By: Adebowale Bello (Freelance Health Writer and DLHA Volunteer)
With Editorial contribution by The Datelinehealth Africa Team
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.
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.
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)
According 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.
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.
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.
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:
Hyper- and hypothyroidism cause high blood pressure through different ways.
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.
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.
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):
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).
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)
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.
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 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)
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)
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)
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)
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.
When 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.
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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.
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:
By controlling blood pressure, the risk of these conditions can be reduced.
When properly controlled, kidney damage risk is drastically reduced.
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.
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 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:
This can be achieved through a combination of healthy eating and regular physical activity.
Aim for at least 30 minutes of moderate-intensity exercise most days of the week, such as brisk walking, cycling, or swimming.
You should instead aim to eat plenty of fruits, vegetables, whole grains, lean proteins and low-fat dairy.
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 1: List of some blood pressure reducing drugs (antihypertensives). Click on image to enlarge.
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.
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.
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.
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.
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.
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Published: March 20, 2023
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