Hypertension in Nigerian Adults: Essential things to know


By: Adebowale Bello (Freelance Health Writer and DLHA Volunteer)

With Editorial contribution by The Datelinehealth Africa Team




  • Hypertension is a leading risk factor for heart diseases.
  • It is a common cause of premature death worldwide including Nigeria.
  • As of 2020, over 28 million Nigerians live with hypertension.
  • 40% of adult Nigerians with hypertension are estimated to be unaware that they have the condition. The rate may be much higher.
  • Globally a little over 1 in 5 people (21%) have it under control. Data from Nigeria indicate the figure may be much worse (2.8%).
  • Hypertension rates are higher in the South east and South south and lowest in North central Nigeria.



Hypertension: A personal story

Mama Abigail is 68 years old. She is a retired teacher who lives with her husband in Calabar, the capital city of Cross River State, in South south, Nigeria.

On this particular day, Mama Abigail goes grocery shopping in the local open market.

As she walks briskly from the market, the skies darken as the rain clouds gather. A bit stressed out from the weight of her purchase, she breathes heavily as she walks on hoping to quickly get a bus heading home.

Suddenly two teenage boys sneak up on her from behind, roughly shoving her as they snatch her purse and bag. 

Mama Abigail struggles vainly for her valuables as the agile boys make away with her bag and climb a waiting bike.

She gives chase but after a few steps suddenly cries out in pain, falling to the ground as she clutches her chest and the last thing she feels is the light splash of rain drops on her cheeks.

She hears the steady beep of the heart monitor as she gains consciousness and her eyes take in the white washed walls while her husband's hand slides over hers as a doctor delivers the diagnosis saying she is hypertensive.

This comes as a shock to Mama Abigail as she had never imagined she could be hypertensive. If she had not known the doctor and his family for a long time, she would have labeled him inexperienced.


In this article, you will learn about the essential things to know about hypertension; its causes, symptoms, diagnosis, prevention and treatment and its impact on public health in Nigeria.



What is hypertension? 


According to the World Health Organization, hypertension also commonly known as high blood pressure is a critical medical condition where blood pressure is persistently greater than the normal blood pressure (15)

Due to your various daily activities, your blood pressure might rise and fall but if it's persistently above 140/90 mmHg then a medical checkup is advised.


To have a better understanding of this, let's discuss your heart and blood pressure and how they are connected.



What is blood pressure? 


A nurse takes blood pressure of a patient sitting on a chair.The heart is the life force of the body and pumps oxygen rich blood through the arteries round the body and the force with which the heart pumps the blood is referred to as the "blood pressure" .

It is measured using either a manual or a digital sphygmomanometer which consists of a cuff that is wrapped around the upper arm and a pressure gauge that measures the pressure in the cuff. 

The two numbers which are read out represent the systolic and diastolic blood pressure with the systolic blood pressure representing the blood pressure when the heart beats while the diastolic blood pressure is the blood pressure when the heart rests.(1)


Image showing AHA Blood pressure numbersAccording to the American Heart Association, blood pressure can be categorized into 5 groups. (2) (See image 1).


A normal blood pressure is lower than 120/80 mmHg and is read as 120 systolic over 80 diastolic or preferably 120 over 80.


If your blood pressure ranges from 120-129  mm Hg (systolic) over < 80 mm Hg, (diastolic) then it is said to be elevated.


If it continuously ranges from 130-139  mm Hg (systolic) over 80-89 mm Hg (diastolic), this is referred to as Stage 1 hypertension.


At stage 2 hypertension, the blood pressure is greater than 140/90 and it becomes an emergency hypertensive crisis when it is greater than 180/120 mmHg.



How common is hypertension in Nigeria?


Geopolitical map of Nigeria

According to the World Health Organization (15), about 1.28 billion adults live with hypertension with the highest figures coming from Africa and Nigeria alone as of 2020 had 28 million individuals living with hypertension. (16)


Hypertension rates are highest in the South east and South south and lowest in North central Nigeria.(24) (See image 2).


Just like Mama Abigail, the majority of these people are not aware that they live with hypertension as they do not show any symptoms. This has earned hypertension the title "the silent killer".


The lack of evident symptoms emphasize the importance for regular medical checkup to identify and treat the condition.



What causes hypertension?


Hypertension has been one of the most studied medical conditions in recent years and it has been classified into two major categories (22) based on causes.

1. Essential or Primary Hypertension

Essential hypertension is hypertension that has no specific cause. Rather it is caused by a combination of lifestyle, genetics and the environment. (3)

Essential hypertension makes up more than 90% of all hypertension cases and tends to develop gradually over the years and this silent killer might show no symptoms till it is too late.

2. Secondary Hypertension

This type of hypertension has a specific and identifiable cause and once that cause is treated, the hypertension can be controlled and managed effectively.

Some of the medical conditions (3) which can lead to secondary hypertension include:

  • Vasculitis - A group of conditions that cause your blood vessels to swell.
  • Polycystic kidney disease - A genetic disorder that causes many fluid-filled cysts to grow in your kidneys.
  • Atherosclerosis - A common condition that develops when a sticky substance (mainly fat) called plaque builds up inside your arteries and narrows them.
  • Cushing's syndrome - A condition where your body produces too much stress hormone known as cortisol especially from the pituitary or adrenal or (suprarenal) glands. Or you are taking high doses or prolonged use of oral corticosteroid medications.
  • Cushing’s disease - This condition is a specific type of Cushing’s syndrome caused by the body’s exposure to high levels of the stress hormone called cortisol due to its overproduction by a tumor of the pituitary gland in the brain.
  • Hyperthyroidism - This condition occurs when a small gland located in the front of your neck (the thyroid gland) produces too much of its hormone. The condition is also called overactive thyroid.
  • Hypothyroidism - This condition occurs when the thyroid gland does not produce enough of its hormone. The condition is also called underactive thyroid.

Hyper- and hypothyroidism cause high blood pressure through different ways.

  • Diabetic nephropathy - A condition that affects the kidneys of people living with diabetes.
  • Substance use - i.e., illegal recreational use of cocaine, amphetamine, etc.



How do I know that I have hypertension?


Most people living with hypertension are not aware and this is because this condition tends to not show any signs or symptoms.

If you however have some of the notable symptoms below, visit with your doctor for a checkup to exclude hypertension.

Notable symptoms

1. Persistent headaches: Previous research mentioned headaches as a symptom of hypertension but recent studies (5) have shown otherwise.

Headaches become a feature of hypertension majorly  when a patient is in the emergency hypertensive crisis stage (4) but apart from that, the prevalence of headaches while having hypertension is low.


2. Chest pain: If high blood is left untreated for a long time, it could damage other organs and pressure or a tight sensation might be experienced in the chest by people living with hypertension.


3. Shortness of breath: The chest pain discussed above makes breathing difficult and extremely hard.


4. Vision problems: When blood pressure is consistently high, it damages eye blood vessels and could lead to blurry vision, double vision or even the sudden and immediate loss of sight.


5. Nosebleeds: Though not as common as other symptoms, nosebleeds could be an indication of high blood pressure as the nose blood vessels may have been damaged already.



What are risk factors for hypertension?


The likelihood of developing hypertension is dependent on various lifestyle and genetic conditions and this means that some people are more at risk of this critical condition than others. 

Here are a few risk factors (9):

  • Race

Several studies have shown that as a black person you're more likely to develop hypertension. In South Africa for example, the risk of hypertension is higher in black South Africans compared to a South African of Caucasian or Indian race.(6)

The risk of further complications from hypertension also increases as the likelihood of developing a cardiovascular disease, having a heart failure or stroke as a black person is higher when compared to all other races. (7) (8)

The difference in risk among races is a result of complex and multiple factors including genes and social determinants of health (i.e., socioeconomic, education, lifestyle, environmental factors and availability and access to quality medical care). 


  • Gender

Studies conducted to see if a particular gender is more at risk of hypertension than the other have unsurprisingly shown that men have higher chances of hypertension compared to women. (10)

This risk difference has been linked to several lifestyle and behavioral factors such as smoking and physical activity while biological differences such as the different chromosomes in each gender also play a major role. (10)


  • Genetics

Having parents who are hypertensive increases your chances and although clinical studies have not been able to clearly point out the genes responsible, hypertension has been observed to run in families.


  • Age

As a person gets older, the body system ages as well and cannot function optimally any longer and the heart works harder to pump more blood which leads to thicker arteries which in turn leads to a higher blood pressure.

Though in previous years, hypertension was viewed as a medical condition which affects middle aged or older persons, studies in Sub Saharan Africa have identified high occurrences of hypertension in young Africans and indeed the WHO reports that 45% of adults aged 25 years and above live with hypertension.

A 15 year Centre for Disease Control study also found that 1 in every 7 youths is hypertensive. (11)


  • Diet

Diet is a significant risk factor for high blood pressure and studies (19) have shown that eating a diet that is high in salt, saturated fat, and cholesterol can increase the risk of developing HBP.

According to the National Health Services, the more salt you eat, the higher your blood pressure and each individual should consume less than 6g of salt daily. (18)


  • Obesity

In recent years the increase in obesity rates have been alarming in Africa and this is a cause for concern as obesity is a major risk factor for medical conditions such as hypertension, diabetes and stroke.

Across all age groups, people living with obesity were found to be at a higher risk of hypertension with their risk rate doubling that of non-obese persons. (12)


  • Smoking

People who smoke or use tobacco products are more likely to develop high blood pressure than non-smokers and this is because the chemicals in tobacco smoke can damage the lining of the blood vessels, making them narrower and stiffer, which can increase blood pressure. (20)


  • Alcohol abuse

The excessive consumption of alcohol has been shown to increase blood pressure by narrowing the arteries making it harder for blood to flow through them, and leading to an increase in blood pressure.

In addition, alcohol stimulates the nervous system and causes the release of hormones that can also contribute to high blood pressure such as cortisol. (21)



How is hypertension diagnosed?


At regular medical check-ups: As an African and Nigerian, you're already at a higher risk of hypertension. 

This is why it's advisable to go for regular medical check-ups to keep tabs on your blood pressure among other vital information of the body.

Different types of blood pressure machinesWhen you go for checkups, your doctor takes your blood pressure reading using a manual or electronic blood pressure machine (sphygmomanometer) which is a device that consists of an inflatable cuff and a pressure gauge (See image 3).

The cuff is placed around the upper arm and inflated to a pressure that briefly stops blood flow in the artery.

The pressure is then slowly released and your doctor listens to the blood flow using a stethoscope or electronic device while watching the gauge to determine your blood pressure reading accurately.

In some cases, additional tests may be necessary to identify the underlying cause of the hypertension or to assess the potential complications of the condition.


These may include blood tests to evaluate kidney function or hormone levels, urine tests to look for signs of kidney disease and imaging tests such as an ultrasound, chest X-ray or computerized tomographic (CT) scan to examine the heart, blood vessels or kidneys.



Why do I need to control hypertension?


Controlling hypertension or high blood pressure is necessary for you to be in good health and reduces the risk of serious health complications.

There are multiple benefits to a well-controlled high blood pressure. Some of them include:

1. Reducing the risk of heart disease and stroke: High blood pressure can damage the arteries and increase the risk of heart disease and stroke.

By controlling blood pressure, the risk of these conditions can be reduced.


2. Preventing kidney damage: Hypertension can also damage the blood vessels in the kidneys, leading to kidney disease or even kidney failure.

When properly controlled, kidney damage risk is drastically reduced.


3. Lowering the risk of eye damage: Uncontrolled hypertension can damage the blood vessels in the eyes leading to vision problems or even blindness.

Alongside diabetes, high blood pressure is among the leading causes of vision problems.(13)


4. Improving overall health: Hypertension can cause a range of other health problems such as headaches, dizziness, and shortness of breath.

For you to live a healthy and more meaningful life, controlling your blood pressure is key. 


How to treat hypertension?


Though hypertension is a chronic medical condition, it can be managed and controlled with a combination of lifestyle changes and medications as recommended by your doctor.


Let's consider the two major ways hypertension can be treated.

Lifestyle Changes

Lifestyle changes are modifications made to daily habits and behaviours that can improve your overall health and well-being. These changes make it easier to prevent and manage hypertension properly.

You should take genuine steps at making lifestyle changes first before using blood pressure reducing medications.

Here are some tips for you to adopt:

  • Maintain a healthy weight: Being overweight or obese can increase blood pressure which makes losing weight a more feasible option as it lowers blood pressure and improves overall health.

This can be achieved through a combination of healthy eating and regular physical activity.


  • Engage in regular physical activity: Regular exercise can help lower blood pressure by improving blood vessel health, reducing stress and promoting weight loss.

Aim for at least 30 minutes of moderate-intensity exercise most days of the week, such as brisk walking, cycling, or swimming.


  • Eat healthy food: A healthy diet for managing hypertension includes foods that are low in sodium, saturated fats and cholesterol as well as avoiding sugary beverages, heavy carbohydrate and processed foods, high-fat meats and full-fat dairy products.

You should instead aim to eat plenty of fruits, vegetables, whole grains, lean proteins and low-fat dairy.


  • Limit your alcohol intake: Drinking too much alcohol can raise blood pressure. It is recommended that men limit alcohol intake to nothing more than two drinks per day and women limit it to one drink per day. Water is a better substitute to alcohol. Drink plenty of it.


  • Quit smoking: Smoking can increase blood pressure and damage blood vessels. Quitting smoking can help lower blood pressure and reduce the risk of complications.


  • Maintain optimism: Optimism is an attitude reflecting a belief or hope that life outcomes in general, will be positive, favorable, and desirable. A recent US study identified that optimism supported better cardiovascular health in African American blacks.





When recommended by your doctor, there are several medications that are available to help you in the treatment and management of hypertension. These blood pressure reducing drugs are known as antihypertensives. They belong in different classes and work in different ways.


Table 1 below lists some of the classes of medications effective against hypertension; how they work (i.e., their mode of action), notable brands and their common or generic names, and possible side effects. (14)

Table listing some blood pressure reducing drugs (antihypertensives).

Table 1: List of some blood pressure reducing drugs (antihypertensives). Click on image to enlarge.



What are the challenges to treating hypertension in Nigeria?


Cost of medications

The cost of treating hypertension in Nigeria can vary widely depending on several factors such as location, the severity of the disease, and the type of treatment.

In general, the cost of medications for hypertension in Nigeria can range from N300 to over N20, 000 per month. However, this cost can still be a significant financial burden for many people in Nigeria, especially in rural areas where a significant proportion of the population lives below the poverty line.


Cost of related services

In addition to medication costs, there are other expenses associated with treating hypertension such as doctor/ hospital visits, laboratory tests, and imaging studies and these costs can further add to the financial burden of managing hypertension.

Costs generally can prevent people with hypertension from taking thier drugs as required or attending follow up care with thier doctor or other caregivers.


Limited access to care

Furthermore, in some areas of Nigeria, there may be limited access to healthcare facilities or a shortage of healthcare workers trained to diagnose and manage hypertension. This can result in delayed diagnosis and treatment, leading to complications and further healthcare costs.


Fake or substandard medications

Other challenges that people with hypertension face in Nigeria is that many of the medications prescribed and bought for treatment are likely to be fake or substandard. Available data indicates that well up to 70% of drugs in circulation in the country are fake or substandard. (17)

The effect of this on the control of hypertension in patients and the community is enormous.

Addressing the affordability, accessibility and medication quality of hypertension treatment is critical to improving the health outcomes and quality of life for people living with hypertension in Nigeria.



Public Health Impact of Hypertension in Nigeria


Hypertension is a major economic burden, with the cost of treatment and management of the disease being high, especially in low-income countries. This cost can be a significant barrier for individuals to seek and receive proper care.

The impact of hypertension on public health in Nigeria is significant as the disease often goes undiagnosed and untreated and this can lead to complications such as heart disease, stroke, kidney disease and vision loss.

These complications can significantly reduce the quality of life and life expectancy of affected individuals while also  increasing healthcare costs.


To address the public health impact of hypertension in Nigeria, there is a need for increased awareness and education about the disease, as well as access to affordable, effective and quality basic healthcare services.


Prevention efforts should focus on promoting healthy lifestyle habits in people, such as regular physical activity, healthy diet, limiting alcohol use, getting quality sleep daily and smoking cessation.


At public policy level, federal and state funded innovative programs should be put in place at local government levels to:

(i) Incentivise people to access low cost basic medical checkup within local community health systems at least once yearly.

(ii) Provide food stamps to means-tested vulnerable populations to purchase healthy foods.

(iii) Implement other social services support, including  home health visits, support groups, transport subsidy etc., for people within the community that are identified to be hypertensive.

(iv) Educate people regularly through public service messaging using local languages and influencers, to promote and consolidate awareness of the benefits of the early detection and management of hypertension.

These public programs will go a long way to reduce the risk of complications and improve outcomes for individuals living with hypertension in the community.




  • Hypertension or high blood pressure is a major cause of cardiovascular diseases in Nigeria. A substantial number of Nigerian adults have the condition, but are unaware of it. 
  • Hypertension can cause you to have a stroke, or a heart attack.
  • It can cause you to go blind or damage your kidney function.
  • Your risk of having hypertension increases five to ten fold, if you are obese, smoke cigarette, are inactive, drink a lot of alcohol and abuse recreational drugs.
  • Regular medical checkup is important for the detection of hypertension as the condition may not produce symptoms.
  • Making adjustment in lifestyles and behaviours will help you to keep hypertension at bay.
  • The use of blood pressure reducing medications as prescribed by your doctor may be an important part of the control of your hypertension.
  • Lastly, there is a role for governments at all tiers to play in putting policies and programs in place to control the burden of hypertension within communities and improve management outcome in people with the condition.




1. Centre for Disease Control. High blood pressure symptoms and causes. 2021. Accessed March 18, 2023.

2. American Heart Association. Understanding Blood Pressure Readings. Accessed March 18, 2023.

3. Mayo Clinic. Secondary hypertension. 2022. Accessed March 18, 2023.

4. Hagen. K et al. Blood pressure and risk of headache: a prospective study of 22 685 adults in Norway, J Neurol Neurosurg Psychiatry. 2002 Apr; 72(4): 463–466. doi: 10.1136/jnnp.72.4.463.

5. Assarzadegan F, Asadollahi M, Hesami O, Aryani O, Mansouri B, Beladi Moghadam N. Secondary headaches attributed to arterial hypertension. Iran J Neurol. 2013;12(3):106-10.

6. Reddy SP, Mbewu AD, Williams DR, Harriman NW, Sewpaul R, Morgan JW, Sifunda S, Manyaapelo T, Mabaso M. Race, geographical location and other risk factors for hypertension: South African National Health and Nutrition Examination Survey 2011/12. SSM Popul Health. 2021 Dec 2;16:100986. doi: 10.1016/j.ssmph.2021.100986. 

7. Egan BM. Burden of hypertension in black individuals. UpToDate. 2022. Accessed March 18, 2023.

8. Spence JD, Rayner BL. Hypertension in Blacks. Hypertension. 2018;72:263–269. https://doi.org/10.1161/HYPERTENSIONAHA.118.11064.

9. Sharma JR, Mabhida SE, Myers B, Apalata T, Nicol E, Benjeddou M, Muller C, Johnson R. Prevalence of Hypertension and Its Associated Risk Factors in a Rural Black Population of Mthatha Town, South Africa. Int J Environ Res Public Health. 2021 Jan 29;18(3):1215. doi: 10.3390/ijerph18031215.

10. Everett B, Zajacova A. Gender differences in hypertension and hypertension awareness among young adults. Biodemography Soc Biol. 2015;61(1):1-17. doi: 10.1080/19485565.2014.929488.

11. Centre for Disease Control. High Blood Pressure in Kids and Teens. 2023. Accessed March 18, 2023. 

12. Onoja M. et al. (2020). Regional Patterns and Association Between Obesity and Hypertension in Africa. Hypertension. 2020;75 (5):1167–1178. doi.org/10.1161/HYPERTENSIONAHA.119.14147

13. Bhargava M, Ikram MK, Wong TY. How does hypertension affect your eyes? J Hum Hypertens. 2012 Feb;26(2):71-83. doi: 10.1038/jhh.2011.37.

14. American Heart Association. Types of Blood Pressure Medications. 2017. Accessed March 15, 2023.

15. World Health Organization. Hypertension. 2023. Accessed March 18, 2023. 

16. Adeloye, D. et al. Prevalence, awareness, treatment, and control of hypertension in Nigeria in 1995 and 2020: A systematic analysis of current evidence.  J Clin Hypert. 2021; 23 (5): 963-977. doi.org/10.1111/jch.14220.

17. Raufu A. Influx of fake drugs to Nigeria worries health experts. BMJ. 2002 Mar 23;324(7339):698. doi: 10.1136/bmj.324.7339.698.

18. National Health Services. Hypertension Prevention. 2019.  Accessed March 15, 2023. 

19. World Health Organization. Diet, nutrition and hypertension. 2013. Accessed March 15, 2023. 

20. Virdis A, Giannarelli C, Neves MF, Taddei S, Ghiadoni L. Cigarette smoking and hypertension. Curr Pharm Des. 2010;16(23):2518-25. doi: 10.2174/138161210792062920

21. Husain K, Ansari RA, Ferder L. Alcohol-induced hypertension: Mechanism and prevention. World J Cardiol. 2014 May 26; 6(5):245-52. doi: 10.4330/wjc.v6.i5.245.

22. Charles L., Triscott J., Dobbs B. Secondary Hypertension: Discovering the Underlying Cause. Am Fam Physician. 2017 Oct 1; 96(7):453-461. PMID: 29094913.

23. Sims, M, et al.: Optimism and cardiovascular health among African Americans in the Jackson Heart Study. Prev Med. 2019 Dec; 129: 105826. doi: 10.1016/j.ypmed.2019.10582.

24. Odili AN, Chori BS, Danladi B, Nwakile PC, Okoye IC, Abdullahi U, Nwegbu MN, Zawaya K, Essien I, Sada K, Ogedengbe JO, Aje A, Isiguzo GC. Prevalence, Awareness, Treatment and Control of Hypertension in Nigeria: Data from a Nationwide Survey 2017. Glob Heart. 2020 Jul 10;15(1):47. doi: 10.5334/gh.848.



Published: March 20, 2023

© 2023. Datelinehealth Africa Inc. All rights reserved.

Permission is given to copy, use and share content without alteration or modification and subject to attribution as to source.





DATELINEHEALTH AFRICA INC., is a digital publisher for informational and educational purposes and does not offer personal medical care and advice. If you have a medical problem needing routine or emergency attention, call your doctor or local emergency services immediately, or visit the nearest emergency room or the nearest hospital. You should consult your professional healthcare provider before starting any nutrition, diet, exercise, fitness, medical or wellness program mentioned or referenced in the DatelinehealthAfrica website. Click here for more disclaimer notice.

Untitled Document