Nigerian journal of cardiology/Nigerian Journal of cardiology, 2023
Genetic differences exist between Blacks and whites through sympathetic-vascular transduction sig... more Genetic differences exist between Blacks and whites through sympathetic-vascular transduction signaling mechanisms. However, the lack of benefit of alpha-1 blockers in whites may not be applicable in Africans. The angiotensin II (Ang II) and alpha-1 receptor pathways are critical for vasoconstriction in Blacks. This article reviewed the consequence of the dual blockade among Nigerians, those with and without cardiovascular disease. Both receptors exhibited crosstalk and mutual regulations. Synergistic inhibition of Forearm vasoconstriction and hypotensive response to enalapril + prazosin (alpha-1 blocker [A1B]) occurred (P < 0.05). High efficacy of dual blockade by angiotensin converting enzyme inhibitor (ACEI) + A1B was reported in hypertensive urgency, hypertensive crises, and heart failure (HF) with reduced ejection fraction congestive HF compared to ACEI (P < 0.05). The high efficacy of dual blockade by ACEI + A1B + diuretics is beneficial for widespread use in Nigerians with cardiovascular disease.
1. In two single dose studies, acute blood pressure reduction with cilazapril was not associated ... more 1. In two single dose studies, acute blood pressure reduction with cilazapril was not associated with any significant change in supine or erect heart rate in either normotensives or hypertensives. 2. To investigate the lack of reflex cardioacceleration, a series of autonomic function tests was undertaken when there was maximum ACE inhibition, maximum evidence of angiotensin II withdrawal and the lowest blood pressure. 3. There was no evidence that cilazapril had any significant impact on indices of sympathetic nervous activity or the integrity of baroreflex mechanisms. 4. The results for the bradycardic response to apnoeic facial immersion, suggested enhanced parasympathetic activity, consistent with the withdrawal of the vagolytic actions of angiotensin II. 5. These results suggest that the absence of a heart rate response to ACE inhibition is not related to a profound sympatho‐inhibitory effect or an impairment of baroreflex function. While there is some evidence of enhanced cardi...
Genetic differences exist between Blacks and whites through sympathetic-vascular transduction sig... more Genetic differences exist between Blacks and whites through sympathetic-vascular transduction signaling mechanisms. However, the lack of benefit of alpha-1 blockers in whites may not be applicable in Africans. The angiotensin II (Ang II) and alpha-1 receptor pathways are critical for vasoconstriction in Blacks. This article reviewed the consequence of the dual blockade among Nigerians, those with and without cardiovascular disease. Both receptors exhibited crosstalk and mutual regulations. Synergistic inhibition of Forearm vasoconstriction and hypotensive response to enalapril + prazosin (alpha-1 blocker [A1B]) occurred (P < 0.05). High efficacy of dual blockade by angiotensin converting enzyme inhibitor (ACEI) + A1B was reported in hypertensive urgency, hypertensive crises, and heart failure (HF) with reduced ejection fraction congestive HF compared to ACEI (P < 0.05). The high efficacy of dual blockade by ACEI + A1B + diuretics is beneficial for widespread use in Nigerians with cardiovascular disease.
This review addresses the disparity in the phenotype of heart failure with respect to incidence, ... more This review addresses the disparity in the phenotype of heart failure with respect to incidence, genetics, response to therapy as well as the socioeconomic factors affecting heart failure indices between sub-Saharan blacks and white patients and attempts to propose solutions.
Hypertensive heart disease(HHD) in Nigerians, is associated with concentric LVH and a high freque... more Hypertensive heart disease(HHD) in Nigerians, is associated with concentric LVH and a high frequency of early valvular regurgitations (VR). HHD is the commonest cause of sudden cardiac death (SCD) in that population, but the role of arrhythmias in these is not known. We therefore (a)investigated the relationship between VR and cardiac arrhythmias in normotensives, hypertensives, and hypertensive heart failure (HHF) in Nigerians and (b) examined the hypothesis that VR increases the prevalence and complexity of cardiac arrhythmias in HHF Nigerians. HHF patients (n=14), HHD patients (n= 23) and Normal controls (N) n=9 underwent 24 hr Holter EKG monitoring and 2D and Doppler Echocardiography, and the presence or absence of VR noted in each individual and groups. Each patient group was sub classified into those with VR or without VR (NVR). There were significant between patient group differences in SVT P<0.001ANOVA),mean and median VT frequency (p <0.02) and ventricular couplets (p...
The renin-angiotensin-aldosterone system (RAS or RAAS), as well as the sympathetic nervous system... more The renin-angiotensin-aldosterone system (RAS or RAAS), as well as the sympathetic nervous system (SNS) are important neuro-endocrine regulators of blood pressure (BP). They modulate vasoconstriction (systemic vascular resistance) and cardiac output/inotropism (CO). [1,2] Evidence have shown that the two systems act independently, especially in the healthy and hypertensive state. [3] However, they could act synergically via multi-level interactions in cardiovascular disease, for example, patients with chronic congestive heart failure (HF). [4] The efficacy of alpha-1 blocker (A1B) may impact prognosis and mortality outcomes and save costs if rationally employed. It appears that the relative contributions of RAS or SNS to vasoconstriction and cardiovascular disease are impacted by Genetic differences exist between Blacks and whites through sympathetic-vascular transduction signaling mechanisms. However, the lack of benefit of alpha-1 blockers in whites may not be applicable in Africans. The angiotensin II (Ang II) and alpha-1 receptor pathways are critical for vasoconstriction in Blacks. This article reviewed the consequence of the dual blockade among Nigerians, those with and without cardiovascular disease. Both receptors exhibited crosstalk and mutual regulations. Synergistic inhibition of Forearm vasoconstriction and hypotensive response to enalapril + prazosin (alpha-1 blocker [A1B]) occurred (P < 0.05). High efficacy of dual blockade by angiotensin converting enzyme inhibitor (ACEI) + A1B was reported in hypertensive urgency, hypertensive crises, and heart failure (HF) with reduced ejection fraction congestive HF compared to ACEI (P < 0.05). The high efficacy of dual blockade by ACEI + A1B + diuretics is beneficial for widespread use in Nigerians with cardiovascular disease.
Genetic differences exist between Blacks and whites through sympathetic-vascular transduction sig... more Genetic differences exist between Blacks and whites through sympathetic-vascular transduction signaling mechanisms. However, the lack of benefit of alpha-1 blockers in whites may not be applicable in Africans. The angiotensin II (Ang II) and alpha-1 receptor pathways are critical for vasoconstriction in Blacks. This article reviewed the consequence of the dual blockade among Nigerians, those with and without cardiovascular disease. Both receptors exhibited crosstalk and mutual regulations. Synergistic inhibition of Forearm vasoconstriction and hypotensive response to enalapril + prazosin (alpha-1 blocker [A1B]) occurred (P < 0.05). High efficacy of dual blockade by angiotensin converting enzyme inhibitor (ACEI) + A1B was reported in hypertensive urgency, hypertensive crises, and heart failure (HF) with reduced ejection fraction congestive HF compared to ACEI (P < 0.05). The high efficacy of dual blockade by ACEI + A1B + diuretics is beneficial for widespread use in Nigerians with cardiovascular disease.
Genetic differences exist between Blacks and whites through sympathetic-vascular transduction sig... more Genetic differences exist between Blacks and whites through sympathetic-vascular transduction signaling mechanisms. However, the lack of benefit of alpha-1 blockers in whites may not be applicable in Africans. The angiotensin II (Ang II) and alpha-1 receptor pathways are critical for vasoconstriction in Blacks. This article reviewed the consequence of the dual blockade among Nigerians, those with and without cardiovascular disease. Both receptors exhibited crosstalk and mutual regulations. Synergistic inhibition of Forearm vasoconstriction and hypotensive response to enalapril + prazosin (alpha-1 blocker [A1B]) occurred (P < 0.05). High efficacy of dual blockade by angiotensin converting enzyme inhibitor (ACEI) + A1B was reported in hypertensive urgency, hypertensive crises, and heart failure (HF) with reduced ejection fraction congestive HF compared to ACEI (P < 0.05). The high efficacy of dual blockade by ACEI + A1B + diuretics is beneficial for widespread use in Nigerians with cardiovascular disease.
Please do NOT make direct edits to the PDF using the editing tools as doing so could lead us to o... more Please do NOT make direct edits to the PDF using the editing tools as doing so could lead us to overlook your desired changes. Rather, please request corrections by using the tools in the Comment pane to annotate the PDF and call out the changes you are requesting. If you opt to annotate the file with software other than Adobe Reader then please also highlight the appropriate place in the PDF file.
Background and objectives: Hypoxemic respiratory failure is a common mode of demise in COVID-19 d... more Background and objectives: Hypoxemic respiratory failure is a common mode of demise in COVID-19 disease. We aimed to describe the time course of SPO 2 changes in COVID-19 patients treated with and without ivermectin. Methods: This was a parallel group, prospective comparative study of propensity matched COVID-19 patients (Cycle threshold Ct<25, SPO 2 <94%). 21 of the patients received Ivermectin (IVM) inclusive regime at 12 mg daily for 5 days, while 26 others received Non-ivermectin Inclusive Regime (NIVM). Results: The IVM group demonstrated earlier and greater increase in SPO 2 (p=0.000) which paralleled greater and faster virological clearance (p=0.000) on Repeat measures Analysis of Variance RMANOVA. There was a significant correlation between absolute SPO 2 and absolute Ct on day 5 (r=0.77) and day 7 (r=0.77) both p=0.000. Incremental SPO 2 also correlated with incremental Ct. by day 5 (r=0.397, p=0.003) and day 7 (r=0.315, p=0.0002) relative to baseline. Increase in platelet count correlated with increased SPO 2 (r=0.252, p=0.029) on IVM, but negatively with NIVM (r=-0.28, p=0.17). Inflammatory markers such as ESR, CRP or D-dimer showed no significant correlation with SPO 2. Increase in SPO 2 on IVM was magnified in males. Conclusion: IVM regime appears to be associated with faster and greater increase in SPO 2 paralleling faster viral clearance in COVID-19 patients.
Background :Hypertension (HT) prevalence and mortality are highest in Sub-Saharan Africa (SSA). A... more Background :Hypertension (HT) prevalence and mortality are highest in Sub-Saharan Africa (SSA). Aims :We reviewed the pathophysiology of HT and pharmaco-therapy with antihypertensive drugs (AHD) in SSA by drug class, for safety and efficacy. Factors impacting uncontrolled Blood pressure (UBP) and amelioration, were analyzed. Methods,Results:14 separate therapeutic audits in 4 SSA nations (total n = 6,496 patients) were evaluated. Calcium Channel blockers (CCB) especially amlodipine, and thiazide diuretics (TD), mostly hydrochlorothiazide (HCTZ) were the commonest AHD. Thiazide Like Diuretics (TLD) were underutilized. The % of patients on AHDs were; 1 drug 5.4-55%; 2 drugs 37-82%; >/= 3 drugs 6-50.3%. 2-drug combinations were :ACEI/ARB + TD (42%), CCB + TD (36.8%), ACEI + CCB (15.8%) of studies. Triple /quadruple therapy included Methyldopa (MTD) with ACEI + CCB or TD. The proportion of patients (%) attaining BP < 140 / < 90 mmHg, ranged from 29 to 53.6%, median, 44%. The commonest co-morbidities, range and median were: Diabetes Mellitus (DM) 9.8-64%, 19.2%; Chronic Kidney Disease (CKD) 5.7-7.5%, 6.9%; and Coronary artery Disease (CAD) 0.9 to 2.6%, 2.3%. ACEI + CCB +/-TD were the preferred AHD for these indications. Conclusions: Therapeutic inertia, non-compliance, refractory HT, co-morbidities, ignorance,substandard AHDs, are modifiable causes of UBP. Prognostic studies relating 24 hour ABPM to complications and mortality in SSA hypertensives, and impact of different AHD classes on ABPM, are needed. Further study of ACEI/ARB + alpha-1 blockers+ TLD on 24 hour ABPM and personalized care, are required.
Background and objectives: Hypoxemic respiratory failure is a common mode of demise in COVID-19 d... more Background and objectives: Hypoxemic respiratory failure is a common mode of demise in COVID-19 disease. We aimed to describe the time course of SPO 2 changes in COVID-19 patients treated with and without ivermectin. Methods: This was a parallel group, prospective comparative study of propensity matched COVID-19 patients (Cycle threshold Ct&lt;25, SPO 2 &lt;94%). 21 of the patients received Ivermectin (IVM) inclusive regime at 12 mg daily for 5 days, while 26 others received Non-ivermectin Inclusive Regime (NIVM). Results: The IVM group demonstrated earlier and greater increase in SPO 2 (p=0.000) which paralleled greater and faster virological clearance (p=0.000) on Repeat measures Analysis of Variance RMANOVA. There was a significant correlation between absolute SPO 2 and absolute Ct on day 5 (r=0.77) and day 7 (r=0.77) both p=0.000. Incremental SPO 2 also correlated with incremental Ct. by day 5 (r=0.397, p=0.003) and day 7 (r=0.315, p=0.0002) relative to baseline. Increase in platelet count correlated with increased SPO 2 (r=0.252, p=0.029) on IVM, but negatively with NIVM (r=-0.28, p=0.17). Inflammatory markers such as ESR, CRP or D-dimer showed no significant correlation with SPO 2. Increase in SPO 2 on IVM was magnified in males. Conclusion: IVM regime appears to be associated with faster and greater increase in SPO 2 paralleling faster viral clearance in COVID-19 patients.
African journal of medicine and medical sciences, Jun 1, 1991
A review of early published research of the efficacy and safety of ACE inhibitors, captopril and ... more A review of early published research of the efficacy and safety of ACE inhibitors, captopril and enalapril in Africans with essential hypertension, malignant hypertension with CKD, hypertensive -diabetic patients and in chronic congestive heart failure is presented. Enalapril monotherapy was ineffective in Africans with essential hypertension. Activation of RAAS in malignant hypertension caused profound hypotensive effect. There was an anti-proteinuric effect in CKD and Hypertensive-Diabetics, with rise in plasma albumin concentration. In CHF patients, enalapril increased treadmill exercise and self paced exercise duration in the short and long term. There was increased pulse pressure indicating arteriolar vasodilator action, reversal of hyponatremia, and increased creatinine clearance and natriuresis. The review established the utility of ACE inhibitors in cardiovascular medicine in Africans, despite the low renin state and lack of monotherapeutic efficacy in blacks with essential hypertension.
The efficacy of Ivermectin (IVM) against SARS-CoV-2 has been demonstrated in vitro, while several... more The efficacy of Ivermectin (IVM) against SARS-CoV-2 has been demonstrated in vitro, while several clinical studies suggest that it is efficacious and safe in reducing morbidity and mortality. Hydroxychloroquine (HCQ, Quinoric®), IVM and Azithromycin(AZM, Zithromax®) (HIA therapy) is being used in several low-and middle-income countries (LMIC) where more expensive medications such as Remdesivir are out of reach. In this study, we set out to compare the efficacy of IVM monotherapy with HIA combination therapy. Methods: This was a single-blind, randomized control trial, of 2 parallel groups of COVID-19 Positive Nigerians. Thirty (30) patients received Ivermectin (Mectizan®) 200 mcg/ kg daily for five days, while 31 patients received HIA triple therapy. Viral cycle threshold (Ct) at pre-treatment baseline, and days 2, 5, 14 and 21 were measured for E-and N-genes (Envelope and Nucleocapsid genes respectively). SpO2 (percentage saturation of oxygen in the blood) was assessed on a daily basis, while inflammatory markers such as Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein, and D-dimer and Neutrophil/Lymphocyte Ratios (NLR), were assessed at baseline and day 7 post treatment. Clinical status was self-assessed daily on a Likert scale. Results: 2-way Repeated measures Analysis of Variance (RMANOVA) did not show any difference between the two groups. However, there was a significant time effect (improvement over time) for SpO2, Ct N-gene, Ct E-gene and clinical status in both groups, and significant reductions in inflammatory markers by day 7 (P < 0.0001). Conclusions: AZT + HCQ may be redundant adjuncts in COVID-19 therapy. Improvements noted are likely due in large part to Ivermectin virucidal and anti-inflammatory actions. RANdOmisEd dRug TRiAl
Background and objectives: Hypoxemic respiratory failure is a common mode of demise in COVID-19 d... more Background and objectives: Hypoxemic respiratory failure is a common mode of demise in COVID-19 disease. We aimed to describe the time course of SPO 2 changes in COVID-19 patients treated with and without ivermectin. Methods: This was a parallel group, prospective comparative study of propensity matched COVID-19 patients (Cycle threshold Ct<25, SPO 2 <94%). 21 of the patients received Ivermectin (IVM) inclusive regime at 12 mg daily for 5 days, while 26 others received Non-ivermectin Inclusive Regime (NIVM). Results: The IVM group demonstrated earlier and greater increase in SPO 2 (p=0.000) which paralleled greater and faster virological clearance (p=0.000) on Repeat measures Analysis of Variance RMANOVA. There was a significant correlation between absolute SPO 2 and absolute Ct on day 5 (r=0.77) and day 7 (r=0.77) both p=0.000. Incremental SPO 2 also correlated with incremental Ct. by day 5 (r=0.397, p=0.003) and day 7 (r=0.315, p=0.0002) relative to baseline. Increase in platelet count correlated with increased SPO 2 (r=0.252, p=0.029) on IVM, but negatively with NIVM (r=-0.28, p=0.17). Inflammatory markers such as ESR, CRP or D-dimer showed no significant correlation with SPO 2. Increase in SPO 2 on IVM was magnified in males. Conclusion: IVM regime appears to be associated with faster and greater increase in SPO 2 paralleling faster viral clearance in COVID-19 patients.
Nigerian journal of cardiology/Nigerian Journal of cardiology, 2023
Genetic differences exist between Blacks and whites through sympathetic-vascular transduction sig... more Genetic differences exist between Blacks and whites through sympathetic-vascular transduction signaling mechanisms. However, the lack of benefit of alpha-1 blockers in whites may not be applicable in Africans. The angiotensin II (Ang II) and alpha-1 receptor pathways are critical for vasoconstriction in Blacks. This article reviewed the consequence of the dual blockade among Nigerians, those with and without cardiovascular disease. Both receptors exhibited crosstalk and mutual regulations. Synergistic inhibition of Forearm vasoconstriction and hypotensive response to enalapril + prazosin (alpha-1 blocker [A1B]) occurred (P &lt; 0.05). High efficacy of dual blockade by angiotensin converting enzyme inhibitor (ACEI) + A1B was reported in hypertensive urgency, hypertensive crises, and heart failure (HF) with reduced ejection fraction congestive HF compared to ACEI (P &lt; 0.05). The high efficacy of dual blockade by ACEI + A1B + diuretics is beneficial for widespread use in Nigerians with cardiovascular disease.
1. In two single dose studies, acute blood pressure reduction with cilazapril was not associated ... more 1. In two single dose studies, acute blood pressure reduction with cilazapril was not associated with any significant change in supine or erect heart rate in either normotensives or hypertensives. 2. To investigate the lack of reflex cardioacceleration, a series of autonomic function tests was undertaken when there was maximum ACE inhibition, maximum evidence of angiotensin II withdrawal and the lowest blood pressure. 3. There was no evidence that cilazapril had any significant impact on indices of sympathetic nervous activity or the integrity of baroreflex mechanisms. 4. The results for the bradycardic response to apnoeic facial immersion, suggested enhanced parasympathetic activity, consistent with the withdrawal of the vagolytic actions of angiotensin II. 5. These results suggest that the absence of a heart rate response to ACE inhibition is not related to a profound sympatho‐inhibitory effect or an impairment of baroreflex function. While there is some evidence of enhanced cardi...
Genetic differences exist between Blacks and whites through sympathetic-vascular transduction sig... more Genetic differences exist between Blacks and whites through sympathetic-vascular transduction signaling mechanisms. However, the lack of benefit of alpha-1 blockers in whites may not be applicable in Africans. The angiotensin II (Ang II) and alpha-1 receptor pathways are critical for vasoconstriction in Blacks. This article reviewed the consequence of the dual blockade among Nigerians, those with and without cardiovascular disease. Both receptors exhibited crosstalk and mutual regulations. Synergistic inhibition of Forearm vasoconstriction and hypotensive response to enalapril + prazosin (alpha-1 blocker [A1B]) occurred (P < 0.05). High efficacy of dual blockade by angiotensin converting enzyme inhibitor (ACEI) + A1B was reported in hypertensive urgency, hypertensive crises, and heart failure (HF) with reduced ejection fraction congestive HF compared to ACEI (P < 0.05). The high efficacy of dual blockade by ACEI + A1B + diuretics is beneficial for widespread use in Nigerians with cardiovascular disease.
This review addresses the disparity in the phenotype of heart failure with respect to incidence, ... more This review addresses the disparity in the phenotype of heart failure with respect to incidence, genetics, response to therapy as well as the socioeconomic factors affecting heart failure indices between sub-Saharan blacks and white patients and attempts to propose solutions.
Hypertensive heart disease(HHD) in Nigerians, is associated with concentric LVH and a high freque... more Hypertensive heart disease(HHD) in Nigerians, is associated with concentric LVH and a high frequency of early valvular regurgitations (VR). HHD is the commonest cause of sudden cardiac death (SCD) in that population, but the role of arrhythmias in these is not known. We therefore (a)investigated the relationship between VR and cardiac arrhythmias in normotensives, hypertensives, and hypertensive heart failure (HHF) in Nigerians and (b) examined the hypothesis that VR increases the prevalence and complexity of cardiac arrhythmias in HHF Nigerians. HHF patients (n=14), HHD patients (n= 23) and Normal controls (N) n=9 underwent 24 hr Holter EKG monitoring and 2D and Doppler Echocardiography, and the presence or absence of VR noted in each individual and groups. Each patient group was sub classified into those with VR or without VR (NVR). There were significant between patient group differences in SVT P<0.001ANOVA),mean and median VT frequency (p <0.02) and ventricular couplets (p...
The renin-angiotensin-aldosterone system (RAS or RAAS), as well as the sympathetic nervous system... more The renin-angiotensin-aldosterone system (RAS or RAAS), as well as the sympathetic nervous system (SNS) are important neuro-endocrine regulators of blood pressure (BP). They modulate vasoconstriction (systemic vascular resistance) and cardiac output/inotropism (CO). [1,2] Evidence have shown that the two systems act independently, especially in the healthy and hypertensive state. [3] However, they could act synergically via multi-level interactions in cardiovascular disease, for example, patients with chronic congestive heart failure (HF). [4] The efficacy of alpha-1 blocker (A1B) may impact prognosis and mortality outcomes and save costs if rationally employed. It appears that the relative contributions of RAS or SNS to vasoconstriction and cardiovascular disease are impacted by Genetic differences exist between Blacks and whites through sympathetic-vascular transduction signaling mechanisms. However, the lack of benefit of alpha-1 blockers in whites may not be applicable in Africans. The angiotensin II (Ang II) and alpha-1 receptor pathways are critical for vasoconstriction in Blacks. This article reviewed the consequence of the dual blockade among Nigerians, those with and without cardiovascular disease. Both receptors exhibited crosstalk and mutual regulations. Synergistic inhibition of Forearm vasoconstriction and hypotensive response to enalapril + prazosin (alpha-1 blocker [A1B]) occurred (P < 0.05). High efficacy of dual blockade by angiotensin converting enzyme inhibitor (ACEI) + A1B was reported in hypertensive urgency, hypertensive crises, and heart failure (HF) with reduced ejection fraction congestive HF compared to ACEI (P < 0.05). The high efficacy of dual blockade by ACEI + A1B + diuretics is beneficial for widespread use in Nigerians with cardiovascular disease.
Genetic differences exist between Blacks and whites through sympathetic-vascular transduction sig... more Genetic differences exist between Blacks and whites through sympathetic-vascular transduction signaling mechanisms. However, the lack of benefit of alpha-1 blockers in whites may not be applicable in Africans. The angiotensin II (Ang II) and alpha-1 receptor pathways are critical for vasoconstriction in Blacks. This article reviewed the consequence of the dual blockade among Nigerians, those with and without cardiovascular disease. Both receptors exhibited crosstalk and mutual regulations. Synergistic inhibition of Forearm vasoconstriction and hypotensive response to enalapril + prazosin (alpha-1 blocker [A1B]) occurred (P < 0.05). High efficacy of dual blockade by angiotensin converting enzyme inhibitor (ACEI) + A1B was reported in hypertensive urgency, hypertensive crises, and heart failure (HF) with reduced ejection fraction congestive HF compared to ACEI (P < 0.05). The high efficacy of dual blockade by ACEI + A1B + diuretics is beneficial for widespread use in Nigerians with cardiovascular disease.
Genetic differences exist between Blacks and whites through sympathetic-vascular transduction sig... more Genetic differences exist between Blacks and whites through sympathetic-vascular transduction signaling mechanisms. However, the lack of benefit of alpha-1 blockers in whites may not be applicable in Africans. The angiotensin II (Ang II) and alpha-1 receptor pathways are critical for vasoconstriction in Blacks. This article reviewed the consequence of the dual blockade among Nigerians, those with and without cardiovascular disease. Both receptors exhibited crosstalk and mutual regulations. Synergistic inhibition of Forearm vasoconstriction and hypotensive response to enalapril + prazosin (alpha-1 blocker [A1B]) occurred (P < 0.05). High efficacy of dual blockade by angiotensin converting enzyme inhibitor (ACEI) + A1B was reported in hypertensive urgency, hypertensive crises, and heart failure (HF) with reduced ejection fraction congestive HF compared to ACEI (P < 0.05). The high efficacy of dual blockade by ACEI + A1B + diuretics is beneficial for widespread use in Nigerians with cardiovascular disease.
Please do NOT make direct edits to the PDF using the editing tools as doing so could lead us to o... more Please do NOT make direct edits to the PDF using the editing tools as doing so could lead us to overlook your desired changes. Rather, please request corrections by using the tools in the Comment pane to annotate the PDF and call out the changes you are requesting. If you opt to annotate the file with software other than Adobe Reader then please also highlight the appropriate place in the PDF file.
Background and objectives: Hypoxemic respiratory failure is a common mode of demise in COVID-19 d... more Background and objectives: Hypoxemic respiratory failure is a common mode of demise in COVID-19 disease. We aimed to describe the time course of SPO 2 changes in COVID-19 patients treated with and without ivermectin. Methods: This was a parallel group, prospective comparative study of propensity matched COVID-19 patients (Cycle threshold Ct<25, SPO 2 <94%). 21 of the patients received Ivermectin (IVM) inclusive regime at 12 mg daily for 5 days, while 26 others received Non-ivermectin Inclusive Regime (NIVM). Results: The IVM group demonstrated earlier and greater increase in SPO 2 (p=0.000) which paralleled greater and faster virological clearance (p=0.000) on Repeat measures Analysis of Variance RMANOVA. There was a significant correlation between absolute SPO 2 and absolute Ct on day 5 (r=0.77) and day 7 (r=0.77) both p=0.000. Incremental SPO 2 also correlated with incremental Ct. by day 5 (r=0.397, p=0.003) and day 7 (r=0.315, p=0.0002) relative to baseline. Increase in platelet count correlated with increased SPO 2 (r=0.252, p=0.029) on IVM, but negatively with NIVM (r=-0.28, p=0.17). Inflammatory markers such as ESR, CRP or D-dimer showed no significant correlation with SPO 2. Increase in SPO 2 on IVM was magnified in males. Conclusion: IVM regime appears to be associated with faster and greater increase in SPO 2 paralleling faster viral clearance in COVID-19 patients.
Background :Hypertension (HT) prevalence and mortality are highest in Sub-Saharan Africa (SSA). A... more Background :Hypertension (HT) prevalence and mortality are highest in Sub-Saharan Africa (SSA). Aims :We reviewed the pathophysiology of HT and pharmaco-therapy with antihypertensive drugs (AHD) in SSA by drug class, for safety and efficacy. Factors impacting uncontrolled Blood pressure (UBP) and amelioration, were analyzed. Methods,Results:14 separate therapeutic audits in 4 SSA nations (total n = 6,496 patients) were evaluated. Calcium Channel blockers (CCB) especially amlodipine, and thiazide diuretics (TD), mostly hydrochlorothiazide (HCTZ) were the commonest AHD. Thiazide Like Diuretics (TLD) were underutilized. The % of patients on AHDs were; 1 drug 5.4-55%; 2 drugs 37-82%; >/= 3 drugs 6-50.3%. 2-drug combinations were :ACEI/ARB + TD (42%), CCB + TD (36.8%), ACEI + CCB (15.8%) of studies. Triple /quadruple therapy included Methyldopa (MTD) with ACEI + CCB or TD. The proportion of patients (%) attaining BP < 140 / < 90 mmHg, ranged from 29 to 53.6%, median, 44%. The commonest co-morbidities, range and median were: Diabetes Mellitus (DM) 9.8-64%, 19.2%; Chronic Kidney Disease (CKD) 5.7-7.5%, 6.9%; and Coronary artery Disease (CAD) 0.9 to 2.6%, 2.3%. ACEI + CCB +/-TD were the preferred AHD for these indications. Conclusions: Therapeutic inertia, non-compliance, refractory HT, co-morbidities, ignorance,substandard AHDs, are modifiable causes of UBP. Prognostic studies relating 24 hour ABPM to complications and mortality in SSA hypertensives, and impact of different AHD classes on ABPM, are needed. Further study of ACEI/ARB + alpha-1 blockers+ TLD on 24 hour ABPM and personalized care, are required.
Background and objectives: Hypoxemic respiratory failure is a common mode of demise in COVID-19 d... more Background and objectives: Hypoxemic respiratory failure is a common mode of demise in COVID-19 disease. We aimed to describe the time course of SPO 2 changes in COVID-19 patients treated with and without ivermectin. Methods: This was a parallel group, prospective comparative study of propensity matched COVID-19 patients (Cycle threshold Ct&lt;25, SPO 2 &lt;94%). 21 of the patients received Ivermectin (IVM) inclusive regime at 12 mg daily for 5 days, while 26 others received Non-ivermectin Inclusive Regime (NIVM). Results: The IVM group demonstrated earlier and greater increase in SPO 2 (p=0.000) which paralleled greater and faster virological clearance (p=0.000) on Repeat measures Analysis of Variance RMANOVA. There was a significant correlation between absolute SPO 2 and absolute Ct on day 5 (r=0.77) and day 7 (r=0.77) both p=0.000. Incremental SPO 2 also correlated with incremental Ct. by day 5 (r=0.397, p=0.003) and day 7 (r=0.315, p=0.0002) relative to baseline. Increase in platelet count correlated with increased SPO 2 (r=0.252, p=0.029) on IVM, but negatively with NIVM (r=-0.28, p=0.17). Inflammatory markers such as ESR, CRP or D-dimer showed no significant correlation with SPO 2. Increase in SPO 2 on IVM was magnified in males. Conclusion: IVM regime appears to be associated with faster and greater increase in SPO 2 paralleling faster viral clearance in COVID-19 patients.
African journal of medicine and medical sciences, Jun 1, 1991
A review of early published research of the efficacy and safety of ACE inhibitors, captopril and ... more A review of early published research of the efficacy and safety of ACE inhibitors, captopril and enalapril in Africans with essential hypertension, malignant hypertension with CKD, hypertensive -diabetic patients and in chronic congestive heart failure is presented. Enalapril monotherapy was ineffective in Africans with essential hypertension. Activation of RAAS in malignant hypertension caused profound hypotensive effect. There was an anti-proteinuric effect in CKD and Hypertensive-Diabetics, with rise in plasma albumin concentration. In CHF patients, enalapril increased treadmill exercise and self paced exercise duration in the short and long term. There was increased pulse pressure indicating arteriolar vasodilator action, reversal of hyponatremia, and increased creatinine clearance and natriuresis. The review established the utility of ACE inhibitors in cardiovascular medicine in Africans, despite the low renin state and lack of monotherapeutic efficacy in blacks with essential hypertension.
The efficacy of Ivermectin (IVM) against SARS-CoV-2 has been demonstrated in vitro, while several... more The efficacy of Ivermectin (IVM) against SARS-CoV-2 has been demonstrated in vitro, while several clinical studies suggest that it is efficacious and safe in reducing morbidity and mortality. Hydroxychloroquine (HCQ, Quinoric®), IVM and Azithromycin(AZM, Zithromax®) (HIA therapy) is being used in several low-and middle-income countries (LMIC) where more expensive medications such as Remdesivir are out of reach. In this study, we set out to compare the efficacy of IVM monotherapy with HIA combination therapy. Methods: This was a single-blind, randomized control trial, of 2 parallel groups of COVID-19 Positive Nigerians. Thirty (30) patients received Ivermectin (Mectizan®) 200 mcg/ kg daily for five days, while 31 patients received HIA triple therapy. Viral cycle threshold (Ct) at pre-treatment baseline, and days 2, 5, 14 and 21 were measured for E-and N-genes (Envelope and Nucleocapsid genes respectively). SpO2 (percentage saturation of oxygen in the blood) was assessed on a daily basis, while inflammatory markers such as Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein, and D-dimer and Neutrophil/Lymphocyte Ratios (NLR), were assessed at baseline and day 7 post treatment. Clinical status was self-assessed daily on a Likert scale. Results: 2-way Repeated measures Analysis of Variance (RMANOVA) did not show any difference between the two groups. However, there was a significant time effect (improvement over time) for SpO2, Ct N-gene, Ct E-gene and clinical status in both groups, and significant reductions in inflammatory markers by day 7 (P < 0.0001). Conclusions: AZT + HCQ may be redundant adjuncts in COVID-19 therapy. Improvements noted are likely due in large part to Ivermectin virucidal and anti-inflammatory actions. RANdOmisEd dRug TRiAl
Background and objectives: Hypoxemic respiratory failure is a common mode of demise in COVID-19 d... more Background and objectives: Hypoxemic respiratory failure is a common mode of demise in COVID-19 disease. We aimed to describe the time course of SPO 2 changes in COVID-19 patients treated with and without ivermectin. Methods: This was a parallel group, prospective comparative study of propensity matched COVID-19 patients (Cycle threshold Ct<25, SPO 2 <94%). 21 of the patients received Ivermectin (IVM) inclusive regime at 12 mg daily for 5 days, while 26 others received Non-ivermectin Inclusive Regime (NIVM). Results: The IVM group demonstrated earlier and greater increase in SPO 2 (p=0.000) which paralleled greater and faster virological clearance (p=0.000) on Repeat measures Analysis of Variance RMANOVA. There was a significant correlation between absolute SPO 2 and absolute Ct on day 5 (r=0.77) and day 7 (r=0.77) both p=0.000. Incremental SPO 2 also correlated with incremental Ct. by day 5 (r=0.397, p=0.003) and day 7 (r=0.315, p=0.0002) relative to baseline. Increase in platelet count correlated with increased SPO 2 (r=0.252, p=0.029) on IVM, but negatively with NIVM (r=-0.28, p=0.17). Inflammatory markers such as ESR, CRP or D-dimer showed no significant correlation with SPO 2. Increase in SPO 2 on IVM was magnified in males. Conclusion: IVM regime appears to be associated with faster and greater increase in SPO 2 paralleling faster viral clearance in COVID-19 patients.
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