Hypertension has killed lots of Nigerian over theyears, both adults and young people. But how can it be treated?
A family health physician, Dr. Sunny Ekwunife was of the view that high blood pressure is poorly diagnosed by doctors. According to him, there are no guiding principles and no coherent decision making steps for the Nigerian patient. He said most of the research and treatment plans, as well as medications are well thought out for white people. “Research in the Nigerian health sector is poor, since the government has not shown any interest. Funding for such research in our hospitals is non-existent or at best from foreign sources. Yet, this is a major problem affecting Nigerians in the prime of their lives”, he noted.
A neuro-surgeon, Dr. Biodun Ogungbo, categorically stated that hypertension or high blood pressure is a “silent killer”. According to him, it is the common medical term used to describe high blood pressure.
“Doctors have calculated that up to 25 per cent or one in every four adults in Nigeria has hypertension. This is a very high percentage and calls for real awareness among people.”
“Sadly, many people are not aware of this silent killer in our midst and those who are aware often neglect to take it serious.”
In the study of patterns of heart diseases in centres in Nigeria, hypertension was ranked first. According to a neurologist, Professor Ogunniyi, it is the medical illness most frequently diagnosed in elderly Nigerians.
“It is also the most common condition associated with dementia in Nigeria. It is the commonest condition in senior executives and army recruits. Doctors in Ibadan studied many autopsies and found that the commonest cause of sudden natural death was heart trouble, of which complications of hypertension constituted the majority of cases. Two autopsy studies have shown that hypertension is the commonest underlying cause of sudden unexpected natural death.”
Ekwunife and Ogungbo both shared their views on the different aspects of hypertension, complications and treatment options.
Who is at risk of developing hypertension?
Dr. Christopher Alebiosu once wrote that the risk factors for hypertension included: beyond 40 years, male sex, family history of hypertension, high salt diet, overweight/obesity, physical inactivity, excessive alcohol consumption, inadequate intake of vegetables and fruits, and diet high in fats. You are more likely to be told your blood pressure is high as you get older. This is because your blood vessels become stiffer as you age. When that happens, your blood pressure goes up. High blood pressure increases your chance of having a stroke, heart attack, heart failure, kidney disease, and early death.
Frequently, high blood pressure does not give you any warning signs. It does not cause headache or vomitting or anything like that. You may even feel on top of the world and in the best of health and happiness. The first sign that shows, however, may be a stroke with paralysis or a heart attack and death. 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.
A 50-year old patient of consultant neuro-surgeon and stroke specialist, Dr. Biodun Ogungbo of Cedarcrest Hospital, Abuja, had a stroke while driving home from work. He never knew he had high blood pressure, until the stroke occurred. Luckily, it caused him a blinding headache which made him slow down and stop the car. He was seen slumped at the wheel and bystanders took him to the hospital. His blood pressure, it was discovered at the hospital, had gone through the roof.
Blood pressure is a measurement of the force against the walls of your arteries as your heart pumps blood through your body. Arteries carry blood away from the heart and so are subjected to the force from the heart. Blood pressure readings are usually written as fractions (for example, 120 over 80 or 120/80 mmHg). The top number is the systolic blood pressure, and the bottom number is the diastolic blood pressure. Normal blood pressure is when your blood pressure is lower than 120/80 mmHg. High blood pressure is when your blood pressure is 140/90 mmHg or above most of the time. Each adult is encouraged to have his or her blood pressure checked regularly. You could also buy the machine and do the checking in the comfort of your home.
What are the causes of hypertension?
Blood pressure can be affected by many things, such as how much water and salt you have in your body and the condition of your kidneys. You also have a higher risk of high blood pressure as an African, if you are overweight, have a family history of high blood pressure, have diabetes, smoke, are often stressed or anxious and drink too much alcohol. Our diet contains a lot of salt and infact some studies document a high occurrence of strokes among Northerners.
Other causes of HTN include (but are not limited to): kidney problems, pregnancy, medications such as birth control pills, steroids and diet pills. However, in most cases (over 90 per cent of all blood pressure), the cause/s of high blood pressure may not be known, and this type of blood pressure without a known cause is called “primary or essential hypertension”, while high blood pressure caused by known events (less than 10 per cent of all blood pressure) is referred to as “secondary hypertension”.
Most of the time, no cause of high blood pressure is found.
What are the symptoms?
With hypertension there may be no symptoms. If you have symptoms such as severe headache, nausea or vomitting, bad headache, confusion, changes in your vision, or nosebleeds you may have a severe and dangerous form of high blood pressure.
What is the treatment of hypertension?
This review is prompted by the gaps in the management of hypertension. The gap is in the knowledge and treatment protocols among doctors. Also, there is a gap between what the doctor says and what the patient does.
Life style modification is most important. Each person should be responsible and stop all bad habits (such as smoking and excessive alcohol consumption). High blood pressure and high blood cholesterol are closely related to excessive consumption of fatty, sugary and salty foods. Reduction of salt intake is an important message for everyone to avoid the risk of a stroke. Salt reduction leads to reduction in high blood pressure and risk of stroke. Eating fruits and vegetables can help prevent cardio-vascular diseases. Physical inactivity is responsible for about 15 per cent of diabetes and heart disease. The American Heart Association recommends 30-60 minutes of exercise 3-4 times per week. Dancing could be both enjoyable and a form of exercise.
Drug treatment and management of hypertension
Treating hypertension with drugs is the most cost-effective way to reduce this important risk factor for heart disease and stroke. It is cheaper to prevent high blood pressure by life style 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. Prevention is cheaper than cure.
The elderly patient (most especially) should be treated starting in most cases with a simple diuretic (these are water tablets that help get rid of excess water and salt). There are then other drugs that can be introduced if the blood pressure is still uncontrolled.
We are in support of a rational, systematic approach to the treatment of HTN in Nigerians. For example, if the first line drug diuretic does not control the blood pressure within a week or two, the doctor can add a second drug by choosing from other drug classes such as: ACE inhibitors ( like Lisinopril, Enalapril, etc), calcium channel blockers(like as Amlodipine, Adalat, etc) and Beta-blockers (like Lopressor, Tenormin etc). In some cases, a combination drug such as ACE inhibitor and a diuretic may be used as a first line drug.
In choosing any of these drugs, one must always keep the cost and availabilty in mind. In addition, patients should be acquainted with the side effects of these drugs, so that they are not taken unawares if they experience any of these side effects. This is often a major reason for discontinuing medications by patients apart from cost.
One crucial problem is the lack of control of blood pressure for many patients, despite medications.
Prospective large scale studies of the treatment of hypertension are required. In Nigeria, unavailability of essential drugs, cost and sometimes fake medications are huge problems that require concerted efforts from the government. A strong, dedicated effort by the government to make sure these drugs are affordable is paramount, because Nigeria is a huge market for any of the major drug companie. We should use our economic clout to bargain for better pricing policies in Nigeria.
Better still, we can empower our pharmaceutical industry to manufacture the drugs at home.
What are the key messages for the management of hypertension?
Prevention, prevention and prevention. Do not over-indulge in sugar, salt, fatty foods and alcohol. Home blood pressure check is recommended.
Each person needs access to a personal general practice physician in the setting of a general practice clinic to look after their blood pressure and carry out regular checks. Most minor problems are looked after by the general practitioner or family physician, trained in holistic medicine and know-how to prevent diseases, keeping you in good health. More serious conditions are referred to specialist doctors in a hospital setting. Doctors must also communicate frequently with each other and with specialists for help in managing difficult patients.
Non-compliance with anti-hypertensive drug therapy can be dangerous to your health. Do not stop or reduce your medications without the advice of your doctor. Although lack of finances is the single most self-reported reason, other factors related to patients’ attitudes and belief contribute frequently.
Hypertension is for life. Some patients think that hypertension goes away and stays away once they have reached a normal level of blood pressure. This false impression and misconception has ended up being the downfall of many. High blood pressure is a permanent disease. It cannot be cured via traditional methods or by prayers. Keep praying but do not stop your medications.
It is a tragic fact that many patients with high blood pressure in the Nigeria do not have their blood pressures adequately controlled, hence many preventable strokes, heart attacks and cases of heart failure occur unnecessarily.
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