World Hypertension Day: Pressure, lifestyle increase high BP among Nigerian youths

•Treatment costs N1.22tr monthly for 76.2m Nigerians living with ailment
•Bad economy, insecurity, abuse of hard drugs, alcohol top reasons more young people are developing hypertension
• Spending more time on mobile phone raises risk of having hypertension, new study finds
• Nigeria yet to conduct nationally representative survey on hypertension since 1991/1992
• NHF seeks support for the Primary Healthcare system to integrate control of hypertension with other diseases
• Cardiologists recommend low salt diet, regular tolerable exercises, screening
• Coalition urges FG to increase sugar tax from N10 to N30

As Nigeria joins the rest of the world to mark World Hypertension Day (WHD) today, recent figures suggest that more than 76.2 million Nigerians are living with hypertension and many more are expected to develop the disease, alongside its complications of stroke, kidney damage, heart attack, erectile dysfunction, and ultimately sudden death if the condition is not properly treated.

According to the Nigerian Heart Foundation (NHF), the prevalence of hypertension is about 38.1 per cent. Indeed, 38.1 per cent of the estimated population of 200 million Nigerians shows that 76.2 million citizens are hypertensive.

Interestingly, it is indicated that more than 50 per cent of these hypertensive Nigerians are youths between the ages of 20 and 50 years. Furthermore, the monthly care cost of hypertension is ₦N15,964.76 ($44.35), according to the Nigerian Medical Association (NMA).

This means that not less than N1.22 trillion is spent monthly to care for 76.2 million Nigerians living with high blood pressure/hypertension.

Also, recent studies indicate that more young people are developing hypertension, which is supposed to be a disease of adulthood. A recent study in Britain revealed that young adults in generally good health make up the group most likely to be suffering from undiagnosed hypertension, which could be fatal as untreated hypertension is said to be deadly.

The shock report showed that younger males with hypertension are particularly likely to be undiagnosed. 66 per cent of males and 26 per cent of females aged 16 to 24 years, and 55 per cent of males and 44 per cent of females aged 25 to 34 years who had hypertension were undiagnosed, compared with 17 per cent of males and 21 per cent of females aged 75 years and over.

NMA President, Dr. Uche Rowland Ojinmah, told The Guardian that young people in their 20s can develop hypertension if they adopt a lifestyle and dietary habit that predispose to the condition, such as smoking, excessive alcohol, high salt diet, reduced physical activity, excessive weight gain (obesity), high saturated fat content in diet, use of illicit drugs like cocaine, heroine, and having family history of hypertension.

Celebrated every May 17, the theme for WHD 2023 is ‘Measure your blood pressure, Control it, Live Longer.’ It is a day dedicated to highlighting the importance of monitoring blood pressure and bringing global awareness to the one billion people living with high blood pressure worldwide.

High blood pressure, also known as hypertension, is the number risk factor for heart disease, stroke, renal complications, and premature death. Usually, high blood pressure alone does not cause any symptoms. Fortunately, hypertension can be prevented and managed, by checking one’s blood pressure regularly, and through treatment.

Ojinmah said although Nigeria has yet to conduct a nationally representative survey since 1991/1992 to obtain recent Non-Communicable Disease (NCD) risk factor data, a systematic review and meta-analysis of NCDs and their risk factors were carried out in 2018.

Ojinmah said the review estimated the prevalence of hypertension in Nigeria to be 31.2 per cent (men 29.5 per cent, women 31.1 per cent).

“We will need a more recent national study (like the 1997 Non-Communicable Disease Survey of the Federal Ministry of Health) to truly answer this question, and it seems one is in the works now at the Ministry of Health in collaboration with other stakeholders,” he said.

On the controversy surrounding the optimal/healthy blood pressure, the medical doctor said the definition of normal blood pressure depends on the guideline you are using. While Nigerian Hypertension Society (2020), The International Society of Hypertension (2020), and European Society of Hypertension define normal BP as less than 130/85mmHg, the American College of Cardiology (2017) uses less than 120/80mmHg.

Cardiovascular Health Physician and Executive Director, NHF, Dr. Kingsley K. Akinroye, said hypertension was estimated to affect approximately 36 per cent of adults aged 30 – 79 in 2021 in Nigeria, with a higher burden on women 39 per cent.

Akinroye, who is also a past Vice-President of World Heart Federation (WHF) and past President, African Epidemiological Association, said the prevalence continues to increase gradually.

The cardiologist said young people are more prone because of their increasingly gradual exposure to the traditional risk factors of hypertension such as unhealthy diet laden with high salt intake, tobacco overweight, physical inactivity and recently air pollution.

To address the menace, Akinroye recommends: investment in preventive measures by government; support for the Primary Healthcare system to integrate the control of hypertension with other diseases; and support for task shifting to Community Health Extension Worker (CHEWs) and Community Health Officers (CHOs) to empower them in management of hypertension and ensuring all the 36 states pay their counterpart funds to ensure participation in the Basic Health Care Provision Fund (BHCPF) as approved by the current administration.

Former Commissioner for Health in Ondo State, Dr. Dayo Adeyanju, said there has been an increase in the burden of hypertension in Nigeria from 8.2 per cent in 1990 to 32.5 per cent in 2020. He said from the 4.3 million population affected in the 90s, hypertensive patients rose to 27 million in 2020. Adeyanju said the fact that the disease is asymptomatic makes more than 29 per cent to be aware of the disease and 12 per cent on treatment.

“Thus, it leads to complications like stroke, ischemic attack, kidney, and heart failure. This is why it is referred to as a silent killer. However, there is disparity in prevalence across age, gender, rural or urban,” he said.

Adeyanju said there is rising incidence among youths in Nigeria in view of the current economic situation that puts a lot of burden on them. He said the change in diet from the local less cholesterol and high fiber food to foreign food loaded with cholesterol also contributes to the high number. The medical doctor further said because there is also genetic predisposition, it makes routine blood pressure check essential.

He explained: “The management of hypertension without complications is about 1,000 per person per week or an average of 4,000 to 5,000 a month. When complications set in, the cost goes up. It depends on the type of complication, for example cost of managing stroke or heart failure or kidney failure is quite expensive. This usually sets in when there is no early diagnosis or patients who are on treatment go on drug holiday neglecting their treatment. This often led to sudden unexpected death.

“Prevention is said to be better and cheaper than cure. Thus, at each of our primary health care, there must be a routine blood pressure check. One wonders how we wake up in the morning and check tyres and oil in our vehicle and fail to routinely check our body. We must endeavour to do our routine checkup annually.”

However, a non-governmental organisation, National Action on Sugar Reduction (NASR) has urged the Federal Government to increase the taxation on sugar beverages from N10 to N30. A representative of the body, Edozie Chukwuma, made the call during a sit-out in Abuja yesterday to discourage consumption.

The Federal Government in 2021 introduced a Sugar-Sweetened Beverage (SSB) tax embedded in the Finance Act of 2021, which levies a ₦10 tax on each litre of all non-alcoholic and sugar-sweetened carbonated drinks.

“We are basically asking the government, Ministries of Finance and Health to protect the lives of Nigerians. Sugary drinks are very cheap and accessible, but the health implications of consuming these drinks are very deep.

“They actually cannot be taken on by the ordinary man, so our ask is basically that soft drinks are taxed, currently there is a N10 per liter tax on sugary drinks and we are asking that this tax is sustained in the Finance Act of 2023.

“We are asking that it should be increased to N30 per liter. It is recommended by the World Health Organisation that above 20 per cent tax on sugary drinks would see behavioural changes and reduction in consumption. We are also saying that funds generated from taxing sugary drinks should be ploughed back into public health,” Chukwuma said.

The coalition representative said treatment of non-communicable diseases was high and ordinary Nigerians find it difficult to make out of pocket payments for medical bills and medications. He said that if the proceeds of the taxation are ploughed back into the health sector the average man would be able to access proper.

Also speaking at the event, Glory Okwu, Programme Coordinator, Project Pink Blue, said the coalition is pro-health and looked forward to a situation where Nigeria would be free from NCDs.

“We know that increasing taxes on sugar-based beverages is going to reduce consumption and also reduce non communicable diseases in the long run. We are just seeking a way to better the health of Nigerians, especially the poor people who cannot afford to cushion the effect of living with NCDs in Nigeria.

A consultant immunologist and microbiologist at the Department of Medical Microbiology and Immunology, Nile University of Nigeria, Abuja, Prof. Boaz Adegboro, said more people in their 20s are developing hypertension for the following reasons: hard drug abuse, alcoholism, unemployment and underemployment, low wages with sky-rocketing inflation, insecurity in the country, rush for money by all means, and peer pressure.

On how to tackle the problem of hypertension in the country, Adegboro recommends: “Government and employers need to create more jobs; workers should earn a living wage; alcohol and hard drug use must be minimised; sociologists must develop means of Nigerians cultivating more noble social values other than just getting rich; religious organisations must reduce the lust for wealth, and replace it with the fear of God and improved social relationships; and security situation in the country must be improved.

Meanwhile, new research suggests that cell phone usage may be connected to blood pressure levels. The more time a person spends on the phone, the higher the risk of having hypertension. Experts say the findings are interesting but more study is needed.

New research, published this month in the European Heart Journal—Digital Health, suggests a link between cell phone usage and hypertension—commonly known as high blood pressure. The study used data from 212,046 people who were part of the UK Biobank, a commonly used data set in European-focused research.

High blood pressure affects millions and is linked to a host of negative health outcomes including heart failure, heart attack, atrial fibrillation and stroke risk.

More time on the phone linked to increased risk of high blood pressure

The researchers looked at the follow-up data from participants and found a correlation between higher cell phone usage and new cases of high blood pressure. They also looked at factors such as genetic risk for high blood pressure.

Participants were asked questions about their cell phone usage and how much time they spend on the phone making or receiving calls.

The researchers found more time on the phone every week was linked to increased risk of high blood pressure. People spending the most time on the phone or over six hours a week had about a 25 per cent increased risk of high blood pressure.

Medical Director, Optimal Specialist Hospitals, Gbaja, Surulere, Lagos State, Dr. Celestine Chukwunenye, said there has been a noticeable rise in the percentage of people living with hypertension worldwide as well as a rise in the percentage of severe and complicated cases.

He said the rise is due to worsening socio-economic and political conditions in the country, lack of exercise, poor dietary habits, increase in cholesterol levels, smoking, excessive alcohol consumption and inadequate night sleep.

He said with the outbreak of COVID-19, people living with hypertension and other co-morbidities were at greater risk of severe illness and death. Fortunately, cases of COVID-19 are now in decline.