Silent Killer: What you need to know about High Blood Pressure

By Oriola Ibiyemi 

Hypertension is a major health concern in Nigeria, affecting millions. According to the World Health Organization (WHO), about one in three Nigerian adults suffers from high blood pressure. A 2018 study published in the Nigerian Journal of Cardiology found that 45% of Nigerians aged 30 and above are hypertensive, yet only one-third of them are aware of their condition. The 2019 Nigeria Non-Communicable Disease (NCD) Survey also highlighted that hypertension accounts for nearly 50% of stroke cases and is a leading cause of heart disease in the country.

Commonly known as High Blood Pressure (BP), it is a serious cardiovascular disorder where the force of blood against the arteries remains persistently high. A blood pressure reading above 140/90 mmHg on multiple occasions is considered hypertensive. The heart, a muscular organ positioned in the mediastinum (the space between the lungs), pumps blood throughout the body. It is encased in a protective sac called the pericardium, which prevents friction and trauma. Normal blood pressure ranges between 100/60 mmHg and 140/90 mmHg. Any reading below 100/60 mmHg is classified as hypotension, while readings above 140/90 mmHg indicate hypertension.

Blood pressure is measured using a sphygmomanometer, also known as a BP monitor. There are two main types: Digital BP Monitors. These are easy to use and display the exact reading automatically. Or Manual Mercury BP Monitors. These require a stethoscope to listen for blood flow sounds and are considered less user-friendly. Due to mercury pollution concerns, countries like Sweden, the Netherlands, and the Philippines have banned them. 

Classification of Hypertension

1.Elevated BP: Systolic pressure of 120-129 mmHg and diastolic pressure below 80 mmHg.

2. Stage 1 Hypertension: Systolic pressure of 130-139 mmHg or diastolic pressure of 80-89 mmHg.

3.Stage 2 Hypertension: Blood pressure exceeding 140/90 mmHg.

Types and Causes of Hypertension

1. Primary (Essential) Hypertension

This form of hypertension has no identifiable medical cause but is linked to risk factors such as:

·Ageing

·Genetics (more common among Black Africans)

·Obesity

·High sodium intake (common due to Nigerian diet rich in salt and processed foods)

·Alcohol and tobacco consumption

·Stress and sedentary lifestyle

2.Secondary Hypertension

This occurs due to underlying medical conditions such as:

·               Kidney disease

·               Pregnancy-induced hypertension

·               Thyroid disorders

·               Diabetes

·               Overuse of NSAIDs (e.g., Diclofenac)

Hypertension requires lifelong management. Poor compliance with treatment can lead to complications such as:

·Coronary artery disease

·Stroke (responsible for 1 in 5 deaths among Nigerian adults)

·Heart attack

·Kidney failure (high BP is a leading cause of kidney disease in Nigeria)

·Pregnancy complications

·Vision problems

·Vascular dementia

Signs of Hypertension

Hypertension is often called the “silent killer” because it may not present symptoms until severe complications arise. However, some warning signs include:

·Occipital headache (headache at the back or middle of the head)

·Elevated BP above 140/90mmHg

·Insomnia

·Fainting

·Chest pain

·Difficulty breathing

·Reduced urine output

·Weakness

·Impaired vision/speech

·Confusion

·Anxiety

·Dizziness

·Vomiting

·Nose bleed

·Heart palpitations. 

Management

1. Lifestyle Changes

·Keep a healthy weight. Know your BMI (Body Mass Index) to assist with this. 

·Eat a healthy diet. Eat full fruits, vegetables, whole grains, less salty foods, and low-fat dairy foods

·Cut down on salt and eat enough potassium containing foods instead e.g tomatoes, bananas, avocados, and potatoes, veggies, nuts

·Avoid fried foods and caffeine 

·Exercise regularly. 

·Do up to 150 minutes of aerobic exercises per week e.g. walking, jogging, skipping, biking

·Engage in resistance training such as lifting light weights. 

·Limit alcohol intake, if possible, stop it entirely

·               Speak to your physician to prescribe antihypertensive medications and be sure of the side effects before starting

·Reduce stress levelss

·Stress relating to work, family, relationship may affect one’s BP reading

·Try yoga, journaling, and avoid stress triggers

·Eat dark chocolates

·They contain 60-70% of cocoa

·2 squares of dark chocolates daily may lower risk of heart disease because it aids in dealing with inflammation and high blood pressure. 

2. Medication Compliance

·Take prescribed antihypertensive medications consistently.

·Consult a doctor about potential side effects before starting any medication.

·Regularly monitor BP at home and visit a doctor for routine check-ups.

How to Measure Blood Pressure Correctly

Non-medical people do not know how to operate manual BP Monitor, so my focus will be on the digital one. Here are the steps to measure your blood pressure: 

1.            Rest for 3-5 minutes before measurement.

2.            Sit in a chair, relax, and remove tight clothing.

3.            Wrap the cuff around the upper arm firmly.

4.            Ensure the machine has functional batteries.

5.            Place the cuff 2-3 cm above the elbow with the arrow facing the palm.

6.            Press the start button and wait for the reading.

Common mistakes that cause inaccurate readings include:

1.            Too much movement during the measurement

2.            Using the wrong cuff size (should not be too loose or too tight)

3.            Crossing legs or wearing tight clothing

4.            Taking BP immediately after eating or drinking coffee

HOW TO GET AN ACCURATE BP READING

1.            D not eat/drink beverages 30 minutes prior to BP check

2.            Empty bladder before BP check

3.            Sit comfortably or lay flat with good back support

4.            Uncross your legs and keep feet flat on the ground

5.            Record BP at the same time every day e.g 8am everyday, 6pm every evening

6.            Ensure cuffed arm is placed at heart level/ the height of your chest on the table

Do not talk while BP is being measured

Now, a BP monitor usually displays two numbers:

·               Systolic pressure (upper number) – Pressure in arteries when the heart contracts.

·               Diastolic pressure (lower number) – Pressure in arteries when the heart relaxes.

For example, a reading of 120/60 mmHg means:

·               Systolic BP = 120 mmHg

·               Diastolic BP = 60 mmHg

The best way to check BP is sitting with the left arm placed at heart level, as the left arm is closer to the heart.

Important Questions to Ask the Doctor

·               What is my average BP reading?

·               What is the ideal BP reading?

·               What lifestyle changes should I make?

·               What kinds of exercises should I do?

·               What medications should I use? What are the side effects?

·               Are the medications fit for pregnancy?

·               Are there supplements/nonprescription medications I should not take? 

Dear reader, Hypertension is a major but manageable health crisis in Nigeria. With early detection, lifestyle modifications, and adherence to treatment, complications can be prevented. Given that nearly one in three Nigerians has high BP, awareness and proactive health measures are critical. Regular check-ups, proper diet, exercise, and stress management can help keep blood pressure under control, ensuring a healthier future for Nigerians.

Oriola Ibiyemi is a registered general nurse, midwife, and public health nurse.