Prof. Jane Ajuluchukwu is a consultant cardiologist at the Lagos University Teaching Hospital (LUTH) and a lecturer at the College of Medicine University of Lagos (CMUL). In this interview with APPOLONIA ADEYEMI, she discusses factors driving hypertension among Africans and preventive measures, especially using lifestyle changes including diet, exercise, among others to tackle it
Rising hypertension is a growing trend that is resulting in the deaths of many Nigerians. What is new in the treatment of hypertension that could reduce deaths?
I graduated as a medical student in 1980. When I graduated the World Health Organisation (WHO), the international Agency which oversees health globally, told us that for somebody to have hypertension and get treated, the person’s blood pressure (BP) should be 160/95 mm Hg. That was before 1999.
As a medical doctor I have practiced on the basis that when I saw a patient with blood pressure (BP) that was 150/90 in those days I would tell the person that he did’nt have hypertension.
But in 1999, because people were dying of stroke, heart failure, kidney failure, which are the complications of hypertension, coupled with study findings from clinical trials showing that when we were using 140/90 to treat hypertension, strokes reduced, the WHO had to come down, reducing the threshold for the treatment of hypertension.
The WHO announced that that it has stopped using 160/95Hg as the threshold for the treatment of hypertension. The starting point to call someone hypertensive became 140/90. We didn’t just know it; there was no where we knew before what we would do. There was even a time that BP was not treated at all; people did not know that it was harmful. That was in the 1940s and 50s. It was insurance companies that noticed that if BP was high like that, affected persons tend to die. Thereafter, people started noticing too. So, we are learning; it is something that is unfolding. We still have not seen all the bad effects, but we know what we know. We know that if someone has hypertension and it is not well treated, it is a risk for stroke. It is a risk for heart failure. It is a risk for kidney failure. Sometimes, it can cause blindness in a particular way.
Also, when hypertension occurs alone in a patient, it is one story; when it is combined with diabetes, high cholesterol or with other medical conditions, then the danger is even higher.
Me that you see here, I have practiced when high blood pressure (HBP) was 160/95 before you can call it hypertension; I am still practicing now that we are using 140/90 as directed by the WHO, but now, the Americans in the group called the American Heart Association (AHA) are saying we have been using this figure, yet people are still losing their lives and that we should go down more to 130/80 as the threshold for the treatment of hypertension. They started this new regulation late last year. So, we in Nigeria are waiting for the WHO. We are waiting for the Nigerian Cardiac Society. It was the AHA that first started this 140/90 even when the WHO said no. The AHA is pushing for a better control of hypertension.
The new thing in the management of hypertension is that the AHA is pushing down the threshold of hypertension, meaning that the measuring level of hypertension is being pushed down.
How will using this new threshold help Nigerians?
If somebody has hypertension it means his BP is above 140/90. Some people have 180/100. Some people have 240/140. When I start treating that have HBP, when their BP get to 140/90, I will say that my treatment is working. Consequently, I will counsel them to maintain their BP at that level, while urging them to use their medicines as prescribed, but the AHA, with the new regulation, is saying that 140/90 is not good enough target and that we should push for the patient’s BP to be nearer 130/80.
The way it will help is that our patients should try more and not stop at 140/90 if we adopt the regulation of the AHA. If the world is saying that when I treat my patient to achieve 140/90 BP and something bad still happened, then we might have to consider going lower to 130/80 in our treatment.
Are there plans for Nigeria to adopt this AHA recommendation on the new threshold for hypertension?
Why not. First of all, people have to be aware of what the world is doing. We have our associations: like I mention the Nigerian Hypertension Society (NHS) and the Nigerian Cardiac Society; we will hear from them on this. Also, the Federal Ministry of Health (FMOH) can even tell us what they want us to do on this. The WHO has not commented on the new AHA recommendation yet, the listed organisations are some of the stakeholders that can say: yes, the new recommendation makes sense to adopt or that it doesn’t make sense.
What can Nigerians do to prevent hypertension?
The preventive measures of hypertension is about lifestyle changes. How did we even start having hypertension? Before the 2nd World War, Africans did not have hypertension at all. We don’t know what happened, whether the missionaries were not measuring our blood pressure level or whether truly, we did not have hypertension.
However, after the 2nd World War, we started to see that the BP of Africans was rising. There was this interesting group, the Koma people of Nigeria that do not eat western diet and they don’t have hypertension.
It is said that factors of industrialisation and westernisation might have brought hypertension because people who don’t have contact with white people do not have hypertension. So, we are just using these factors to put things together.
One of the things that was found out very strongly is salt: the higher salt is in your food, the higher your blood pressure; the fatter you are, the higher your blood pressure. The more you smoke, the higher your blood pressure.
What are all these Koma people eating? Vegetables. There are things in vegetables that counteract hypertension. The more vegetables and fruits that we eat, the better.
Similarly, people should keep their weight down. In addition, one of the things that industrialisation did is that we are not walking; we are using ‘okada’ (motorbike) more.
Before, we would have walked to the farm; we are not walking to the farm any more. Rather, we sit down more in offices and we are gaining weight. Hence, all these things that come with industrialisation are the factors that are pushing hypertension.
How do people gain this fat/weight?
We are eating more than our body needs. The fat is what your body has stored. Food is energy. When you eat your body uses it and what is left is stored as fat with a view to use it afterwards.
So, if we eat a little bit, we would eat as much as our body would need. There would be no need to store anything, but if we are eating too much food, we need to burn it off by farming, walking and exercises. Then there would be nothing to store as fat.
Research has shown that the fatter you are the higher your blood pressure would be. Also, the higher your salt intake the higher your blood pressure would be.
With much eating in commercial places one could consume much salt considering that they use high salt as preservatives.
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