The Prevalence Of Hypertension Among The Nigeria Population

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CHAPTER ONE

INTRODUCTION

Hypertension (HTN or HT), also known as high blood pressure (HBP) is a long term medical condition in which the blood pressure in the arteries persistently elevated. The term hypertension is used to describe blood pressure that is sustained at a higher than the generally  accepted level.

The normal maximum level for a particular age group varies from the others for example at 20 years the blood pressure is usually between 120/80mmHg and 140/90mmHg, at 50years, it is 160/95mmHg while at 75 years it could be as high as 170/105mmHg (Rose and Wilson, 2012).

Hypertension is define as a sustained elevation in the blood pressure of an individual above levels considered normal for the individuals age, sex, race, body, size etc. This definition implies that there has to be a reference value for an individual which is set arbitrary based on the above mentioned biosocial indices, in other words there are various research groups and which became adopted by the World Health Organisation (WHO).

According to Rose and Wilson (2012), Hypertension  can also be referred to as the persistently high blood pressure in adults, it is generally accepted that a blood is abnormally high when the resting supine attend systolic pressure is equal to or greater than 140mmHg and diastolic pressure equal to or greater than 90mmHg.

The American Heart Association (AHA 2005) graded hypertension as follows:

1. Normal blood pressure: Systolic blood pressure <120mmHg and diastolic blood pressure of <80mmHg.
2. High normal blood pressure: Systolic blood pressure 130mmHg – 139mmHg and diastolic blood pressure of 85mmHg-90mmHg.
3. Grade 1 (Mild hypertensoin): Systolic blood pressure 140mmHg – 150mmHg and diastolic blood pressure of 90mmHg – 99mmHg.
4. Grade 2 (Moderate hypertension): Systolic blood pressure 160mmHg – 175mmHg and diastolic blood pressure of 100mmHg – 109mmHg.
5. Grade 3 (Severe hypertension): Systolic blood pressure ≥180mmHg and diastolic blood pressure of ≥ 110mmHg. Awareness of hypertension refers to having been informed of once’s hypertensive status by a health professional.

BACKGROUND OF THE STUDY

Hypertension is one of the most common worldwide diseases affecting humans and is a major risk factor for stroke and mainly other heart problems diseases.

The prevalence of hypertension is higher among minorities than whites, and it increases with age in all groups. There is increased morbidity and mortality associated with the following cardiovascular complications of hypertension.

1. Aortic dissection
2. Congestive heart failure
3. Coronary artery disease with associated angina pectoris and myocardial infarction
4. Left ventricular hypertrophy
5. Peripheral vascular disease
6. Renal insufficiency
7. Stroke secondary to cerebal hermorrhage or thromboses

Traditionally in Africa, communicable diseases and maternal, perinatal and nutritional causes have accounted for the greatest burden of disease, whereas high blood pressure was almost non-existent in African societies in the first half of the twentieth century, estimates now show that in some settings in Africa more than 40 percent epidermiological date suggest that this figure will rise to 150 million by 2025.

According to the American Heart Association (AHA) approximately 86 millions adult (34%) in the united states are affected by hypertension. The proportions of the global burden of disease attributable to hypertension has significantly increased from about 4.5 percent (nearly 1 billion adults) in 2000 to 7 percent in (2010). This makes hypertension the single most important cause of morbidity and mortality globally and highlight the urgent need of action to address the problem (AHA 2010).

However the biggest problem for controlling hypertension is compliance with treatment. Despite very effective and cost effective treatment, target blood pressures levels are very rarely reached, even in countries where cost of medication is not an issue.

Hypertension is high blood pressure. Blood pressure is the force of blood pushing against the walls of arteries as it flows through them. Arteries are the blood vessels that carry oxygenated blood from the heart to the body’s tissues.

As blood flows through arteries, it pushes against the inside of the artery walls. The more pressure the blood exerts on the artery walls. The higher the blood pressure will be the size of small arteries also effects the blood pressure. When the muscular walls of arteries are relaxed, or dilated, the pressure of the blood flowing through them is lower than when the artery walls narrow or constrict.

Blood pressure is highest when the heart beats to push blood out into the arteries. When the heart relaxes to fill with blood again, the pressure is at its lowest point. Blood pressure when the heart beats is called systolic pressure and blood pressure when the heart is at rest is called diastolic pressure when the blood pressure is measured the systolic pressure is stated first and the diastolic pressure second.

Blood pressure is measured in millimeters of mercury (mmHg). For example, if a person’s systolic pressure is 120 and diastolic pressure is 80, it is written as 120/80mmHg. The American heart association (AHA), has long considered blood pressure less than 140 over 90 normal for adult.

However, the National Heart, Lung and Blood Institute in Bethesda, Maryland released new clinical guidelines for blood pressure in (2003), lowering the standard normal readings. A normal reading was lowered to less than 120 over less than 80 (MC Namara and Damian, 2006).

1.2 CLASSIFICATION OF HYPERTENSION

Hypertension can be classify into major and minor, the major types of hypertension are classify into two categories namely: Primary (essential) hypertension and secondary hypertension. While the minor are resistant hypertension, isolated, pulmonary etc.         

MAJOR TYPES OF HYPERTENSION (HIGH BLOOD PRESSURE)

PRIMARY (Essential) HYPERTENSION:

The Primary hypertension is the most common type of hypertension, for this type of hypertension, there is no single identifiable cause, there is no apparent underlying disease, condition or disorder causing the high blood pressure, instead, hypertension occurs because of genes, diet and lifestyle.

Primary hypertension is the most common type of hypertension, affecting 95% of hypertensive patients, it tend to be familial and is likely to be the consequence of an interaction between environmental and genetic factors, prevalence of essential hypertension increase with age, and individuals with relatively high blood pressure at younger ages are at increased risk for the subsequent development of hypertension, hypertension can increase the risk of cerebral, cardiac, and renal events.

SECONDARY HYPERTENSION:

Secondary hypertension is a less common form of the disease that occurs because of a specific condition. Disorders including sleep apnea, tumours and kidney failure can all cause hypertension to occur as a side effect.

Secondary hypertension affect only 5% of hypertensive patients, it has many different causes including:  chronic kidney disease, sleep openea, tumors or other disease of the adrenal gland, coarctation of the aorta. A narrowing of the aorta that you are born with that can cause high blood pressure in the arms, pregnancy, use of birth control pills, Alcohol addiction, thyroid dysfunction.

MINOR TYPES OF HYPERTENSION (HIGH BLOOD PRESSURE)

Malignant Hypertension: is high blood pressure that occurs suddenly and drastically. A person might experience numbness in the body as well as vision problems, extreme fatigue, confusion, anxiety and seizures.

There are various disease which may cause this condition  including sclerodema, kidney disease, spinal cord injuries, tumour of adrenal gland, use of illegal drugs like cocaine, and the use of certain medications like birth control pills, when the underlying condition is cured, the blood pressure goes back to normal.

Isolated Systolic Hypertension: does not have an identifiable cause, this type of hypertension is a result of old age and a poor diet. The arteries become stiff, resulting in a high systolic number with a normal diastolic number.

White Coat Hypertension: occurs only when a person’s blood pressure is taken in a clinical setting, outside of a doctor’s office, blood pressure is normal, it is believed that visit a clinic or doctor’s office

Resistant Hypertension: is called such when three medications fail to successfully treat the condition

Pulmonary Hypertension: some forms of pulmonary hypertension are serious conditions that progressively become worse and are not curable, treatment can help and improve the quality of life.

Pseudo-Hypertension: This type of blood pressure usually appears in senior citizens. Non-compensability, and other’s sign of pseudo hypertension is a falsely elevated blood pressure reading obtained by the blood pressure machine. This is due to calcification of the blood vessels which cannot be compressed.  

CAUSES OF HYPERTENSION (HIGH BLOOD PRESSURE)

The exact causes of high blood pressure are not known, but several factors and conditions may play a role in its development including:

Smoking

Being overweight or obese

Lack of physical activity

Too much salt in the diet

Too much alcohol consumption (more than 1 to 2 drinks per day)

Genetics

Stress

Older age

Family history of high blood pressure

Chronic kidney disease

Adrenal and thyroid disorders

Sleep apnea

 

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