Again, in the study of the Department of Internal Medicine in Nursing, Medical University, Lublin, Poland, the classification of blood pressure used in the 2007 ESH/ESC Guidelines comprises categories of optimal (systolic blood pressure less than 120 mmHg and diastolic blood pressure less than 80 mmHg), normal (systolic blood pressure 120-129 mmHg and/or diastolic blood pressure 80-84 mmHg), and high-normal (systolic blood pressure 130139 mmHg and/or diastolic blood pressure 85-89 mmHg) blood pressure, followed by 3 grades of hypertension, and a separate category for isolated systolic hypertension.
Isolated systolic hypertension (systolic blood pressure 140 mmHg or higher), is graded as 1, 2, or 3, according to the systolic blood pressure level, provided that the diastolic blood pressure is less than 90 mmHg. When systolic and diastolic blood pressure falls into different categories, the highest category is used in assessing total cardiovascular risk.
Environmental factors, such as sedentary lifestyle, stress, smoking, obesity, salt (sodium) sensitivity and alcohol intake, also are significant. The aforementioned factors, for example, increased salt intake and obesity, have long been known culprits. These factors alone are probably not sufficient to raise blood pressure to abnormal levels but are synergistic with a genetic predisposition.
Talking about the complications of hypertension, the figures relating to hypertension are simply staggering. In 2008, worldwide, an estimated 40% of adults aged 25 or above had been diagnosed with hypertension, with the number of cases rising from 600 million in 1980 to 1 billion in 2008, almost 15% of the entire world’s population. By 2025, it is estimated over 1.5 billion people will have hypertension.
Now, hypertension is often called ‘the silent killer’ because it is a disease that shows no early symptoms, and simultaneously, is the single most significant risk factor for heart disease: myocardial infarction, left ventricular hypertrophy, congestive heart failure, aneurysm, stroke, etc. According to WHO, complications of hypertension are thought to cause 9.4 million deaths each year more than all the deaths from infectious diseases combined.
Symptoms that can be associated with hypertension include headache, shortness of breath, chest pain, dizziness and nose bleeds, are very generic and cannot necessarily be relied upon to diagnose hypertension and so also go unnoticed. Often hypertension fails to be picked up until a serious medical problem occurs because the patient is asymptomatic and therefore does not consult a healthcare professional early on.
By then, it can be too late, hypertension can permanently damage eyes, lungs, the heart or kidneys, and of those with malignant, or highly elevated blood pressure, fewer than 10% will survive beyond 1-2 years.
Also, a 2009 study on ‘The global cost of non-optimal blood pressure” relayed that once hypertension causes complications, treating these complications entails costly interventions such as cardiac bypass surgery, carotid artery surgery and dialysis, all of which drain individual and government budgets. An estimated 10% of health care spending is directly related to increased blood pressure and its complications, increasing to as much as 25% of health care spending in Eastern Europe and Central Asia.
The African region has the highest prevalence of hypertension among adults aged over 25, implying a massive economic burden for the continent, including the cost of caring for all the complications arising from hypertension such as cerebrovascular disease, ischemic heart disease and congestive heart failure as well as indirect costs such as the lost productivity of workers struck by stroke, heart failure, and ischemic heart disease.
Other costs include the lost savings and assets that are foregone when families must meet catastrophic healthcare expenditures, such as those associated with rehabilitation following stroke, or dialysis following renal failure.
Again, WHO recorded that the prevalence of hypertension varies across the WHO regions and country income groups. The WHO African Region has the highest prevalence of hypertension (27%) while the WHO Region of the Americas has the lowest prevalence of hypertension (18%). A review of current trends shows that the number of adults with hypertension increased from 594 million in 1975 to 1.13 billion in 2015, with the increase seen largely in low- and middle-income countries. This increase is due mainly to a rise in hypertension risk factors in those populations.
Howbeit, the book “HYPERTENSION: PUTTING THE PRESSURE ON THE SILENT KILLER” relayed how hypertension can be curtailed, saying that If hypertension is diagnosed early and appropriately treated, it is possible to minimize the risk of heart attack, heart failure, stroke and kidney failure. Prompt management of high blood pressure can also reduce the risk of other complications such as retinopathy, a disease of the retina which results in vision loss and impairment.
Unlike with the diagnosis of other non-communicable diseases such as diabetes, detecting high blood pressure is relatively straightforward, cost-effective and feasible in low-resource settings, as well as something which all adults can do themselves, particularly where measurement devices are affordable and accessible. There are three types of devices that can be used to measure blood pressure: mercury, aneroid and electronic.
WHO recommends the use of affordable and reliable electronic devices that have the option to select manual readings. In resource-constrained settings where batteries run down quite frequently, semi-automatic devices are valuable as they enable manual readings. Given that mercury is toxic, it has been recommended that they be phased out in favour of electronic devices. As for aneroid devices such as sphygmomanometers, these are recommended for use only if calibrated every six months and used by those who have been trained and assessed in how to measure blood pressure with such a device.
In fighting hypertension, In 2016, WHO and the United States Centers for Disease Control and Prevention launched the Global Hearts Initiative to support governments to prevent and treat cardiovascular diseases. Of the five technical packages that comprise the Global Hearts Initiative, the HEARTS technical package aims to improve the prevention and management of cardiovascular diseases, including hypertension detection and management.
The five modules of the HEARTS technical package (Healthy-lifestyle counselling, Evidence-based treatment protocols, Access to essential medicines and technology, Team-based care, and Systems for monitoring) provide a strategic approach to improve cardiovascular health in countries across the globe. Fifteen countries have started implementing the HEARTS technical package (Barbados, Bhutan, Colombia, Chile, China, Cuba, Ethiopia, India, Iran, Morocco, Nepal, Philippines, Tajikistan, Thailand, and Viet Nam). By scaling up protocol-based management, improving access to medicines and technologies, and better measuring outcomes, successes are already being achieved.
In conclusion, it’s good to remind you that hypertension is a serious medical condition that significantly increases the risks of heart, brain, kidney and other diseases. And that, An estimated 1.13 billion people worldwide have hypertension, most (two-thirds) living in low- and middle-income countries. Let’s be cautious!
Ogungbile Emmanuel Oludotun
Qwenu! publishes opinions, stories, reflections, and experiences on contemporary issues. Click here to read articles from many Africans at home and in the diaspora. Embedded tweets and guest articles do not represent the opinions of Qwenu! as we only provide a platform for writers to express themselves. Email your articles to firstname.lastname@example.org Follow us @qwenu_media Featured image: Jair Lázaro@jairlazarofuentes