Hypertension

Hypertension, commonly known as high blood pressure, is a chronic condition in which the force of blood against artery walls is consistently too high. It is one of the most common and dangerous non-communicable diseases in Nigeria, affecting an estimated one in three adults. Often called the "silent killer," hypertension typically produces no noticeable symptoms for years while silently damaging blood vessels, the heart, kidneys, and brain. Left uncontrolled, it is a leading cause of stroke, heart attack, heart failure, and kidney disease.

Hypertension is usually symptom-free, which is why it often goes undetected for years. When symptoms do occur — usually in severe or long-standing cases — they may include: • Persistent headaches, especially at the back of the head in the morning • Dizziness or lightheadedness • Blurred or double vision • Shortness of breath • Chest pain or tightness • Nosebleeds • Pounding or irregular heartbeat (palpitations) • Fatigue Important: The absence of symptoms does not mean blood pressure is normal. The only reliable way to know your blood pressure is to have it measured.

Blood pressure is determined by the amount of blood the heart pumps and the resistance in the arteries. The higher the volume of blood pumped and the narrower the arteries, the higher the blood pressure. Primary (essential) hypertension accounts for about 90–95% of cases and has no single identifiable cause. It develops gradually over many years due to a combination of genetic and lifestyle factors. Secondary hypertension has an identifiable underlying condition, including: • Chronic kidney disease • Hormonal disorders (e.g., hyperaldosteronism, thyroid disease, phaeochromocytoma) • Obstructive sleep apnoea • Certain medications (e.g., oral contraceptives, NSAIDs, decongestants, stimulants) • Narrowing of the aorta (coarctation) Treating the underlying condition can resolve or improve secondary hypertension.

Non-modifiable risk factors: • Age: risk increases significantly after age 40 • Family history of hypertension or cardiovascular disease • African ethnicity: hypertension is more common and tends to be more severe in Black Africans Modifiable risk factors (things you can change): • Excess salt (sodium) intake: very common in Nigerian diets • Being overweight or obese • Physical inactivity • Heavy alcohol consumption • Smoking and tobacco use • Chronic stress • Low potassium intake (inadequate fruits and vegetables) • Poorly controlled diabetes Medications and substances: • Long-term use of NSAIDs (e.g., ibuprofen, diclofenac) • Oral contraceptive pills (especially in older women who smoke) • Herbal and traditional medicine preparations (some contain substances that raise blood pressure)

Uncontrolled hypertension is the leading preventable cause of premature death and disability in Nigeria. It damages blood vessels throughout the body and leads to: • Stroke: the most common and devastating complication; hypertension greatly raises risk of both ischaemic and haemorrhagic stroke • Heart attack (myocardial infarction) • Heart failure: the heart is overworked and eventually weakens • Chronic kidney disease and kidney failure (hypertensive nephropathy) • Retinal damage and vision loss (hypertensive retinopathy) • Peripheral artery disease • Hypertensive emergency: a sudden, severe rise in blood pressure that can cause organ damage within hours • Aneurysm: bulging and rupture of blood vessel walls • Vascular dementia

Lifestyle measures that can prevent or significantly reduce high blood pressure: Diet: • Reduce salt intake to less than 5 grams (1 teaspoon) per day: limit processed foods, seasonings, and stock cubes high in sodium • Eat plenty of fruits, vegetables, and whole grains (DASH diet approach) • Limit saturated fats and red meat • Reduce or eliminate alcohol consumption Physical activity: • Aim for at least 150 minutes of moderate exercise per week (brisk walking, cycling, swimming) Weight management: • Achieve and maintain a healthy body weight Other measures: • Quit smoking • Manage stress through relaxation, adequate sleep, and social support • Monitor blood pressure regularly at home or at a pharmacy For those already diagnosed with hypertension, taking antihypertensive medication consistently as prescribed — even when feeling well — is the most important step in preventing complications.