Faculty of Clinical Sciences 

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    Comparison of Dual Therapies for Lowering Blood Pressure in Black Africans
    (2019-03-16) Ojji, D. B.
    BACKGROUND:The prevalence of hypertension among black African patients is high, and these patients usually need two or more medications for blood-pressure control. However, the most effective two-drug combination that is currently available for blood pressure control in these patients has not been established. METHODS: In this randomized, single-blind, three-group trial conducted in six countries in sub-Saharan Africa, we randomly assigned 728 black patients with uncontrolled hypertension (≥140/90 mm Hg while the patient was not being treated or taking only one antihypertensive drug) to receive a daily regimen of 5 mg of amlodipine plus 12.5 mg of hydrochlorothiazide, 5 mg of amlodipine plus 4 mg of perindopril, or 4 mg of perindopril plus 12.5 mg of hydrochlorothiazide for 2 months. Doses were then doubled (10 and 25 mg, 10 and 8 mg, and 8 and 25 mg, respectively) for an additional 4 months. The primary end point was the change in the 24-hour ambulatory systolic blood pressure between baseline and 6 months. RESULTS: The mean age of the patients was 51 years, and 63% were women. Among the 621 patients who underwent 24-hour blood-pressure monitoring at baseline and at 6 months, those receiving amlodipine plus hydrochlorothiazide and those receiving amlodipine plus perindopril had a lower 24-hour ambulatory systolic blood pressure than those receiving perindopril plus hydrochlorothiazide (between group difference in the change from baseline, −3.14 mm Hg; 95% confidence interval [CI], −5.90 to −0.38; P=0.03; and −3.00 mm Hg; 95% CI, −5.8 to −0.20; P=0.04, respectively). The difference between the group receiving amlodipine plus hydrochlorothiazide and the group receiving amlodipine plus perindopril was −0.14 mm Hg (95% CI, −2.90 to 2.61; P=0.92). Similar differential effects on office and ambulatory diastolic blood pressures, along with blood-pressure control and response rates, were apparent among the three groups. CONCLUSIONS: These findings suggest that in black patients in sub-Saharan Africa, amlodipine plus either hydrochlorothiazide or perindopril was more effective than perindopril plus hydrochlorothiazide at lowering blood pressure at 6 months. (Funded by GlaxoSmithKline Africa Noncommunicable Disease Open Lab; CREOLE Clinical Trials.gov number, NCT02742467.)
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    Prevalence of Operable Intracranial Lesions from Mild Traumatic Brain Injury in a National Trauma Centre
    (SpringerOpen, 2024-02-02) Yusuf, Ayodeji Salman
    Background: Mild traumatic brain injury (TBI) occupies majority of head traumas in most emergency units. Although patients with mild TBI can be reviewed and discharged on head injury advice, a sizeable number require admission for observation or intervention due to operable intracranial lesions. The aim of the study was to establish the preva lence of operable lesions in patients with mild TBI. Materials and methods: This was a prospective study of consecutive adult patients with mild TBI who had cranial computerized tomography (CT) done at the National Trauma Centre, Abuja. All participants gave informed consent and the study had ethical clearance in the Hospital. Results: One hundred and three mild TBI patients with cranial CTs were recruited aged 16–76 years with mean age of 32.25±12.35 years. With intention to treat, twenty (20.4%) of them were diagnosed with operable intracranial lesions on CT scans, 19 males and 2 females. Majority of them (14; 66.7%) were young adults within 20–40 years of age. The lesions were 16 extradural haematomas (76.2%), 3 subdural haematomas (14.3%) and 2 depressed skull fractures (9.5%) of the operable cohort. Conclusions: Significant number of patients with mild TBI had operable intracranial lesions. Therefore, there is need to screen patients with mild TBI appropriately in order to avoid missed operable lesions. Keywords: Mild traumatic brain injury, Computerized tomography scan, Haematoma, Clinical decision rule, Operable intracranial lesions, Nigeria