol or hydroflumethiazide is associated with significant metabolic side-effects which require regular monitoring and intervention as appropriate.
D, PROFJUMAFRANCIS, N PROFOGOLAELIJAHS.  1993.  Cardiovascular risk factor profiles in mild to moderate hypertensives seen at Kenyatta National Hospital.East Afr Med J. 1993 Nov;70(11):693-5. East Afr Med J. 1993 Nov;70(11):693-5. : Kisipan, M.L. Abstract
Sixty newly diagnosed adult patients with mild to moderate essential hypertension were assessed to determine their cardiovascular risk factor profiles. Detailed history and physical examinations were done. Resting 12-lead ECG was done and serum levels of uric acid, fasting cholesterol, and fasting glucose were determined. Twenty nine patients had hypertension and two or more cardiovascular risk factors. The most prevalent cardiovascular risk factors other than hypertension were electro-cardiovascular left ventricular hypertrophy (31.7%), obesity (28.3%) and hypercholesterolaemia (28.3%). About a half of these patients (48.3%) can be classified as high risk hypertensives. This calls for aggressive management of cardiovascular risk factors as a whole and not just hypertension alone if we are to reduce incidence of hypertensive complications.
N, PROFOGOLAELIJAHS.  1993.  Yonga G.O OGOLA E.N. Juma F.D Metabolic effects of popranolol and hydroflumethiazide in Kenyans with mild to moderate hypertension. East Africa Med J.70: 696,199Yonga G.O OGOLA E.N. Juma F.D Metabolic effects of popranolol and hydroflumethiazide in Kenyan. East Africa Med J.70: 696,1993. : Kisipan, M.L. Abstract
Sixty newly diagnosed adult patients with mild to moderate essential hypertension were assessed to determine their cardiovascular risk factor profiles. Detailed history and physical examinations were done. Resting 12-lead ECG was done and serum levels of uric acid, fasting cholesterol, and fasting glucose were determined. Twenty nine patients had hypertension and two or more cardiovascular risk factors. The most prevalent cardiovascular risk factors other than hypertension were electro-cardiovascular left ventricular hypertrophy (31.7%), obesity (28.3%) and hypercholesterolaemia (28.3%). About a half of these patients (48.3%) can be classified as high risk hypertensives. This calls for aggressive management of cardiovascular risk factors as a whole and not just hypertension alone if we are to reduce incidence of hypertensive complications.
N, PROFOGOLAELIJAHS.  1993.  YongaG.O OGOLA E.N Juma F.D Cardiovascular risk factor profiles in patients seen at Kenyatta National hospital with mild to moderate hypertension. East Africa J.70: 693,1993. East Africa J.70: 693,1993. : Kisipan, M.L. Abstract
Sixty newly diagnosed adult patients with mild to moderate essential hypertension were assessed to determine their cardiovascular risk factor profiles. Detailed history and physical examinations were done. Resting 12-lead ECG was done and serum levels of uric acid, fasting cholesterol, and fasting glucose were determined. Twenty nine patients had hypertension and two or more cardiovascular risk factors. The most prevalent cardiovascular risk factors other than hypertension were electro-cardiovascular left ventricular hypertrophy (31.7%), obesity (28.3%) and hypercholesterolaemia (28.3%). About a half of these patients (48.3%) can be classified as high risk hypertensives. This calls for aggressive management of cardiovascular risk factors as a whole and not just hypertension alone if we are to reduce incidence of hypertensive complications.

1992

N, PROFOGOLAELIJAHS, OTIENO PROFOGUTUELLY.  1992.  Lore W, Muita AK, Ogola ES.The efficacy and tolerability of enalapril–hydrochlorothiazide combination as a first line therapy in black patients with mild to moderate arterial hypertension: a clinical study in Kenya.East Afr Med J. 1992 Jan;69(1):18-21.. East Afr Med J. 1992 Jan;69(1):18-21.. : Kisipan, M.L. Abstract
The study aimed at evaluating tolerability and efficacy of the combination enalapril 20 mg with hydrochlorothiazide 12.5 mg (co-renitec) as first line therapy in black patients with mild to moderate primary hypertension. Fifty patients completed a twelve weeks of open clinical study preceded by two weeks of washout period. They were evaluated every four weeks and haematological, biochemical urine microscopy and electrocardiographic tests were undertaken before the start and after the completion of study. Pre-treatment values of mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 172.16 mm hg (+/- 20.41) and 104.38 mm hg (+/- 7.339) respectively. The usual daily dosage was one tablet which was increased to two after eight weeks in case the DBP was not normalized, i.e. less than or equal to 95 mm hg. In 44 (88%) patients, the DBP was normalised at the end of the study period; three patients (6%) were resistant to treatment and another three (6%) exhibited labile response to the treatment. Clinical tolerance was considered to be very good with only five episodes of headache, backache and anxiety, probably not related to the test drug. Biological tolerance was excellent: there was no change in the haematologic parameters; there was a decrease of 5% in mean blood urea, of 9% in the mean serum creatinine and of 4% in the mean serum uric acid and a 5% increase in plasma potassium from 3.99 to 4.28 mmol/l.(ABSTRACT TRUNCATED AT 250 WORDS)
N, PROFOGOLAELIJAHS.  1992.  Ogola ES, Muita AK, Adala H.Chloroquine related complete heart block with blindness: case report. East Afr Med J. 1992 Jan;69(1):50-2.. East Africa. Med J.69: 50,1992.. : Kisipan, M.L. Abstract
A 27-year old African woman with history of regular chloroquine ingestion presented with progressive deterioration of vision, easy fatiguability, dyspnoea, dizziness progressing to syncopal attacks. Ophthalmological assessment revealed features of chloroquine retinopathy, cardiac assessment revealed features of heart failure and a complete heart block with right bundle branch block pattern. The heart block was treated by pacemaker insertion and the heart failure resolved spontaneously following chloroquine discontinuation. She however remains blind.
N, PROFOGOLAELIJAHS.  1992.  OGOLA EN, Muita A.k ADALA h. Chrolroquine related complete heart block blindness. Case report and review of literature. East Africa. Med J.69: 50,1992.. East Africa. Med J.69: 50,1992.. : Kisipan, M.L. Abstract

Sixty patients with Diastolic Blood Pressure (DBP) of 100-110mmHg matched for age, sex and Bp levels were randomly assigned to propranolol 80mg daily or Hydroflumethiazide (HFM) 50mg daily. HFM causes a significant reduction in systolic blood pressure (SBP) and DBP within 4 weeks compared both with baseline and propranolol (SBP 143.7 +/- 12.3 vs 158.1 +/- 10.9mmHg, P < 0.05; DBP 92.0 +/- 4.5 vs 102.4 +/- 5.1mmHg, P < 0.05), (SBP 143.7 +/- 12.2 vs 152 +/- 11.0mmHg P < 0.05; DBP 92.0 +/- 4.5 vs 101.1 +/- 6.1mmHg, P < 0.05), respectively. Propranolol produced no significant difference from the baseline at 4 weeks (SBP 152.0 +/- H.0 vs 154.1 +/- 11.5mmHg NS; DBP 101.1 +/- 6.1 vs 102.2 +/- 5.6mmHg, NS). Reduction in BP by HFM was maintained after 8 and 12 weeks with further reduction but which did not achieve statistical significance. Increased dose of propranolol (160mg daily) after 4 weeks caused significant reduction in BP by 8 week (SBP 146.8 +/- 11.8 vs 152.0 +/- 11.0mmHg, P < 0.05; DBP 95.9 +/- 4.4 vs 101.1 +/- 6.1mmHg P < 0.05), which was maintained upto 12 weeks. The values however remained higher than in the HFM group. More patients in the HFM group achieved target BP (< 140/90), SBP 53.8% vs 29.6% P < 0.05, DBP 69.2% vs 14.8% P < 0.01. Incidence of side effects was similar and will be discussed. Thiazides are superior to B'blockers as initial monotherapy in black hypertensives.

N, PROFOGOLAELIJAHS.  1992.  LORE W; MUITA A.K; OGOLA E.N; Efficacy and tolerability of Enalapril hydrochlorothiazide combination as first line therapy in essential arterial hypertension in Blacks, a Clinical Trial Kenya. East Africa .Med J.69: 18, 1992. East Africa .Med J.69: 18, 1992. : Kisipan, M.L. Abstract

Sixty patients with Diastolic Blood Pressure (DBP) of 100-110mmHg matched for age, sex and Bp levels were randomly assigned to propranolol 80mg daily or Hydroflumethiazide (HFM) 50mg daily. HFM causes a significant reduction in systolic blood pressure (SBP) and DBP within 4 weeks compared both with baseline and propranolol (SBP 143.7 +/- 12.3 vs 158.1 +/- 10.9mmHg, P < 0.05; DBP 92.0 +/- 4.5 vs 102.4 +/- 5.1mmHg, P < 0.05), (SBP 143.7 +/- 12.2 vs 152 +/- 11.0mmHg P < 0.05; DBP 92.0 +/- 4.5 vs 101.1 +/- 6.1mmHg, P < 0.05), respectively. Propranolol produced no significant difference from the baseline at 4 weeks (SBP 152.0 +/- H.0 vs 154.1 +/- 11.5mmHg NS; DBP 101.1 +/- 6.1 vs 102.2 +/- 5.6mmHg, NS). Reduction in BP by HFM was maintained after 8 and 12 weeks with further reduction but which did not achieve statistical significance. Increased dose of propranolol (160mg daily) after 4 weeks caused significant reduction in BP by 8 week (SBP 146.8 +/- 11.8 vs 152.0 +/- 11.0mmHg, P < 0.05; DBP 95.9 +/- 4.4 vs 101.1 +/- 6.1mmHg P < 0.05), which was maintained upto 12 weeks. The values however remained higher than in the HFM group. More patients in the HFM group achieved target BP (< 140/90), SBP 53.8% vs 29.6% P < 0.05, DBP 69.2% vs 14.8% P < 0.01. Incidence of side effects was similar and will be discussed. Thiazides are superior to B'blockers as initial monotherapy in black hypertensives.

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