Hypertension, cause of heart failure in more than 90 percent of our patients, says Dr Adeoye, a cardiologist

Dr Abiodun Adeoye is a cardiologist at the cardiac unit of the University College Hospital. In this interview by Sade Oguntola, he calls attention to the importance of hypertension and why it is better prevented and treated, as Nigeria joins others to mark World Hypertension Day an occasion that raises awareness about the disease.

WHAT do we know about hypertension in Nigeria?

What we know about hypertension in Nigeria is that its prevalence and incidences are increasing. In the 1970s, we believed that hypertension was rare even in rural areas compared to urban areas. But now, because of urbanisation, you will find increasing cases of hypertension, and the associated complications are on the increase both in rural and urban areas.

Currently, more than 80% of the heart failure patients at the cardiology unit of University College Hospital (UCH), Ibadan, have it because of hypertension. Of course, there are other causes of heart failure, such as ventricular heart diseases, cardiomyopathies, ischeamic heart diseases, and others. Moreover, the number of people with hypertension outweighs that of all infectious diseases in adults. Hypertension is a real problem in Nigeria.

Does hypertension affect all genders and age groups in Nigeria?

Women are protected from hypertension during the pre-menopausal stage. But immediately after menopause, the rate at which men and women are exposed to having hypertension is similar. But we are having more cardiovascular events in women now. Cardiovascular events include stroke, heart attack, heart failure, kidney failure, and other cardiovascular diseases.

The incidence of hypertension is on the rise, and that is why researchers are paying attention to understanding gender disparity in hypertension. My work on hypertension has shown that metabolic syndrome, which is a risk factor for all these cardiovascular events, is more prevalent in women than men, even among the staff in the hospital.

Why are hypertension and its medical complications important?

Hypertension is a great problem, and it’s important to ensure we control our blood pressure. It is for this reason that World Hypertension Day should be marked with real seriousness to alert individuals that hypertension can damage different organs of the body, including the brain, eye, kidney, ear, and the heart itself. Also, sometimes anti-hypertensive drugs used for its management may have some side effects. You can ask somebody who did not have diabetes before and is now on an anti-hypertensive drug, especially a diuretic, about developing metabolic derangement. After a while, the blood glucose will be up because of the metabolic derailment. So the best is to actually make sure that we accurately measure the blood pressure, and if it’s there, you treat it appropriately and prevent complications. But, as always, prevention is better than cure. And once it has come, we have to be strict about the management and maintenance of blood pressure control.

What are the signs and symptoms of high blood pressure?

By the time you begin to have signs of hypertension, it has already caused some damage to the body. That’s why they have always been saying it’s a silent killer. That name has not changed. By the time you have a persistent headache and cannot sleep, it has already caused problems in the brain. By the time the leg is swelling and you are told that your blood pressure is high, it is already affecting the heart and the kidney. So the best thing is not to wait until there is a symptom. It is important to have a regular blood pressure check-up. Blood pressure measurement is the simplest thing one can do. You can get your blood pressure apparatus at home and monitor your blood pressure. Some blood pressure apparatus also interprets the read. If it is high, it tells you so, and if you treat it by taking your drugs, it can be controlled.

What exactly is the cause of hypertension?

In more than 90 percent of cases, we don’t know the cause of hypertension. However, the other one with a known cause is said to be secondary hypertension. Of course, when you know the background cause of that, hypertension, you can cure it. But, the one whose cause is not known—that’s the one that we call essential hypertension. The possible risk factors for hypertension are either modifiable or non-modifiable. Modifiable risk factors are those that are within our control to change. The non-modifiable risk factors are the ones that are not within our control to change, like age, gender, family history of hypertension, genetic makeup, and being black. For instance, hypertension is more common in blacks, and it is because of the genes that we carry. Also, blacks are prone to having kidney problems, which invariably lead to high blood pressure.

Modifiable risk factors include unhealthy diets because of excessive salt consumption, a diet high in fat, low intake of fruits and vegetables, physical inactivity, use of tobacco and alcohol, being overweight or obese, and a sedentary lifestyle. Also, non-classical risk factors include being a man, irregular sleep, sleep apnea, consumption of energy drinks, use of painkillers and anti-inflammatory drugs, and air pollution, which is a risk factor for hypertension.

A study in Benin reported that high salt intake can be an independent predictor of hypertension. Why is this so?

The finding that high salt intake can be an independent predictor of hypertension was reported in Benin, Enugu, and other parts of Nigeria. These are communities with more salty soil and water. Now, the type of hypertension in Nigeria is salt- and water-related. That is why whatever medication you are giving is meant to help push out water from the body. But it must also be combined with a reduction in salt intake for good blood pressure control. It is not debatable that, in blacks, salt and hypertension are associated. So if you take more salt, you will have higher blood pressure. Salt taste thresholds vary from one region to another. Those communities with a high intake of salt, compared with those with lower consumption, are more likely to develop hypertension.

A dietary habit that consists of a high intake of sugar is said to be a risk factor for hypertension. What’s the link between sugar and hypertension?

We are used to people talking about sugar in relation to diabetes. However, diabetes is the twin brother of hypertension. One will come before the other. Or, at times, they come at the same time as co-morbidities. So if there’s blood pressure, then with time, diabetes will show up. There is a limit to the quantity of sugar that should be in your blood. When it crosses the margin of what is normal, we say the person is becoming diabetic. And once you are diabetic, the high blood sugar level could affect your blood vessels. As a result, there will be what is called peripheral vascular disease. This affects the workings of the heart. The heart is forced to pump out blood against resistance. Cumulatively, this increases the blood pressure. A high blood pressure that remains sustained becomes hypertension.

How does stress affect blood pressure, particularly with the many challenges Nigerians are faced with?

Stress can affect blood pressure indirectly. When there is stress, some hormones are released that cause the heart to work much faster. As a result, the blood pressure will go up. Even when you are taking a hypertension drug and if you are still stressing yourself, your blood pressure will not come down. That is why we always urge people to reduce their stress levels and not carry people’s burdens. For example, you already know that on your route home, the traffic is going to be heavy. Why would you now get into heavy traffic and be stressing yourself? You already know that this is likely to happen.

Apart from stress, when you are sleeping, your blood pressure is supposed to come down. But when it’s not coming down during sleep, we will say you are a non-deeper. That will mean you now have an increased risk of heart attack, stroke, and even kidney disease. Whether you will have a sound sleep depends on how low your blood pressure is. When the blood pressure is high, even if you use sleeping tablets, you might not sleep. Naturally, the blood pressure should dip at night. However, that is not the case for individuals with such conditions as kidney disease and diabetes.

Are there natural remedies or supplements for managing hypertension?

Well, I cannot dispute the fact that there are some remedies that people claim control blood pressure. However, the natural remedy for blood pressure control is the daily consumption of large amounts of fruits and vegetables. In a study, we found that taking a good quantity of green leafy vegetables daily can prevent high blood pressure. Also, it can prevent a stroke. But if you ask me about native medications or herbal recipes, that’s where there’s a problem because we cannot quantify what is inside them. Orthodox medicines are not the same as herbal recipes. I have seen people after taking such herbal recipes come down with adverse reactions, including kidney and liver damage.

What are the knowledge gaps that need to be addressed to improve the understanding of hypertension development and reduce treatment and control gaps?

We are doing a lot of studies on hypertension. It is the study that is bringing us to say that a high intake of salt is a risk factor for hypertension and that when your blood pressure does not dip at night, it is an indication that you have a higher possibility of coming down with heart attack, stroke, and even kidney disease. So, we are increasing scientific knowledge on hypertension. I want to believe that Nigerians’ knowledge about hypertension, its complications, and what needs to be done is increasing equally. This is quite unlike before. But the problem is: do they practice those things that they know can prevent hypertension? Are medications for hypertension accessible and affordable? Some people will say, I know that I need drugs, but I can’t afford them.” So, that knowledge is there, but the availability of hypertension medication is an issue. And if the government can continue the way they are currently doing, maybe with time, the drugs will be more accessible and affordable.

The Federal government is encouraging local production of anti-hypertensive drugs and other drugs generally. There’s a blueprint from the Federal Ministry of Health to make drugs cheaper and more available. Even vaccines will be produced in the country very soon. So, those are the great efforts that they are making.

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