The number of young adults suffering from high blood pressure, also known as hypertension in Nigeria, is rising by the day, findings by Weekend Trust has revealed.
Often thought to be a disease of older adults or the elderly, studies have shown that younger adults within the ages of 18 to 45 years are increasingly coming down with high blood pressure in the country.
This has led to growing concerns, as some studies have shown that the prevalence rate of hypertension among young adults in Nigeria is as high as 21.3 per cent in some areas.
Also, some of those affected are students of secondary and tertiary institutions who have a hard time coping with the rising cost of medications.
Already in Nigeria, hypertension is a leading cause of death and illness among the elderly.
Experts say the risk of developing hypertensive cardiovascular complications is greater in younger than older individuals.
They said the presence of hypertension at a young age increased the risk of cardiovascular events at middle age. It contributes to an earlier onset of coronary heart disease, heart failure, stroke and transient ischaemic attacks.
High blood pressure occurs when the force of blood flowing through your blood vessels is consistently too high.
According to the World Health Organisation (WHO), your blood pressure is high when you have consistent systolic readings of 140 mm Hg or higher, or diastolic readings of 90 mm Hg or higher.
Prof Augustine Odili, the president of the Nigerian Cardiac Society and chairman of the Africa Regional Advisory Group for the International Society of Hypertension, explained it thus: “Measurement of blood pressure is written in two values. The one written on top is the systolic and the one below is the diastolic. So if your systolic blood pressure is above 140 and the diastolic blood pressure is above 90, you are said to have hypertension.”
Most cases of hypertension are asymptomatic; that is why it has been dubbed the ‘silent killer’.
Patients speak
When Hassan, 23, fell ill last year, he least expected to get a diagnosis of high blood pressure. However, after tests and four-day admission, he has been on a daily dose of high blood pressure medicine since then.
He said he was extremely shocked, even though his mother was hypertensive.
“My mother was diagnosed in her 50s, so I thought I was too young to suffer from it. I always thought it was only people in their 50s and 60s and above that suffer from high blood pressure,” he said.
Hassan, who wants to be known only with his first name, said he had made some lifestyle changes, including trying to get some rest from his busy work schedule at an information and communication technology (ICT) firm.
He added that he disliked taking drugs, even occasionally, but now, he has to make extra efforts to take his pills daily.
Aderibigbe Bisi, 56, a mother of five, said she got the shock of her life when her 19-year-old son, an undergraduate, was diagnosed of high blood pressure.
She and her husband do not suffer from the condition, but some persons from her maternal family have it, although as older adults.
“He has been receiving treatment and hoping that it would get better with time and not be on a lifelong medication from this age.
“He is one of the best students in his school; and he is always studying. But his siblings that eat too don’t have the condition,” she added.
Mark Yakubu (not his real names), a 34-year-old journalist, has been on high blood pressure drugs for four years. He recalled that he was always having persistent headache in the mornings before he went to the hospital.
“I always thought it was the stress of my job,” he said. But when he finally went to the hospital after he fell very ill, his blood pressure read 180. He also had malaria then. He was admitted and had to take sometime off work to recover
He said he had been on high blood pressure drug since then.
Julia, 30, a stroke survivor, said she suffered the attack at the age of 28. Before then, each time she measured her blood pressure, it was always high. But no one placed her on drugs; and she also took it lightly.
She recalled that she was also having a lot of challenges and stress meeting up with her family’s needs as.
Then one night, she suddenly couldn’t move her body, so she was rushed to the hospital and diagnosed with stroke. She spent over a month in the hospital before she was discharged.
Today, while she is better, she said if a doctor had placed her on medication earlier, she may not have developed stroke.
Prof Odili, who is also the immediate past vice president of the Nigerian Hypertension Society, said a study he did with other researchers across the six geopolitical zones showed that the prevalence of hypertension among adults in Nigeria was about 38 per cent, which means that four out of every 10 adults in Nigerian were hypertensive.
He added that there was no difference in prevalence between people in rural or urban areas.
The coordinating minister of health and social welfare, Prof Muhammad Ali Pate, said several pockets of studies and surveys in Nigeria put the prevalence of hypertension in excess of 30 per cent.
Quoting the 2019 WHO NCD Country Profiles, he said no communicable diseases accounted for 29 per cent of all deaths in the country with cardiovascular disease, predominantly hypertension, responsible for 11 per cent of all the NCD deaths.
Also, the president of the Nigerian Hypertension Society, Prof Simeon Isezuo, in a statement, noted that 1 of every 3 adults had hypertension.
He said, “Hypertension has no symptoms until a serious damage has been done to the body. Thence, many people with this condition are unaware of it, and only a few are placed on treatment. Furthermore, many of those who are on treatment do not achieve normal blood pressure levels, mainly because they do not take their medicines regularly.”
According to him, it is the leading cause of stroke, heart failure, chronic kidney disease and heart attack, resulting in the death or disability of people, usually breadwinners in economically productive years of their lives. Sadly, hypotension remains a silent killer in Nigeria, It is, however, preventable and treatable.
He said health workers should utilise every contact with patients and clients as opportunities to check blood pressures, irrespective of the reason for the consultations.
“Home blood pressure monitor should similarly be encouraged. Blood pressure measurement requires appropriate apparatus. I urge the health industries to continue to improve in making this equipment affordable and user-friendly. I also encourage government at all levels and the private sector to develop a policy of rewarding employers with blood pressure apparatus. Friends and relatives should develop the habit of using these equipment as favoured gift items,” he added.
Findings of a study on disparities in hypertension prevalence among young adults in Nigeria revealed that out of 924 young adults aged 18 to 40 years in three states (Abia, Oyo and Kano), 416 (45.0%) were less than 30 years old, while 508 (55.0%) of the respondents were 30 years of age and above.
The study, which was done by Rabiu Ibrahim Jalo, Eniola Adetola Bamgboye and IkeOluwapo Oyeneye, revealed that, “Overall, the prevalence of hypertension among young adults in the three states was 169 (18.2%), higher among females 107 (19.2%), compared to males, 61 (16.7%).”
Another study done by Obinna Nwoke and other researchers on hypertension among young adults in Nigeria revealed that there’s an increased prevalence of prehypertension and hypertension among young adults.
They said this called for a comprehensive national screening, public enlightenment and targeted prevention programmes that foster healthy lifestyle behaviours, physical activity and healthy eating among students.
They said hypertension is a problem lacking relevant attention because it is still erroneously considered a disease of the old.
“Identifying young individuals who present greater risks for developing hypertension may help target public health prevention efforts to reduce morbidity and mortality. This could help reverse the present trend so that the number of cases of hypertension in the country would not hit 39.1 million by 2030 as has been projected,” they said.
Also, another study published in the Saudi Journal of Medicine noted that the increasing trend of early onset of hypertension is a major concern in the development of Nigeria as the young and active workforce population are being incapacitated and worst still depleted.
Causes of hypertension in young adults – Experts
The risk factors for hypertension in young adults, according to experts, include obesity, low birth weight, family history of hypertension and diabetes, poor nutrition and sedentary lifestyle.
Odili, who is a professor of cardiovascular epidemiology at the University of Abuja, said factors fuelling hypertension in young adults were multi-dimensional.
He said a major risk factor was physical inactivity, which is linked to obesity, adding that, “The greatest risk factor for hypertension is age. So, as people age, the their blood pressure increases.”
He said another one was genetic predisposition, explaining, “If the person is genetically predisposed, and as he or she grows, now tries to do lifestyle modifications, there is a possibility that the trigger will not be pulled, or even when it is pulled, not all the bullets will be fired.”
Asked if stress contributes to high blood pressure among young adults, he said that as a risk factor, it is not well defined.
“Stress actually contributes, but I will carefully avoid it. Maybe you want me to mention stress first, especially knowing the way our country is. Yes, stress is a risk factor for hypertension, but it is really not as well defined as some of the other ones I mentioned.
“However, of course there are ways – when you are stressed up you release a lot of cortisol, which elevate blood pressure. And wherever you talk about stress, people think of money. ‘If you don’t have money, you are stressed up.’ Lack of money is a stimulus for stress, but it is not the stimulus that is the main issue, it is the individual’s reaction to the stimulus. Somebody may have N5, 000 and be happy with his life, yet another person has N500,000 but will be under intense stress.
“People waking up very early for office engagements, doing two to three jobs and trying to meet three deadlines may be stressful, but an individual’s reaction to it will determine the effect of such stressful condition on his or her blood pressure,” he explained.
The expert highlighted that a salient point to note in high blood pressure in young adults is the fact that life course approach plays a key role.
He said life course approach to chronic diseases, including hypertension, means the chronic disease spans through the entire lifespan of an individual.
He explained it thus: “The fact that somebody develops hypertension at 40 years means the process actually started from the womb. So, a child who is obese and has very minimal physical activity may already be on the trajectory of developing hypertension.
“The fact that that child has not yet become hypertensive does not mean that the child is well.
“There is a theory or hypothesis called Becca’s hypothesis. This hypothesis is named after the person who first proposed it. The hypothesis is that when people have bad intrauterine conditions, for example, low birth weight, their system is programmed towards a high predisposition to hypertension, diabetes and other chronic diseases. For example, people who may be born small but add a lot of weight at critical life stages, or critical transition points from adolescent to adult, before long they grow too big. If you measure their blood pressure at that time, maybe using the standard of 140/90, they will apparently be normal, but that person is already on the trajectory of developing hypertension.”
He stressed that this means that hypertension as a disease starts through the life course of an individual.
He said, “The main message is that waiting for the time when someone has hypertension before you start doing any intervention is not good enough. Along the whole life course, propensity to hypertension has even started and we should do everything within our power to make sure that we control these things among children and young adults because it is the children of today who are already on the trajectory of hypertension that will develop hypertension tomorrow.”
Young adults suffering from hypertension said they and their parents spent a lot of money on medicines monthly as they have to take the drugs daily.
Idris, 35, said there was over a 50 per cent increase on the amount he spent monthly on a high blood pressure medication called Amlodipine now, compared to last year.
The president of the Nigerian Hypertension Society, Prof Simeon Isezuo, said the rising cost of medicine for treatment of hypertension, a long-life disease, is a major concern.
He said that in the immediate, health care providers are encouraged to cautiously use the most affordable and available effective and safe medicines for the treatment of hypertension.
Prof Odili harped on the need for increased awareness creation about hypertension among the youth and other members of the populace.
He said some young people suffering from the disease were unaware that they have it. This further hampers access to lifestyle changes and efforts to reduce or manage their blood pressure, he added.
‘We should use more bicycles in Nigeria’
As a way of encouraging physical activity in the country, Prof Odili called for more use of bicycles.
He said, “If you look around in our country, there are very few bicycles; and none in some places. So we should think of how best to introduce bicycles. It is more pocket-friendly and more friendly to the environment; and above all, friendly to your health.”
The Nigerian Hypertension Society said cycling should also be encouraged as a means of short distance transport, and vehicle parking spaces should be located at fairly far distance from places
Prof Simeon, the president of the society, on his part, said efforts should be made to prevent hypertension.
“Prevention is always better than cure. The fact that hypertension was a rare condition among native Africans before western civilisation suggests that it is preventable. I, therefore, recommend consumption of traditional African food derived from roots, stem and leaves, regular exercise and optimum weight for prevention of hypertension. Unhealthy foods should be taxed to discourage their consumption. Legislation should be enacted to enforce appropriate label of salt, fat and sugar contents on food packages,” he advised.
He also called on government to take necessary measures to bring down the prices of medicines.
He said, “Hypertension is an inheritable disease that may affect multiple members of the same family, I, therefore, advocate that Nigerians should strengthen traditional African family system in the control of hypertension. These include sharing of information about hypertension, promotion of native African diet, and involvement in physical domestic activities instead of living them exclusively for house-helps.
“Families should support and encourage their members with hypertension to take their medicines regularly. Regular blood pressure check should be encouraged in the family. Ultimately, every family, household or home in Nigeria should have a blood pressure apparatus for regular checks.
What FG is doing — Minister
The Coordinating Minister of Health and Social Welfare, Prof Muhammad Ali Pate, said that over the years, the federal government had instituted several strategic interventions at the tertiary, secondary and primary health care levels with the target of screening at least 80 per cent of eligible population and placing 80 per cent of people with hypertension on standard treatment and care, as well as ensuring that 80 per cent of those on treatment have their blood pressure sustainably controlled .
He said, “There is the need to avert complication and contribute to achieving at least 25 per cent relative reduction in unconditional probability of dying prematurely from cardiovascular diseases and other NCDs. In addition to these, the healthy lifestyle interventions specified in the National NCDs Multi-Sectoral Action Plan importantly apply.
“Considering the duty and responsibility of PHCs in prevention services, the ministry, in collaboration with the NPHCDA, WHO Country Office and Resolve To Save Lives (RTSL) launched the National Hypertension Control Initiative (NHCI) in August 2019 with focus on strengthening the PHCs to provide hypertension services, such as awareness creation, education, screening, early detection, quality treatment, care and support including referral in line with standard national tools and guidelines to reduce morbidity and mortality due to hypertension in the country,” he said.(Daily trust)
