Hypertension is one of the major cardiovascular disease risk factors worldwide. It is characterised by an increased pressure exerted by blood on the walls of the arteries. Its prevalence has been rapidly increasing despite advancing information on the preventative measures against the disease, with about 28.3% Ghanaians of all ages affected.
It has been nicknamed the ‘silent killer’ because there are no typifying symptoms of hypertension. Hypertension is of significant public health concern due to the impact of the disease on life and productivity. The life-altering effects of hypertension include stroke, heart failure, kidney failure and death.
Even though both males and females are affected, men in their mid-forties have a higher risk of developing hypertension than women. Younger adults and children tend to have secondary hypertension, which is caused by other conditions such as nephrotic syndrome and glomerulonephritis. However, research indicates that hypertension in younger populations is on the rise. The major risk factors include excessive alcohol, overweight and lack of physical activity.
Women also have a significant risk of developing hypertension in pregnancy. This is worth noting since mothers are celebrated in May. Out of 14,000 deaths of women in Ghana between the last two elections, hypertension in pregnancy was the leading cause of death in the urban areas.
|Normal||Systolic less than 120mmHg, diastolic less than 80mmHg|
|At risk (prehypertension)||Systolic between 120-139mmHg, diastolic between 80-89mmHg|
|High Blood Pressure (Hypertension)||Systolic more than 140mmHg, diastolic more than 90mmHg|
Hypertension also significantly worsens the likelihood of recovering from other diseases such as COVID-19 among others.
About 1.56 billion people worldwide are estimated to be living with this deadly preventable disease by 2025. Many people living with the disease do not know about their predicament. Emergency rooms worldwide are recording a high incidence of cases who present with debilitating end organ disease due to uncontrolled hypertension. The blood pressure readings usually above 130/80mmHg are considered prehypertension, while those above 140/90mmHg have severe hypertension as shown in the table below. Most patients who come to the emergency room with hypertension may not have been compliant on medications for reasons including religious beliefs, financial reasons, and fear of side-effects from antihypertensive drugs. This has led to a high prevalence of about 56% of people presenting with co-existing target-organ damage at the first diagnosis of hypertension.
These target-organ damages range from nerve problems, visual abnormalities, strokes and heart conditions. Strokes and heart attacks can happen suddenly even when a person is driving, and may contribute to road traffic accidents with tragic consequences.
There is a negative impact on the productivity of a person living with hypertension, especially if there is a consequent end organ damage. This results in poor quality of life and increase in the economic burden on society.
It is imperative that hypertension is prevented, or at least controlled to preserve productivity and reduce hospitalisation due to complications. The preventive measures require lifestyle and behaviour changes – including healthy diets, reduced alcohol intake, quitting of tobacco use, and increase in physical activity levels. Controlling hypertension requires these lifestyle changes as well as medications. Understanding the disease as a patient, knowing the therapeutic action of the drugs and their side-effects, regularly checking your blood pressure, religiously taking the right dosage of drugs as prescribed by your physician, and regular follow-up consultations with your doctor can help control high blood pressure to reduce the risk of life-threatening complications.
Where side-effects of medication are an issue, taking advantage of a wide complement of drugs should be utilised to enable the patient to switch. Once the right combination of drugs is supplied, they should be regularly refilled. It is worth noting here that COVID-19 in 2020 resulted in the National Health Insurance Scheme (NHIS) extending review periods from 1 to 3 months, making refills last longer, and perhaps making room for remote digital health services between reviews. A question worth asking here is if digital health services will be covered by the NHIS soon.
A small window exists for enforcement. This is in the area of driving. For instance, in the UK a trailer driver is expected to surrender their driver’s licence after suffering a heart attack or stroke for 3 months, pending medical clearance. This ensures safety of all on the roads. It also ensures that people are more responsible for their health.
In Ghana there are opportunities to utilise screening exercises and technology. In all the pharmacies operated by Ernest Chemists Ltd., one can check their blood pressure for free.
The May Measure Month (MMM) initiative (http://www.maymeasure.org/), a global campaign run by the International Society of Hypertension with over 80 countries participating this year between May and November 2021, aims at testing over 1 million people.
In addition to the traditional visit to a preferred healthcare provider, one can take advantage of screening events at the malls, pharmacies and various office settings. Technology in this space has now made it possible for one to buy their own blood pressure measuring apparatus, some of which are utilised with the Internet of Things (IoT) to link the user with their doctor. Additional corporate solutions such as those being developed by teams under the Innovative Health Tech programme by GIZ, the Doctors for Road Safety (DfRS) initiative under the Kwanso project and the Ernest Chemists Pharmacy Omron Blood Pressure Screening Programme mean that high blood pressure control is well within reach.
>>>The author is a health technology enthusiast and can be reached on WhatsApp/Call: 0557389017. Contributors: Dr. Adwoa Adoma Nketia works in the Emergency Room at the Legon Hospital and Volunteers as Medical Director for Doctors for Road Safety and Dr. Josephyne Bertha Konadu is a Public Health expert and a medical doctor. This article was published by Omron Healthcare (GH) in collaboration with Ernest Chemists Ltd, supported by the Doctors for Road Safety (DfRS) initiative.