By Paul Adunwoke
This year’s World Hypertension Day will be marked on May 17. And to prevent the disease, Nigerians have been advised to engage in healthy lifestyle practices, eat less salt, exercise regularly, eat more fruits, quit smoking, have regular blood pressure checks, reduce stress and visit doctors for help when necessary.
Although the World Health Organisation (WHO), prescribed one doctor to 600 people, but presently, statistics have shown that there is one doctor to about 6,000 Nigerians, which limits access to treatment of hypertension and its complications.
In view of this, a Consultant Physician/Nephrologist at the Medical Department, Lagos State University Teaching Hospital, Ikeja, Lagos, Dr Adebowale Adekoya, has advised government to prevent hypertension and curb deaths that may occur from it, by creating more awareness on the condition.
He said It will also help, if government can create free blood pressure checking points, where people can easily walk in and undergo check for free, as well as receive advice or referral to a clinic, if necessary.
He noted that effective National Health Insurance Scheme (NHIS) would encourage proper health-seeking behaviour and reduce the financial burden of out-of-pocket payment for medications and health services, which may hinder people from procuring medications they need for treatment.
“Government should invest heavily in health care delivery, while essential medications like anti-hypertensive should be available and affordable.
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Also, the current rising burden of hypertension is a dangerous recipe for many of its complications like chronic kidney disease, stroke and heart failure among Nigerians”, he said.
Adekoya explained that about 150,000 Nigerians die yearly from hypertension and heart related conditions, and that the economic cost of treating hypertension and its complications is a huge burden.
The average monthly cost of medications for treatment of hypertension is about N5, 000 in a country where minimum wage is N18, 000.
The implication remains that many of these patients resort to cheaper options with dire consequences.
He defined hypertension as systolic blood pressure (SBP) of 140mmHg or more, or a diastolic blood pressure (DBP) of 90mmHg or more, or the use of anti-hypertensive.
He said: “Hypertension might be primary or secondary. Primary (or essential) hypertension has no identifiable cause. It results from a blend of genetic and environmental factors. On the other hand, secondary hypertension has many causes, which include endocrine, renal and vascular disorder”.
“Primary or essential hypertension is commoner. It accounts for 90 to 95 per cent of cases, while secondary hypertension accounts for two to 10 per cent. Hypertension is a form of non-communicable disease with increasing global burden.
The prevalence is high in Nigeria and figures depend on the setting where the study was conducted, and the benchmark used in the diagnosis of hypertension. The prevalence is about 30 to 45 per cent in adults.
“The key to effective prevention of hypertension and its complications is strict lifestyle modification, regular health check and compliance with use of life-long medications.
Life style modification entails restriction of salt intake, as well as other dietary changes, stress reduction, moderation of alcohol intake, smoking cessation and avoidance of sedentary life style.
Hypertension is a silent killer because it has no symptoms, which present only following damage to important organs of the body like the heart, kidney and brain. It is a major risk factor for stroke, myocardial infarction, vascular disease and chronic kidney disease.
“Management of hypertension is not just the duty of your doctor. You must get involved by ensuring modification of your lifestyle and regular use of your medications. Say no to hypertension and its complications. Regular health check is a must.”
Dr. Ehi Iyayi, a Consultant Cardiologist, Lagos State University Teaching Hospital said hypertension is a medical condition characterised by persistently elevated blood pressure. In other words, when a person’s blood pressure is higher than the accepted normal values, which means greater than 140/90mmHg, on three separate occasions then a diagnosis of hypertension can be made.
He said: “Secondary hypertension occurs due to an underlying cause. It accounts for much fewer cases of hypertension in the general population. Some of the causes of secondary hypertension include, kidney diseases, thyroid disease, that is an overactive thyroid gland, use of certain drugs such as steroids, some contraceptive (birth control) pills, and use of illegal substance like cocaine.”
Iyayi noted that hypertension can be prevented by adopting healthy lifestyle habits such as brisk walking, jogging, eating lots of fruits and vegetables and weight loss for obese people, among others.
He said: “Access to good health care is generally inadequate in Nigeria, especially in the rural areas. Many people who have hypertension are unaware of their condition. Unfortunately, many detect their hypertension when certain complications such as stroke, heart failure or heart attack have occurred.”
Dr. Ademola Orolu, a Consultant Family Physician said individuals should consult their doctors, when they experience any symptom at all and not only when hypertensive.
Upon presentation, the clinician would evaluate symptoms the individual experiences, as well as examine him/her to identify any effect of hypertension on the organs. Appropriate investigations are ordered to detect damage to organs like the heart, kidneys, and eyes.
He said some diseases, which include diabetes mellitus, hyperlipidemia elevated blood fat may also be present in the individual. These are also screened for.
All these are done in the work up to definitive management of patient, so as to individualise treatment. Lifestyle modifications, including health education on moderation of habits, stress reduction, dietary adjustment and aerobic exercises are important in the management of every hypertensive patient.
He said: “Thirty minutes of moderate exercises such as brisk walking, jogging, cycling, thread mill exercise, swimming not less than five days of the week, moderate salt intake, moderate alcohol intake, if at all, avoidance of smoking, low consumption of saturated fat, replacement of red meat and mutton, with white meat, fish and skinned poultry; boiled or grilled are the essentials of lifestyle treatment of hypertension.
These measures must be done in combination to achieve result. If these do not control the blood pressure, patients are advised to commence use of medications, while they still continue the lifestyle measure.
If the blood pressure is highly elevated and its effect on vital organs is detected, medication is commenced immediately in addition to lifestyle control.
“Follow-up in the clinic is essential to confirm improvement and challenges with treatment, which can be easily addressed. Most patients default in follow-up due to the wrong belief that once the blood pressure normalises, it means cure.
Unlike malaria or other acute infections, hypertension has no permanent cure. Lifestyle modification is a lifelong approach to management of hypertension with or without medication.