World Hypertension Day: Sudden death on the prowl in Nigeria

Tag : Digital Sphygmomanometer

Before the advent of European foods, bread butter milk, cheese,sugar excess salt and processed foods were foreign to the peoplewho lived close to a life span of 100 years in Nigeria.

At that time , Nigeria was an agro- based under-developed countrywhose population lived on a diet composed more of vegetables andconsumption of meat in a lower proportion. But with the developmentof the economy in the last 30 years , the dietary habits of theupper and middle class have changed drastically with increasingconsumption of animal fat. In Nigeria today hypertension has beenidentified as the major cause of most sudden deaths in Nigeria.

However, as the world celebrates World Hypertension Day today, withthe theme, “Measure your blood pressure at home” Saturday Vanguard health team, Chioma Obinna and Ebun BabalolaX-rays the problems associated with hypertension in the country andwhat governments are doing to check the disease.

With increasing consumption of animal fat by upper and middle classNigerians, the nation may be in the pre -epidemic era of anunprecedented sudden death syndrome arising from cerebral andcoronary artery diseases in middle aged people. This concern isborne out of the development in recent times of sharp increase inthe number of people who die suddenly or without an apparent cause.
It is even being said in certain circles that the sudden deathsyndrome may aptly explain why the country’s life expectancyhas dropped to 44 years.

Unfortunately, sudden death as a major health problem has receivedlittle or no attention in medical circles either because those whofall victims are often those perceived as being hale and hearty orthe inability to understand the symptoms or causes of thephenomenon.
One of the most common underlying reasons identified with suddendeath is coronary heart diseases caused by fatty buildups in thearteries that supply blood to the heart muscle.

In Nigeria, it shows that it is mostly caused by hypertensionrelated factors and dietary - induced problems. Statisticsavailable show that about 335, 00 people die of coronary heartdisease with out being hospitalized or admitted to an emergencyroom every year.
Hypertension has also been identified as a major contributor ofsudden death, the time of death as well as the mode of death areunexpected - usually occurring within minutes after symptoms appeareven though the victim may or may not have been diagnosed of heartdisease.
Medical experts say etiological factors that aggravate thecondition include aggressive lifestyle , obesity , smoking amongstothers. This they say was due to the fact the proportion ofNigerians in middle age habour two or more of these factors withoutknowing , other symptoms are suppressed until death strikessilently or suddenly.
According to the Lagos State Commissioner for Health, Dr. JideIdris, “Such well individuals fall into the category ofpeople who never bother to go for regular medical check- up justbecause they feel well , forgetting that even aging and the effectof wear and tear of normal daily activities take their toll onour human mortal body”.
Noting that hypertension still remains the commonest cardiovasculardisease which kills suddenly, through its leading complications,strokes and heart attack, Dr Idris said although hypertensivestroke had killed and maimed middle age persons in the lastdecades, it is only recently that Nigeria entered its own era ofheart attack and sudden cardiac death.
Amazingly , there are usually no warning symptoms , the victimsbeing said to be well or hale and hearty by their family members.

Even with the down turn in the economy , the consumption ofsaturated fat, refined sugars and excess salt in foods has been onthe increase. So called anatomic profiles of robust cheeks and potbellies as marks of affluence should really give cause for concern.
The growing number of deaths is enough warning that the stage isset for an epidemic of sudden death and the time to act is now.
However, it also pitiable that even though hypertension is the mostcommon cardiovascular condition in Nigeria and in the world atlarge, and it is fully treatable, the social conditions in Africamake the implementation of blood pressure control programmesdifficult. Lack of a clear strategy based on evidence hasundermined further these efforts. The problem of defining astrategy for control confronts all societies.
Hypertension affects 1.5 billion people globally
...as the world celebrates 2008 World hypertension Day
No fewer than 1.5 billion people worldwide are affected by epidemicof hypertension, a major risk factor for heart disease, stroke andkidney diseases. Because it has no symptoms, many people live withthis condition without being aware of it.
Hypertension is the most common cardiovascular condition in theworld and the problem of defining a strategy for control confrontsall societies.
In recognition of these facts and more, the World HypertensionLeague (WHL) in 2005 launched the first-ever World Hypertension Dayto create awareness among the people around the world. It was alsoinitiated to highlight the risks associated with hypertension andto communicate information on prevention, detection, treatment andcontrol. However, the 2008 4th annual World Health Day with thetheme , “Measure your blood pressure-at home” is beingcelebrated in 35 countries of the world, including Nigeria, today.
According to initiators, the theme emphasizes the importance ofbeing aware of one’s blood pressure and taking responsibilityof self health. Measuring blood pressure at home helps theindividual and the care provider to understand how blood pressurecan be controlled on a day-to-day basis through lifestyle changesand appropriate therapies and medication. Unfortunately, inNigeria few people pay attention to their health.
In a chat with Saturday Vanguard Health, the State Commissioner forHealth, Dr. Jide Idris stre ssed that the theme is to “beaware and get your blood pressure checked regularly”. Idris who disclosed that in order to address the problem, the stateinitiated a state-wide hypertension screening programme emphasizedthat knowing your numbers is the first step to preventhypertension, subsequently to prevent heart disease, stroke andkidney diseases.

The Commissioner who disclosed that over 84, 000 people have beenscreened of hypertension since the inception of the programme saidindividuals can only achieve positive in the area of managinghypertension if, he or she is active in his/her community as wellas to make people know their blood pressure.
He announced that the state is embarking on the 3rd round of theprogramme by next week as part of activities to mark thisyear’s World Hypertension Day in the state.
It is essential for individuals to check his blood pressure,Akinroye
Dr. Kingsley Akinroye is the president the Nigerian HeartFoundation (NHF). He spoke on the need for regular blood pressurecheck - up as well as the need for massive awareness campaign onthe condition.
Exercpts:
In Nigeria, hypertension is the number one heart disease,approaching a “national epidemic level” and affectingnot less than 25 per cent of the adult population (above age 15).Itis no respecter of sex, rich or poor, or place of abode (whetherurban or rural). Latest scientific evidence in Nigeria revealsthat the prevalence of hypertension in rural areas is risingsteadily and fast approaching than that of urban areas. Butunfortunately, little or nothing is being done about it.
Hypertension in chronic haemodialysis patients contributessignificantly to morbidity and mortality. Treatment decisions areusually based on predialysis readings, which may not accuratelyreflect control during the interdialytic period. I am mostparticular, about the theme of this year’s World HypertensionDay - “Measure your blood pressure - at home”.
This is because it emphasizes the need for individuals to takeresponsibility for their health and their family. It is essentialfor every individual to check their blood pressure regularly andknow the two essential numbers. Blood pressure can be checked athome by an individual and by family members.
There are cheap home blood pressure kits that are available on theNigerian market. But the problem is ignorance. Most Nigerians neverbordered about this problem until it strikes. Again, lifestyleslike healthy diets with low salt, low sugar, fruits and high fibreare helpful for blood pressure control. Regular physical activityat home and amongst family members in addition to avoidance oftobacco smoking helps in control of blood pressure.
Another problem faced by hypertension patients, is mostly the costof medicare. Drug management of hypertension is very expensive,since most drugs are imported to Nigeria. Government should lookinto the cost of these drugs and see how it could be reduced. Mostpeople die because they cannot afford the cost of managing thesecondition. But another measure, the government and othernon-governmental organizations should emphasis more on preventionwhich is advisable to start from childhood, within the family andat workplace. I will also mention here that the Lagos stategovernment is doing quite a lot with its state’s widehypertension and diabetes screening programmes. If other statesshould emulate this laudable programme, I believe it will go a longway in enlightening Nigerians about the looming epidemic ofhypertension.
Impact of hypertension on mortality
Given the high cause mortality in Africa, it is also believed thathypertension has contributed immensely to the high rate of death inthe country. Findings have shown that more that 1200 adults fromthe rural district of Igboora, Ibarapa, Oyo State, Nigeria, havefallen victims.
Mortality in this community was high by 2.8 per cent per year. Itseems unlikely, however, that all of the attributable risk inpeople with hypertension resulted solely from cardiovasculardiseases. Chronic diseases are a predisposing factor for fatalinfection, and this could lead to short survival in patients withstroke, heart failure, or renal insufficiency.
Measuring blood pressure
Blood pressure is measured with a monitor called asphygmomanometer. This is a digital box attached to a tube with acuff on the end. The cuff is placed around the upper arm andinflated to a certain level, then deflated slowly. A sensor in thecuff provides information about the blood pressure or a doctor ornurse will listen to the blood flow using a stethoscope.

The top figure - the systolic blood pressure - is a measure of thepressure when your heart muscle is contracting and pumping blood.This is the maximum pressure in your blood system.
The bottom figure - the diastolic blood pressure - is the pressurebetween heart beats when the heart is resting and filling withblood. This is the minimum pressure in your blood system.

Types of high blood pressure

* Primary hypertension
More than 9 in 10 people with high blood pressure have what’scalled ‘primary’ or ‘essentialhypertension’. This means that there’s no single clearcause of it.
Although the exact cause of high blood pressure isn’t fullyunderstood, it’s known that some factors to do with yourlifestyle can contribute. These include:
* smoking
* your family history
* obesity (being very overweight)
* drinking a lot of alcohol - especially if you binge drink
* lack of exercise
* your diet
*Secondary hypertension
Around 1 in 20 people with high blood pressure have‘secondary hypertension’. This means your condition canbe linked to a recognised cause - in fact, it may be a symptom ofanother underlying disease or factor such as:
* kidney disease
* endocrine disease
* narrowing of the aorta
* steroid medicines
* the contraceptive pill
*pregnancy, which can cause pre-eclampsia
.