Hypertension: The Bad News About Statistics

By

Dr. Murtala Muhammad Umar

General Hospital Gusau, Zamfara State

drmmu2000@yahoo.co.uk

 

The world came together on May 14th to mark the traditional world hypertension day, a day set aside to create awareness on the scourge of this  non communicable disease with high predilection for the black race. Hypertension refers to a cardiovascular (heart and blood vessels) disease that is characterized by sustained high blood pressure. The World Health Organization (WHO) gives a ceiling of blood pressure (BP) greater than 140/90 mmHg (millimeters of mercury=unit of BP measurement). The numerator (systolic BP) corresponds to the pressure in the blood vessels when the heart is contracting to pump oxygenated blood to the body tissues, while the denumerator (diastolic), represents the pressure in the blood vessels when the heart is at rest, receiving deoxygenated blood from the body.The hole mark of the disease if uncontrolled, is the affectation of virtually all body system ranging from the heart itself to the brain, eyes, kidneys, etc. the unfortunate thing about hypertension is that it goes unnoticed without any symptom(s) unless accidentally peaked or when complications ensue.

 

The recent available statistics about hypertension both in Nigeria and other parts of the world is alarming and the future appears blink. Studies carried out years back showed that 10% of Nigerians have the disease (more than 10 million people) out of which only 10% are aware of their hypertensive status. The research also showed that only 10% of Nigerians that know they are hypertensives are on treatment majority of whom do not comply with their medications and follow ups. A high prevalence of 13% have been reported in the country. This means not less than 13 million Nigerians have the disease. From a global perspective, researchers at the University of Tulane (New Orleans, Louisiana) have estimated that by 2025, over 29% of all adults worldwide will have hypertension. Furthermore, they caution that their prediction, based on data from 2000, is a conservative one and that the real figure for 2025 could turn out to be higher.  Currently one billion people in the world are hypertensive and God forbade, if urgent intervention is not made 1 in every 3 people in the world may be affected as predicted by this research.

 

Hypertension based on the cause can be divided into primary or essential hypertension in which no identifiable cause but risk factors can be implicated and secondary hypertension when a cause is known. The primary hypertension is by far the commonest and account for up to 98% of hypertension and has risk factors that potentiate it. Risk factors are the result of statistical analysis of the elements that are present in people that do show elevated blood pressures.  The more risk factors present in your personal or family history, the greater the chance is that you too will develop the condition.  However it is really not that cut and dried, and some people with many risk factors present never do develop any signs of blood pressure elevation while others that seem free of identifiable factors, are found with higher than normal readings.  It becomes a bit simpler to understand when you divide the factors into two kinds, those that you can't change (also called "uncontrollable" risk factors) and those that may be lessened by appropriate actions that you may take ("controllable").  In the uncontrollable category, there are four headings:  heredity, present when your parents or other close members of your family have a history of high blood pressure; race, for reasons that are still poorly understood, a higher percentage of Black North Americans develop Hypertension(HBP) than white North Americans:  sex, women before menopause are slightly less at risk than men, after menopause they catch up quite rapidly; age, the older you are the greater your chances of developing  HBP.  It is in the controllable category that you find the things you can do something about and where the greatest educational emphasis is placed.  Here there are seven headings: 

 

 

  1. Weight:  the more your weight exceeds the normal for your height, the greater the chance of HBP.  Lowering your weight to normal can actually reduce your blood pressure levels;    

  2. Alcohol consumption; statistics prove that regular, excessive drinking can increase blood pressure; 

  3. sodium:  to some people who are sensitive to the amount of sodium they consume (present in table salt and other foods and medicines), blood pressures rise when salt is taken in excess of body needs; 

  4. Smoking:  the nicotine in tobacco smoke causes the small blood vessels in the body to squeeze down (contract) which results in increased blood pressure levels; 

  5. Oral contraceptives:  some women are sensitive to this medication which results in their developing HBP.  Smoking and birth control pills together make for a very high risk factor; 

  6. Repressed anger:  people who hold a lot of anger inside and are constantly frustrated with their situation tend to have more heart and blood pressure problems; 

  7. Sedentary life-style:  when the heart, blood vessels and muscles are not exposed to regular exercise, they lose their tone, and HBP may result.  In addition lack of activity contributes to weight gain. 

 

With all the indications in the "controllable" category, it is easy to understand how some people manage to overcome their tendency to develop HBP and improve their odds.  The pay off is not only a reduction in heart problems, and an increased life span, but also a life more than a mere existence, enjoyable, rewarding and fun to live.

 

Hypertension as earlier said is a disease associated with life threatening complications. It is the commonest cause of stroke and one of the leading causes of chronic renal failure in our environment. These two complications alone are quite disabling even when patients are able to survive. The controllable factors identified above must go with routine measurement of blood pressure especially after the age of 40 when the disease usually starts. Doctors, nurses and other relevant health workers should ensure that no adult passes through the four walls f their clinics/hospitals without his/her blood pressure  measured. Governments, NGOs, health workers union etc. can do a lot by embarking on blood pressure measurements campaigns especially in the rural areas to diagnose people with the disease. They are digital blood pressure machines that are available in the market which people can buy for their personal use in consultation with their physicians. As earlier discussed, uncomplicated hypertension is usually symptomless making compliance with medication difficult. If the disease were to present with symptom such as pain, the presentation will be early and compliance enhanced. Hypertensives should appreciate the fact that by religiously complying with their medication and regular follow ups, they are preventing life threatening complications such as heart disease, renal failure, stroke, impotence, blindness to mention but a few. The governments and other concern agencies can come to the aid of the millions of people with the disease by subsidizing the cost of anti hypertensive drugs and where possible dispense them free to indigent patients.

 

Lastly, there is need to re stressed the need for modification of life styles. Cigarette smoking, alcoholic intake, sedentary life, excessive intake of salt as highlighted earlier increase the risk of developing high BP and should be let go. Moderate exercise even in the form of walking for 30 minutes daily, would go along way in reducing the risk of hypertension and ensure adequate control of blood pressure for those already with the disease. The bad news about the present and future prevalence of hypertension can be reversed if and only if the society assumes greater responsibility for its own health. It is our earnest hope that come may 14th 2007 when we shall be celebrating another world hypertension day, the alarming statistics, of 1 billion people with hypertension, would have dropped to a tolerable figure. ,