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HYPERTENSION PREVALENCE IN NIGERIA

 

CHAPTER ONE

 INTRODUCTION

 

1.1.  Background of the Study

Blood pressure (BP), sometimes called arterial blood pressure is the pressure exerted by blood in circulation on the walls of blood vessels. Blood pressure is one of the principal vital signs. When addressed without added specification “blood pressure” refers to the arterial pressure of the systemic circulation. During every heartbeat, blood pressure varies between maximum (systolic) and minimum (diastolic) pressures. (Caro, 1978) The blood pressure in the circulation is principally due to the pumping action of the heart. (Klabunde, 2005) Differences in mean blood pressure are responsible for blood flow from one location to another in the circulation. The rate of blood flow depends immensely on the resistance to flow presented by the blood vessels. Average blood pressure decreases as the circulating blood flows away from the heart through arteries and capillaries due to losses of energy to viscosity. Average or mean blood pressure reduces over the whole circulation, although most of the drop occurs along the small arteries and arterioles. (American Heart Association 2011) Gravity affects blood pressure via hydrostatic forces (e.g., during standing), breathing, valves in veins, pumping from contraction of skeletal muscles also influence blood pressure in veins. (Klabunde 2005)

Blood pressure without further specification usually refers to the systemic arterial pressure measured at a person’s upper arm and is a measure of the pressure in the brachial artery, the major artery in the upper arm. In humans blood pressure is normally expressed in terms of the systolic pressure over diastolic pressure and is measured in millimetres of mercury (mmHg), for example 120/80.

Blood pressure varies in healthy people as well as animals, but the variation is controlled by the nervous and endocrine systems. When blood pressure is pathologically low it is called hypotension, and when it is pathologically high is hypertension. The two have various causes and range from mild to severe.

           Hypertension (HTN) or high blood pressure (High BP) sometimes referred to as arterial hypertension is a medical condition in which the blood pressure in the arteries is increased. Blood pressure is read by two measurements, namely, systolic and diastolic, they depend on whether the heart muscle is contracting (systole) or relaxed between beats (diastole). This equals the maximum and minimum pressure respectively. Normally, blood pressure at rest is between the range of 100-140mmHg systolic (top reading) and 60-90mmHg diastolic (bottom reading). The blood pressure is high when it is often at or above 140/90 mmHg.

Hypertension is classified as either primary (essential) hypertension or secondary hypertension; about 90–95% of cases are categorized as “primary hypertension” which means high blood pressure with no obvious underlying medical cause. (Agarwal et al.,2008) The remaining 5–10% of cases (secondary hypertension) are caused by other conditions that distress the arteries, kidneys, heart or endocrine system.

Hypertension strains the heart, causing hypertensive heart disease and also coronary artery disease if untreated. Hypertension also is a major risk factor for stroke, aneurysms of the arteries (e.g. aortic aneurysm), peripheral arterial disease and is a cause of chronic kidney disease. A reasonably high arterial blood pressure is linked to a shortened life expectancy while mild elevation isn’t. However, dietary and lifestyle adjustments can enhance BP control and decrease the risk of health problems, although drug treatment is still frequently necessary in people for whom lifestyle changes are not sufficient or not effective.

The relationship between blood pressure and risk of cardiovascular diseases events is continuous and consistent as well as independent of any other risk factors. Therefore, the higher the Blood Pressure, the greater the likelihood of heart attack, failure of the heart, kidney diseases, and stroke (Chobanian et al.,2003). The burden of non-communicable diseases (NCDs) such as hypertension is increasing in epidemic proportions in Africa. According to the World Health Report 2001, NCDs accounted for 22% of the total deaths in the region in the year 2000; cardiovascular diseases alone accounted for 9.2% of the total deaths, killing even more than malaria. (World Health Report , 2002). Major target-organ complications of hypertension, such as left ventricular hypertrophy (Opadijo et al.,2003), diastolic dysfunction, congestive heart failure, ischemic heart disease, stroke (Osuntokun et al.,1979), and renal failure (Akinkugbe, 1992) have been established by various researchers in Nigeria.

Reducing the prevalence of hypertension would decrease mortality and disability in middle-aged and older persons and lead to a better quality of life. Reduction of hypertension prevalence could be achieved through risk factor prevention programmes as well as using low-cost management. However, in most countries of the African region, implementation of these approaches and programmes is hampered by dearth of data on the prevalence and control levels of hypertension. Scarcity of data is sometimes understood as non-existence of the problem (Chobanian et al.,2003).. There is paucity of hypertension prevalence in many populations of Nigeria. Thus, burden of hypertension in these populations might be underestimated and might leave the illness undiagnosed and untreated. Uncontrolled hypertension clearly places a substantial strain on health care delivery system. Estimating the prevalence of hypertension in populations of Nigeria would be useful in efforts to control hypertension and other NCDs.

1.2 AIM AND OBJECTIVES

The aim and objectives of this research projects include the following:

  1. To determine the level of blood pressure among different age range of people in Izzi local government area, Ebonyi state.
  2. To investigate and evaluate the tendency and prevalence of hypertension in Izzi local government area (LGA), Ebonyi state.

To contribute and assist in health policy formulation and implementation vis-à-vis hypertension and blood pressure for the government, NGO and corporate bodies

CHAPTER TWO

LITERATURE REVIEW

Blood pressure is created by the force of blood pushing against the walls of blood vessels (arteries) as it is pumped by the heart. Hypertension, also known as high or raised blood pressure, is a condition in which the blood vessels have persistently raised pressure. The higher the pressure in blood vessels the harder the heart has to work in order to pump blood. If left uncontrolled, hypertension can lead to a heart attack, enlargement of the heart and eventually heart failure. Hypertension can also lead to stroke, kidney failure and blindness (World Health Organization, 2013).

2.1. Systemic arterial blood pressure

2.1.1. Classification

Classification of blood pressure for adults
Category systolic, mmHg diastolic, mmHg
Hypotension < 90 < 60
Desired 90–119 60–79
Prehypertension 120–139 80–89
Stage 1 Hypertension 140–159 90–99
Stage 2 Hypertension 160–179 100–109
Hypertensive Emergency ≥ 180 ≥ 110
Source: American Heart Association, 2007

The table on the right shows the classification of blood pressure adopted by the American Heart Association for adults who are 18 years and older. (Mayo Foundation for Medical Education and Research 2010) It assumes the values are a result of averaging blood pressure readings measured at two or more visits to the doctor. (Chobanian et al.,2003; National Heart Lung and Blood Institute 2008)

In the UK, blood pressures are usually categorised into three groups; low (90/60 or lower), normal (values above 90/60 and below 130/80), and high (140/90 or higher). (Pesola et al 2001)

2.1.2. Normal range of blood pressure

While average values for arterial pressure could be computed for a given population, there is often a large variation from person to person; arterial pressure also varies in individuals from moment to moment. Additionally, the average of any given population may have a questionable correlation with its general health; thus the relevance of such average values is equally questionable. However, in a study of 100 human subjects with no known history of hypertension, an average blood pressure of 120/80 mmHg was found, (Pesola et al 2001) which are currently classified as desirable or “normal” values. Normal values fluctuate through the 24-hour cycle, with highest readings in the afternoons and lowest readings at night. (Van Berge-Landry et al., 2008) Various factors, such as age and sex, influence a person’s average blood pressure and variations in it. In children, the normal ranges are lower than for adults and depend on height. (National Heart, Lung and Blood Institute 2003) As adults age, systolic pressure tends to rise and diastolic tends to fall. (Pickering et al. 2005) In the elderly, blood pressure tends to be above the normal adult range,( Eguchi et al., 2007) largely because of reduced flexibility of the arteries. Also, an individual’s blood pressure varies with exercise, emotional reactions, sleep, digestion, time of day and circadian rhythm.

Differences between left and right arm blood pressure measurements tend to be random and average to nearly zero if enough measurements are taken. However, in a small percentage of cases there is a consistent difference greater than 10 mmHg which may need further investigation, e.g. for obstructive arterial disease.( Agarwal et al2008; Appel et al 2006)

The risk of cardiovascular disease increases progressively above 115/75 mmHg. (Fries 1976) In the past, hypertension was only diagnosed if secondary signs of high arterial pressure were present, along with a prolonged high systolic pressure reading over several visits. Regarding hypotension, in practice blood pressure is considered too low only if noticeable symptoms are present.(Chobanian et al., 2003)

Clinical trials demonstrate that people who maintain arterial pressures at the low end of these pressure ranges have much better long term cardiovascular health. The principal medical debate concerns the aggressiveness and relative value of methods used to lower pressures into this range for those who do not maintain such pressure on their own. Elevations, more commonly seen in older people, though often considered normal, are associated with increased morbidity and mortality.

Reference ranges for blood pressure in children
Stage Approximate age Systolic Diastolic
Infants 1 to 12 months 75–100 50–70
Toddlers and preschoolers 1 to 5 years 80–110 50–80
School age 6 to 12 years 85–120 50–80
Adolescents 13 to 18 years 95–140 60–90

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