Research

Gender disparities in pulmonary hypertension at a tertiary centre in Cameroon

L N Aminde, A Dzudie, A P Kengne, J Ndjebet, S Mapoh, X Kuelang, F Kamdem, B H Mbatchou Ngahane, M-S Doualla, K B Ngu, K Sliwa, F Thienemann

Abstract


Background. Pulmonary hypertension (PH) is a potent cause of heart failure and has been little investigated in the African setting.

Objective. To investigate the effects of gender on the clinical presentation, echocardiographic features and outcomes of patients with PH in Douala, Cameroon.

Methods. A prospective cohort study was conducted from March 2012 to December 2013 as part of the Pan African Pulmonary Hypertension Cohort study. PH was diagnosed by echocardiography and defined as a right ventricular systolic pressure >35 mmHg in the absence of acute right heart failure. Patients were followed up for a maximum of 12 months for primary endpoint mortality.

Results. In total, 130 patients with PH were recruited; 71 (54.6%) were women. The median age was 59.2 years for men and 58.3 years for women (p=0.76). Active smoking and alcohol use were more frequent in men than women (both p<0.001), but women had greater exposure to indoor cooking fumes than men (p<0.001). Previous tuberculosis infection (11.3% v. 1.7%) and S3 gallop rhythm (30.9% v. 11.9%) were more common in women (both p<0.03). Women had a significantly higher mean systolic blood pressure (134 mmHg v. 125 mmHg; p=0.04) and pulse pressure (53.8 mmHg v. 44.9 mmHg; p=0.01) and a lower mean haemoglobin concentration (10.4 g/dL v. 12.4 g/dL; p<0.05) compared with men. Echocardiographic left ventricular (LV) systolic dysfunction was more frequent in men: mean LV ejection fraction 42.6% v. 51.5% (p=0.01) and mean fractional shortening 21.4% v. 28.6% (p=0.01). The overall mortality rate was 20.3%, and rates were similar in the two groups (Kaplan-Meier log rank 1.1; p=0.30).

Conclusions. Despite differences in baseline characteristics including cardiovascular risk factors, mortality rates on follow-up were similar in men and women in this study. However, these different baseline characteristics probably suggest differences in the pathogenesis of PH in men and women in our setting that need further investigation.

 


Authors' affiliations

L N Aminde, School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia; Cardiology Unit, Department of Internal Medicine, General Hospital Douala, Cameroon; Clinical Research Education, Networking and Consultancy, Douala, Cameroon

A Dzudie, Cardiology Unit, Department of Internal Medicine, General Hospital Douala, Cameroon; Clinical Research Education, Networking and Consultancy, Douala, Cameroon; Soweto Research Group, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

A P Kengne, Clinical Research Education, Networking and Consultancy, Douala, Cameroon; Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa

J Ndjebet, Douala Cardiovascular Centre of Bonapriso, Cameroon

S Mapoh, Cardiology Unit, Department of Internal Medicine, General Hospital Douala, Cameroon; Clinical Research Education, Networking and Consultancy, Douala, Cameroon

X Kuelang, Universite de Montagne, Bangante, Cameroon

F Kamdem, Cardiology Unit, Department of Internal Medicine, General Hospital Douala, Cameroon; Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon

B H Mbatchou Ngahane, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon; Pulmonology Unit, Department of Internal Medicine, General Hospital Douala, Cameroon

M-S Doualla, Rheumatology Unit, Department of Internal Medicine, General Hospital Douala, Cameroon; Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon

K B Ngu, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon; Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, South Africa

K Sliwa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, South Africa

F Thienemann, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Department of Internal Medicine, University Hospital Zürich, Switzerland

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Keywords

Pulmonary hypertension; Gender; Sex; Risk factors; Tuberculosis; Clinical presentation; Outcome; Cameroon; Africa

Cite this article

South African Medical Journal 2017;107(10):892-899. DOI:10.7196/SAMJ.2017.v107i10.12321

Article History

Date submitted: 2017-09-22
Date published: 2017-09-22

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