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Hypertension is more common among black people and if untreated, can result in heart failure, stroke or chronic kidney diseases

Hypertension which is also referred to as high blood pressure is one of the most common non- communicable diseases threatening the lives of people globally. At the 64th World Health Assembly held in Geneva, Switzerland, in May 2011, Margaret Chan, director-general of the World Health Organisation, WHO, decried the alarming rate at which chronic and non-communicable diseases, especially hypertension, are fast replacing communicable diseases as the leading threat to public health and health budgets worldwide. The world health body said 80 percent of global deaths are as a result of cardiovascular diseases, including hypertension.

In Nigeria, it is also one of the most common non-communicable diseases with a prevalence of about 20 to 25 percent in adults. It is generally referred to as a silent killer because unlike other diseases, at the initial stages, it presents no symptoms. High blood pressure frequently does not give warning signs. It is only after an organ in the body is irritated or damaged, that the consequences of high blood pressure are realised and this could lead to sudden death.

 In a recent study of patterns of heart diseases in some medical centres in Nigeria, hypertension was ranked first.  The study also showed that 10 per cent of the Nigerian population has regular high blood pressure. Olujimi Akinkugbe, emeritus professor of medicine, confirmed that hypertension is essentially prevalent in 10 percent of the population of adults in Nigeria aged between 15 and 70. “Prevalence rate was about the same in males and females; so, if we are talking of a population of 140 million, that means about 10million people have hypertension,” he said. Of that 10 percent, perhaps between seven and eight million will fall into the category of mild hypertension where there are no symptoms at all unless a check is conducted.

Corroborating Akinkugbe’s position at a recent public function in the United States, Onyebuchi Chukwu, minister of  health, said that eight million Nigerians are hypertensive.

Biodun Ogungbo, a neurosurgeon said “doctors have calculated that up to 25 percent or one in every four adults in Nigeria has hypertension.”  He considers this to be a very high percentage which calls for real attention. “Sadly, many people are not aware of this silent killer in our midst and those who are aware often neglect to take it serious,” he said.

He explained that it is the medical illness most frequently diagnosed in elderly Nigerians. It is also the most common condition associated with dementia in Nigeria  and  the commonest condition in senior executives. Doctors in Ibadan recently studied many autopsies and found that the commonest cause of sudden natural death is heart trouble, of which complications of hypertension constitutes the majority of cases.

Peter Ugbodaga, a family physician and permanent secretary, Ministry of Health, Edo State, told Newswatch that black people are more prone to hypertension. “If you are a black man, you are at the risk of blood pressure because the ailment is more common in the black population compared to the Asians. It is also more severe amongst the black population,” he said.

He explained that children could suffer the ailment but their own is usually secondary to something. In other words, there is usually a cause in their own particular case. For instance, if they have kidney disease, they can also have what is called endocrine or hormonal disease.

Although hypertension affects people more as they grow older, young people who live under a lot of pressure from their jobs, relationships and lifestyle, equally suffer from the disease. Anger or rage can trigger it.

There are also pointers that indicate that hypertension is more common in the urban group in the cities than in the rural areas, because in the city, people are exposed to more kinds of stress, violence, salt intake, overweight, little exercise, and other risk factors.

Ibrahim Katib, a consultant cardiologist at the University of Ilorin, believes that the prevalence of hypertension among Nigerians should be stemmed by government and concerned individuals through prevention, rather than cure. “If one is hypertensive and wants the blood pressure to be reduced, medication is not the only thing. Once the medication has started; it becomes a life-long thing and cannot be stopped unless the medical personnel says so. “You have to be up and doing and engaged in regular exercise for the blood pressure to be reduced as doing this will assist greatly to burn some calories within the system,” he said.

He also warned against consumption of alcohol and smoking of cigarette in order to avoid the disease. He advised each adult to have his or her blood pressure checked regularly.  A person could also buy the blood pressure monitor and do the checking in the comfort of his or her own home. This is because the only way a person will know if his or her blood pressure is high or low (or normal) is to check it using a blood pressure monitor.

 Experts have listed some of the things individuals should do to avoid hypertension.  The first one is healthy diet. This will entail diet that is high in fresh fruits, vegetables and low fat dairy products, low in ‘sleepy’ fat and salt. The second one is regular physical activity. Optimum  of  30  to 60 minutes of moderate activity  three to seven times in a week. In fact, the American Heart Association recommends 30 to 60 minutes of exercise three to four times per week. According to the association, dancing could be both enjoyable and a form of exercise.

 The third is low risk alcohol consumption:  That is two standard drinks per day and less than 14 per week for men and less than nine per week for women. Other things listed are maintenance of ideal body weight, low salt intake, which is the restriction of salt intake to less than 100 mm per day and living in a smoke-free environment.

Udoka Chris Okafor, a lecturer in the Department of Physiotherapy, Lagos University Teaching Hospital, LUTH, told Newswatch that lifestyle is a major factor responsible for hypertension. He believes that lifestyle modification is the cornerstone of anti-hypertensive therapy. People who live sedentary lifestyle are highly at risk. He explained that those who do office work like bankers and administrators who adopt a single posture regularly are not helping themselves. On the other hand, individuals who are active or who engage in active livestyle have little risk of developing hypertension except those that have the sickness running in their family. “Even at that, if you have two persons of the same parents that have the history of the ailment, the one that usually engages in physical exercise is less at risk compared with the one that lives a sedentary lifestyle,” he said.

 He said that hypertension could be managed by engaging patients in exercises but this has to be done after consultation with both the physician and physiotherapist because there are several reports of people who died because they engaged in physical exercises without consulting the physician.

Okafor added that people who are in the habit of eating foods that have a lot of fat are equally at the risk of being hypertensive.  He advised people to always eat the right kind of food and avoid eating foods that are rich in fat and carbohydrates. They should also avoid high salt diet, coffee, alcohol consumption, and should rather take adequate vegetables and fruits.

He identified some of the symptoms of hypertension as constant headache, impairment in vision, and dizziness. Blood pressure is continually changing, depending on activity, temperature, diet, emotional state, posture, physical state and medication use. The complications can also occur at any time, even during sleep.

Experts say that if high blood pressure is untreated it could lead to several complications. At this stage, it affects many organs of the body. In the heart, it ultimately causes heart failure; in the brain, it causes stroke; in the kidneys, it causes chronic kidney disease; peripheral arterial disease in the vasculature and blindness in the eyes.

There are many benefits of lowering blood pressure. Lowering of blood pressure will lead to between 35 and 40 per cent reduction in stroke, 20 to 25 percent reduction in heart attack, greater than 50 per cent reduction in heart failure with a less impressive reduction in kidney failure.

In a study titled, “Prevalence, awareness, treatment and control of hypertension in a Nigerian population” by Obinna Ikechukwu, a doctor and colleagues, it was documented that there is poor detection, treatment and control of hypertension in Nigeria. Once a person is afflicted with hypertension, its follow up treatment is normally for life. A. C. Mbakwem, consultant cardiologist and senior lecturer, Lagos University Teaching Hospital, LUTH, said at a recent seminar organised by Gemini Pharmaceutical Company, that the inability of doctors to properly dispense information to patients on how they can manage their lifestyles is responsible for the high mortality rate arising from hypertension.

She called on doctors to ensure that they take adequate time during consultation with their patients to educate them on the activities to indulge in and the foods to eat, which will keep them free from the cause of the dreaded illness. The renowned cardiologist added that where the doctors are unable to discharge this responsibility, the nurses and other care givers should be carefully trained to carry out this function.

Brian Rayner, another cardiologist at the University of Cape Town, South Africa, said the disease is on the rise due to certain factors. He identified lack of awareness even in the developed world as well as poor feeding habits and lack of exercises as causes. He advised people to constantly exercise their bodies, eat good fruits and vegetables. These, he said, have the capacity to check the development of the disease in patients having the symptom and also prevent others from contracting it.

Treating hypertension with drugs is the most cost-effective way to reduce the risk factors for heart disease and stroke. It is, however, cheaper to prevent high blood pressure by lifestyle changes compared to drug treatment. In the same way, it is cheaper to treat hypertension than to treat complications such as stroke or heart attack. Therefore, prevention is better than cure. Adults are advised to always try to be calm and relaxed in every situation so as to avoid hypertension.

However, Ugbodaga, said that once a person is diagnosed to be hypertensive, the first thing a doctor should do is counseling because it is a life-long disease. Then after advising the patient on dieting and healthy lifestyle and the blood pressure is still high, the doctor would recommend the requisite drugs. “Patients must take medications on a regular basis and no vacation. It is only your doctor that can vary your drugs. It is not a question of saying because you took drugs yesterday and because the blood pressure is down; you stop. If you do, it will suddenly shoot up. Therefore, once you are hypertensive, you must take your drugs on a regular basis, you must go for your regular check-up and you must also modify your lifestyle,” he said.

 Ugbodaga explained that some of the drugs for hypertension are very expensive while some are also relatively cheap. “So, you can look at the profile of the patient because it doesn’t really make sense for somebody who is on grade level four or six salary to be given a prescription of drugs that even his monthly salary cannot buy. So you must profile your patients and give appropriate medication that will suit the socio-economic status of that patient and also be able to control the high blood pressure at the same time,” he said.  He, however, explained that the cheaper drugs have relatively more side effects than the newer ones that have been produced and have little or no side effects but those ones are  expensive.

Reported by Annette Oghernehaboke