Experts endorse natural options for beating hypertension
•NHF urges FG to make the implementation of policy on non-communicable diseases compulsory nationwide
•7,000 steps daily, plant-based foods lower risks of getting COVID-19, having severe disease after infection
“Finding out I had hypertension was a shock. I had always thought I was fairly healthy for my age, and put anything out of the ordinary down to simply getting older,” 42-year-old Adamu Musa told journalists.
“My diagnosis was completely accidental. I thought I had an eye infection and had called my optician to cancel my yearly eye test because of it. He insisted I came in, took a look, and told me that it wasn’t an infection… it was burst blood vessels caused by high blood pressure. I called my doctor, had a blood pressure test straight away, and was told that I had hypertension. It turned out that my cholesterol was also very high and the doctor said I could have a heart attack or stroke at any point,” Musa said.
Musa, who is married with six children, further explained: “My doctor prescribed some medications and told me to lose weight, get more active, and eat healthily. In a few months, I’d managed to lose around 5kg through diet and gentle exercise but my blood pressure and cholesterol were still too high. I bought myself a monitor so that I could keep track of what was helping to lower my blood pressure. The answer was exercise. I joined a gym and, five years later, I’ve managed to get my blood pressure and cholesterol levels under control. If I stop exercising. I know that my blood pressure goes up, so I’m determined to carry on so that my medicines can be kept at a low dose.
“The fact that I’m still here and feeling better than before is all thanks to my optician for insisting on that eye test.”
Musa is one of the estimated 70 million Nigerians living with hypertension or rather high/raised blood pressure (BP). He is also one of the 1.3 billion people living with hypertension worldwide, which fewer than one in five have it under control.
Raised blood pressure is either defined as blood pressure at or over 140 mmHg systolic or 90 mmHg diastolic or as receiving drug therapy for raised BP regardless, which are their blood pressure values. Individuals considered to have “high normal” BP are defined as those with a systolic BP between 130-139 mmHg &/or diastolic BP between 80 and 89 mmHg.
Chair, Hypertension Working Group of Nigerian Heart Foundation (NHF), Prof. B.J. C. Onwubere, in his remarks at a Zoom meeting organised by the NCD Alliance Nigeria tagged “Task Shifting and Task Sharing (TSTS) Policy and Basic Health Care Provision Fund (BHCPF) Policy for NCDs: Improving the PHC System in Nigeria” told journalists that high blood pressure is the number one risk factor for Cardiovascular Disease (CVD). In 2019, 10.8 million deaths, or 19 per cent of all deaths worldwide, were attributable to hypertension. More than half were due to CVD.
Executive Director, NHF, Dr. Kingsley Kola Akinroye, told The Guardian: “Hypertension affects more than one billion people worldwide. Often known as ‘the silent killer because it shows no signs or symptoms, it is a major risk factor for several types of CVD.
“Uncontrolled hypertension imposes an enormous economic burden on society. An estimated 10 per cent of global healthcare spending is directly related to hypertension and its complications.”
Akinroye, who is also a cardiologist, however, said hypertension is normally relatively easy to manage through a combination of lifestyle interventions and cost-effective medications, but levels of awareness, treatment, and control remain low in all regions of the world.
To address the menace, the new World Heart Federation (WHF) Roadmap for Hypertension, which builds on the previous 2015 edition, was launched on September 10, 2021. It is an essential guiding document for healthcare professionals, health authorities, and policymakers who want to reduce the global burden of hypertension and save lives. It provides evidence-informed, practical guidance on priority interventions that can be adapted to local contexts.
The WHF Roadmap series covers a large range of cardiovascular conditions. These Roadmaps identify potential roadblocks and their solutions to improve the prevention, detection, and management of cardiovascular diseases and provide a generic global framework available for local adaptation.
According to the document, a key challenge in effective raised blood pressure control is that most hypertensive individuals are usually asymptomatic for years prior to a significant cardiovascular event, but face an increased risk of stroke, heart attacks, and kidney disease. Raised blood pressure is one of the most frequent reasons for consultation in primary care and, left untreated, can lead to a range of complications including myocardial infarction, stroke, heart failure, renal failure, and death. Despite international efforts to control the disease, its prevalence continues to rise, increasing from 600 million in 1980 to 1.3 billion in 2019.
Akinroye added: “This Roadmap focused on the challenges with reference to the demand side (demographic and socio-economic factors, knowledge and beliefs, social relations, norms, and traditions) and the supply side (health systems, resources, and processes) and solutions to them. Therefore, this is a paradigm shift for scientists, policymakers, and implementers. For Africa, a continent with the highest burden of cardiovascular diseases, the prime solutions should be the implementation of opportunistic screening and out-of-office blood pressure measurements at home, marketplaces, shops, barbing centres, pharmacies, patent – medicine stores, faith-based centres, and workplaces amongst others, the strengthening of primary care and a greater focus on task sharing as in Cuba, Colombia, and Malaysia.
“Like the global trend in the last 18 months of COVID -19 pandemic, studies from Nigeria revealed that higher rates of morbidity and mortality rates were from people living with hypertension. Therefore, task sharing for management and control of hypertension should be instituted in our primary health care system.”
He said, in addition, with the recent National Health Act of 2018 that included hypertension as one of the Non-communicable Diseases (NCDs) to be financed with the Basic Healthcare Provision Fund; the Federal Government of Nigeria needs to make it compulsory that all the 36 states and Federal Capital Territory (FCT) implement the policy.
According to Akinroye, it is noteworthy that this current WHF Roadmap for Hypertension defines hypertension as persistent elevation in office/clinic systolic BP≥140 and/or diastolic BP≥ 90 mmHg. This definition, he said, would prevent the significant and unrealistic increase in the number of individuals that may require BP management at the primary level compared to the American College of Cardiology (ACC) and American Heart Association (AHA) definition of hypertension where lower levels are used.
The cardiologist said the need for a call for Task sharing in the management of hypertension in Nigeria is also strengthened by the evidence that hypertension causes over 50 per cent of heart disease, stroke, heart failure cases; over 40 per cent of deaths in people living with diabetes, and a leading risk for fetal and maternal death in pregnancy, dementia, chronic kidney disease, and blindness.
He said recent research has shown that various environmental factors affect BP and hypertension and the latest evidence shows that air pollution especially fine particulate matter≤ 2.5 ug (PM 2.5) contributes highly to the incidence of hypertension in Africa, Asia where PM 2.5 levels are among the highest in the world.
Akinroye said for effective domestication of this Roadmap in Africa; it is recommended that high consideration should be given to the application of the understanding of the culture and health system structure; with responsibility of the government to effectively manage and fund primary health care to scale up interventions, and the need to re-focus CVD/ hypertension programme from specialised secondary care to the primary health care system.
Meanwhile, according to the Global Burden of Disease, ischemic heart disease is one of the biggest causes of morbidity and mortality across the world. Yearly, there are over 18 million deaths due to cardiovascular disease worldwide, of which 9.96 million are attributed to raised blood pressure. Complications of raised blood pressure account for 53 per cent of all heart disease and stroke-related deaths. Blood pressure has a continuous relationship with the incidence of stroke, myocardial infarction, heart failure, peripheral artery disease, and end-stage renal disease.
Trials show that lowering blood pressure reduces the risk of subsequent cardiovascular events, including a 35-40 per cent reduction in the risk of stroke and a 20-25 per cent reduction in the risk of myocardial infarction.
Roadmaps focusing on raised blood pressure, secondary prevention and tobacco control, atrial fibrillation, cholesterol, rheumatic heart disease, CVD and diabetes, heart failure, and Chagas disease, have already been published. Mostly these Roadmaps provide a generic global framework available for local adaptation and are intended to serve as a basis for developing region- or country-specific action plans.
The WHF Roadmaps are aimed to support Goal 3 of the United Nations Sustainable Development Goals (SDGs), ‘Ensure healthy lives and promote well-being for all at all ages, which includes a target of a one-third reduction in premature mortality from non-communicable diseases (NCDs) by 2030.
Meanwhile, researchers say walking 7,000 steps a day can lower the risk of death by 50 per cent to 70 per cent. The study was published in JAMA Network.
Their study matches up with the American Heart Association’s recommendation of 150 minutes of exercise per week.
According to a new study, people who took about 7,000 steps per day had a 50 per cent to 70 per cent lower risk of dying from all causes after 11 years of follow-up when compared with people who took fewer steps each day.
It didn’t seem to matter how quickly they moved, either. The findings also held regardless of factors such as race, income level, smoking, weight, and diet.
Researchers analyzed data from 2,210 participants with an average age of 45 in the 20th year of the examination. More than half (57 percent) of participants were women and 42 percent were Black. There were a significantly greater proportion of women and Black participants in the lowest step group.
Participants in the low step group compared with the moderate and high step volume groups had: higher Body Mass Index (BMI); lower self-rated health; and higher prevalence of stage 2 hypertension and diabetes.
The recommended physical activity guidelines from the American Heart Association (AHA) include:
•Get at least 150 minutes per week of moderate-intensity aerobic activity (such as walking).
•Another alternative is to get 75 minutes per week of vigorous aerobic activity (such as running or uphill hiking, rowing).
•Another alternative (ideally) is a combination of both, spread out over the week.
•Add moderate-intensity to high-intensity, muscle-strengthening activity (such as resistance or weights) on at least two days per week.
•Spend less time sitting. Even light-intensity activity can offset some of the risks of being sedentary.
•Increase your amount and intensity gradually over time.
Meanwhile, although metabolic conditions such as obesity and type 2 diabetes have been linked to an increased risk of COVID-19, as well as an increased risk of experiencing serious symptoms once infected, the impact of diet on these risks is unknown. In a recent study led by researchers at Massachusetts General Hospital (MGH), United States (U.S.), and published in the journal Gut, people whose diets were based on healthy plant-based foods had lower risks on both counts. The beneficial effects of diet on COVID-19 risk seemed especially relevant in individuals living in areas of high socioeconomic deprivation.
“Previous reports suggest that poor nutrition is a common feature among groups disproportionately affected by the pandemic, but data on the association between diet and COVID-19 risk and severity are lacking,” says lead author Dr. Jordi Merino, a research associate at the Diabetes Unit and Center for Genomic Medicine at MGH and an instructor in medicine at Harvard Medical School.
For the study, Merino and his colleagues examined data on 592,571 participants of the smartphone-based COVID-19 Symptom Study. Participants lived in the United Kingdom (U.K.) and the U.S., and they were recruited from March 24, 2020, and followed until December 2, 2020. At the start of the study, participants completed a questionnaire that asked about their dietary habits before the pandemic. Diet quality was assessed using a healthful Plant-BasedDiet Score that emphasises healthy plant foods such as fruits and vegetables.
During follow-up, 31,831 participants developed COVID-19. Compared with individuals in the lowest quartile of the diet score, those in the highest quartile had a nine per cent lower risk of developing COVID-19 and a 41 per cent lower risk of developing severe COVID-19. “These findings were consistent across a range of sensitivity analyses accounting for other healthy behaviors, social determinants of health, and community virus transmission rates,” says Merino.
“Although we cannot emphasize enough the importance of getting vaccinated and wearing a mask in crowded indoor settings, our study suggests that individuals can also potentially reduce their risk of getting COVID-19 or having poor outcomes by paying attention to their diet,” says co-senior author Andrew Chan, MD, MPH, a gastroenterologist and chief of the Clinical and Translational Epidemiology Unit at MGH.
The researchers also found a synergistic relationship between poor diet and increased socioeconomic deprivation with COVID-19 risk that was higher than the sum of the risk associated with each factor alone.
“Our models estimate that nearly a third of COVID-19 cases would have been prevented if one of two exposures — diet or deprivation — were not present,” says Merino.
The results also suggest that public health strategies that improve access to healthy foods and address social determinants of health may help to reduce the burden of the COVID-19 pandemic.
“Our findings are a call to governments and stakeholders to prioritize healthy diets and wellbeing with impactful policies, otherwise we risk losing decades of economic progress and a substantial increase in health disparities,” says Merino.
Also, new findings using daily step count analysis show that regular physical activity in middle-aged adults reduces the chances of mortality associated with cardiovascular disease.
Physical activity provides health benefits for many conditions such as cardiovascular disease, diabetes, and several cancers, and generally improves the quality of life of individuals. As such, regular exercise is one of the most important behaviors to improve or maintain individual health.
To examine how physical activity affects various health conditions, researchers have used a variety of metrics to quantify daily activity, including the number of daily steps taken by people. However, studies have only recently considered using this metric with clinical endpoints, such as mortality, to determine the efficacy of the metric itself.
In a new study published in the JAMA Network by American researchers led by Dr. Amanda Paluch from the Institute for Applied Life Sciences at the Department of Kinesiology from the University of Massachusetts, scientists were able to establish a clear linkage between daily step count and mortality.
All-cause mortality was examined from a prospective cohort study part of the Coronary Artery Risk Development in Young Adults (CARDIA) study, with individuals aging between 38 and 50 years old. Data was collected from Black and White men and women between 2005 and 2006 with the help of an accelerometer.
This provided information on daily step volume, intensity, and time spent active. Participants were classified as having low step volume (<7000 steps/d), moderate (7000-9999 steps/d), and high (>10 000 steps/d) with peak 30-minute stepping rate counting as stepping intensity and time spent at 100 steps/min or more as active time.
A range of covariates was included to avoid the interference of confounding factors. This included characteristics of age, race, education, smoking history and alcohol consumption, BMI, and dietary habits. This information was self-declared by participants, who also declared their health status as poor, fair, good, very good, or excellent.
Researchers analysed the data using a series of regression models corrected for the various covariate factors. Each model included a subset of covariates to account for differences in step volume, intensity, and activity, with non-significant interactive effects being set aside gradually.
Importantly, a sensitivity analysis was also conducted to account for deaths during data collection, with 72 of the 2110 participants dying over the study period.
The analysis showed that, relative to the low step group, groups with moderate to high step rates had a reduced risk of mortality in Black and White participants as well as among both men and women.
Comparing covariate groups, researchers found Black and female participants took fewer steps than White and male participants respectively. However, step intensity was not associated with mortality as step volume was the significant metric involved.
The associations of step count with mortality but not step intensity aligned with previous findings that used the same accelerometer on another cohort of over 6000 participants, as well as studies from Norway that considered step count as a proxy for physical activity.
The lack of ethnic and socioeconomic diversity among studies of this type remains to be resolved, as data remains lacking on the high-risk group. This is of particular concern as the lowest step group had the highest rates of cardiovascular disease, hypertension, and diabetes, and was associated with minority groups.
The study had several strengths including long-term follow-up data collection. Nonetheless, it remains an observational study. Moreover, the range of covariates and confounding factors may induce indirect effects difficult to incorporate into the analysis, as health conditions often overlap with physical activity.
Future studies based on these findings could include a further breakdown of the differential factors affecting step volume, and determine why step intensity may not be as important. Including further diversity into cohorts is also key as insight is lacking on high-risk groups that may not have the support needed.
Meanwhile, an avocado a day could help redistribute belly fat in women toward a healthier profile, according to a new study from the University of Illinois Urbana-Champaign and collaborators.
One hundred and five adults with overweight and obesity participated in a randomized controlled trial that provided one meal a day for 12 weeks. Women who consumed avocado as part of their daily meals had a reduction in deeper visceral abdominal fat.
Led by Naiman Khan, an Illinois professor of kinesiology and community health, the researchers published their study, funded by the Hass Avocado Board, in the Journal of Nutrition.
“The goal wasn’t weight loss; we were interested in understanding what eating an avocado does to the way individuals store their body fat. The location of fat in the body plays an important role in health,” Khan said.
“In the abdomen, there are two kinds of fat: fat that accumulates right underneath the skin, called subcutaneous fat, and fat that accumulates deeper in the abdomen, known as visceral fat, that surrounds the internal organs. Individuals with a higher proportion of that deeper visceral fat tend to be at a higher risk of developing diabetes. So we were interested in determining whether the ratio of subcutaneous to visceral fat changed with avocado consumption,” he said.
The participants were divided into two groups. One group received meals that incorporated a fresh avocado, while the other group received a meal that had nearly identical ingredients and similar calories but did not contain avocado.
At the beginning and end of the 12 weeks, the researchers measured participants’ abdominal fat and their glucose tolerance, a measure of metabolism, and a marker of diabetes.
Female participants who consumed an avocado a day as part of their meal had a reduction in visceral abdominal fat — the hard-to-target fat associated with higher risk — and experienced a reduction in the ratio of visceral fat to subcutaneous fat, indicating a redistribution of fat away from the organs. However, fat distribution in males did not change, and neither males nor females had improvements in glucose tolerance.
“While daily consumption of avocados did not change glucose tolerance, what we learned is that a dietary pattern that includes an avocado every day impacted the way individuals store body fat in a beneficial manner for their health, but the benefits were primarily in females,” Khan said. “It’s important to demonstrate that dietary interventions can modulate fat distribution. Learning that the benefits were only evident in females tells us a little bit about the potential for sex playing a role in dietary intervention responses.”
The researchers said they hope to conduct a follow-up study that would provide participants with all their daily meals and look at additional markers of gut health and physical health to get a more complete picture of the metabolic effects of avocado consumption and determine whether the difference remains between the two sexes.
“Our research not only sheds a valuable light on benefits of daily avocado consumption on the different types of fat distribution across genders, but it also provides us with a foundation to conduct further work to understand the full impact avocados have on body fat and health,” said study coauthor Richard Mackenzie, a professor of human metabolism at the University of Roehampton in London.
“By taking our research further, we will be able to gain a clearer picture into which types of people would benefit most from incorporating avocados into their diets and deliver valuable data for health care advisers to provide patients with guidance on how to reduce fat storage and the potential dangers of diabetes,” Mackenzie said.
Also, eating more nutritious, plant-based foods is heart-healthy at any age, according to two research studies published today in the Journal of the American Heart Association, an open-access journal of the American Heart Association.
In two separate studies analyzing different measures of healthy plant food consumption, researchers found that both young adults and postmenopausal women had fewer heart attacks and were less likely to develop the cardiovascular disease when they ate more healthy plant foods.
The American Heart Association Diet and Lifestyle Recommendations suggest an overall healthy dietary pattern that emphasizes a variety of fruits and vegetables, whole grains, low-fat dairy products, skinless poultry and fish, nuts and legumes, and non-tropical vegetable oils. It also advises limited consumption of saturated fat, trans fat, sodium, red meat, sweets, and sugary drinks.
One study, titled “A Plant-Centered Diet and Risk of Incident Cardiovascular Disease during Young to Middle Adulthood,” evaluated whether long-term consumption of a plant-centered diet and a shift toward a plant-centered diet starting in young adulthood is associated with a lower risk of cardiovascular disease in midlife.