Written by Gachomo Mapis pharmD & Commissioned by Abonnema Foundation, Inc.
The turn of the 21st century was marked by concerns over the public health burden of hypertension globally. Hypertension substantially increases the risk of cardiovascular and renal diseases such as stroke, coronary artery disease, heart failure and end-stage renal disease. The concern over cardiovascular disease is especially relevant in the healthcare of a developing nation like Nigeria. In Nigeria, 57 million people are estimated to be hypertensive with many still undiagnosed. There are currently 22% total deaths due to non-communicable diseases (NCD); of that, 9.2% is related to cardiovascular diseases. Hypertension is identified as the leading cause of Target Organ Damage (TOD) like blindness, kidney failure and coronary artery diseases. Emerging data from hospital studies show that hypertension or its complication is the most common non-communicable disease in Nigeria. Stroke specifically accounts for 5%-17% of all deaths in the medical ward. In 2007, mortality from stroke in the country was put at 126 per 100,000 population and rising.
Hypertension, also commonly referred to as high blood pressure, is a cardiovascular disease that is characterized by sustained elevated blood pressure. The World Health Organization (WHO) uses a cut off of 140/90 mmHg as a measure of normal blood pressure. The numerator represents the systolic blood pressure and this is the pressure in the blood vessels when the heart is contracting to pump oxygenated blood into the body. The denominator is the diastolic blood pressure which refers to the pressure in the blood vessels when the heart is relaxing and receiving deoxygenated blood from the body. High blood pressure causes systemic damage because it requires the heart to work harder than normal to circulate blood through the blood vessels. In scientific circles, stricter guidelines now ascribe a blood pressure of 120/80 mmHg as the normal blood pressure level.
The rising trend in hypertension prevalence in Nigeria is attributed to many factors but physical inactivity, alcohol consumption, education level and socio-economic status all play a role. Hypertension prevalence differs according to gender. In general, hypertension prevalence is higher amongst men than women. The prevalence also differs among urban dwellers and rural dwellers. Hypertension prevalence is higher in urban areas than rural areas.
These differences can be attributed to lifestyles. For example, women are more likely than men, to attend clinic check-ups, report for follow-up visits and accept their diagnosis. People in urban areas consume more processed foods and typically drive more compared to their rural counterparts.
Many treatment options are available for managing hypertension in Nigeria. A series of studies (by Salako and Falase) showed that Nigerians respond well to Thiazide diuretics and Calcium channel antagonists when these drugs were used as monotherapy. Other classes of drugs, such as beta adrenergic blockers, require the use of high doses before they are effective in Nigerian hypertensives. The use of high doses of these drugs often causes unacceptable side effects. Therefore, it is recommended that for effective management of hypertension in the Nigerian population, the use of Thiazide diuretics or Calcium channel antagonists as monotherapy or in combination with other classes of antihypertensive agents is the standard of care.
In Nigeria, current data on trends in hypertension treatment, control and unawareness is limited. Hypertension awareness in the population is generally accepted as very low. A majority of patients with high blood pressure in Nigeria are unaware that they have the disease, perhaps because they rarely see a doctor to check their blood pressure. Hypertension is insidious in nature and is often asymptomatic and most cases present in the doctors’ office only when complications have set in. Even patients that are aware they have high blood pressure do not truly understand how serious it can be so they fail to get adequate treatment or remain compliant on medication.
A strategic shift in cultural attitudes favoring the adoption of healthy lifestyles is important in reducing hypertension prevalence in Nigeria. Reduction in the consumption of processed foods, reduction in salt intake, anger/stress management, limited alcohol intake, avoidance of tobacco and increased physical activity (even as little as a 30-minute walk per day) will go a long way in combating this growing trend. The most important point is that as individuals, we Nigerians need to assume greater responsibility for our own health and not solely rely on healthcare providers. It is critical that you know your hypertension numbers and act on this information.
Ultimately, it is important to recognize that hypertension is the most modifiable cardiovascular risk and because it is easily preventable and treatable, there is a need to promote public health awareness through increase in screening and education opportunities as a primary preventive measure. The Nigerian public should be encouraged to make appointments for routine health check-ups especially after the age of 40 when hypertension usually seems to be more common. In addition, health care providers in the country need to educate patients on the importance of taking their medications regularly to avoid complications such as kidney failure, impotence, stroke and blindness, illnesses that many Nigerians fail to associate with elevated blood pressure.
References:
Okechukwu S Ogah, Ikechi Okpechi, Innocent I Chukwuonye, Joshua O Akinyemi, Basden JC Onwubere, Ayodele O Falase, Simon Stewart, and Karen Sliwa: “Blood pressure, prevalence of hypertension and hypertension related complications in Nigerian Africans: A review” http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3530788/. December 26 2012
Dr. Murtala Muhammad Umar: “Hypertension: The Bad News About Statistics” General Hospital Gusau, Zamfara State. http://www.gamji.com/article6000/NEWS6034.htm.