Health

Hypertension: How African countries can save lives

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2 years ago

From Left, Professor Amam Mbakwen, Professor Alabi Oyesile, Ghana’s Minister of Health, Kwaku Agyeman-Manu, Dr Abiodun Adeoye and Professor Mayowa Owolabi at the event, recently.

M R Micheal Uchunor was 31 years old when he developed a stroke. The brother called out for help after he was found on his bed with slurred speech and unable to walk. Since he recovered, he has been going around telling people to guard against stroke by making sure they control their blood pressure.

“In 2012, I was told at the hospital that I had a stroke due to hypertension. I couldn’t talk for nine months, but could only nod in response to questions. After I was discharged in Lagos, my brothers took me to Ghana to complete my treatment,” Uchnor retorted.

His life journey was truncated by stroke. His wedding was called off. The wife-to-be left him, claiming she cannot marry a cripple. Even though he is back on his feet, he still experiences some forgetfulness from time to time.

He added “stroke is very expensive to treat; once you have a stroke, you are alone, with no money and rejected by society. What kept me alive is the support I received from my extended family and God. Many individuals with stroke are neglected, some locked away by relatives to die. What I do now is to take campaign on stroke and hypertension as its major cause around Catholic churches.”

Uchunor is just one of the thousands of people living with stroke. Many of the cases are linked with hypertension, the number one cause of preventable deaths globally. Yet, it is not receiving the required attention, especially in Africa.

Today, hypertension remains a neglected health challenge and the number one cause of death in Africa. Turning around its wheel was the aim of a two-day international conference on novel strategies for accelerating hypertension control in Africa.

Having as its theme, ‘African Control of Hypertension through Innovative Epidemiology and a Vibrant Ecosystem (ACHIEVE),’ the Centre for Genomics and Precision Medicine and African Research Universities Alliance (ARUA), University of Ibadan Centre of Excellence in Non-Communicable Diseases, organised the conference in partnership with World Hypertension League (WHL) and Resolve to Save Lives.

“Several years ago, almost one out of every two Africans who are at least 25 years old had hypertension. And what is more worrisome is that only seven percent of them have a controlled blood pressure; the remaining 93 percent are either not detected, not on treatment or not controlled,” said Professor Mayowa Owolabi, WHL’s Regional Director.

Professor Owolabi said uncontrolled hypertension increases the risk of having heart failure, stroke, sudden death and even kidney failure, so much that every minute, six Africans are developing a stroke and at least every minute, one Nigerian is suffering from stroke.

“So, all stakeholders need to resolve to save lives because hypertension is a problem that affects everybody. Currently, about 74 percent of deaths globally are due to non-communicable diseases(NCDs) and many of these are linked to hypertension. It is the most important health problem in Africa,” he added.

Besides, determinants of developing hypertension, including the socioeconomic, political, legal, ethical, anthropologic and economic factors are also important for consideration in tackling hypertension.

He added, “a third of all deaths is accounted for by commercial determinants of health – that is the tobacco, alcohol and food industries. For instance, obesity, which cuts across the entire African region, doubles the risk of hypertension and those who consume up to 12 servings of green leafy vegetables are not likely to be hypertensive.”

Professor Alabi Oyesile, Dean of the Faculty of Arts, University of Ibadan, said poverty is now in epidemic proportion in many parts of the world, making many to struggle in a bid to make ends meet, adding that the government too is contributing to increasing cases of hypertension.

According to him, “when people are not happy when they wake up and through the day, it can affect their body system. So, government too is a contributory factor to hypertension. The earlier we look for ways to solve some of these problems, the sooner we will have a healthy nation that will drive development.”

Professor Amam Mbakwen, Vice President, World Heart Federation, said, “Whether it is the kidney, brain or heart, we all know that hypertension is a major problem. Hypertension is easy to diagnose, easy to treat but we are not controlling it, meaning that something is not just adding up.”

She said answering this question will also help to prevent deaths due to heart failure which occur in Nigerians at an average age of 50, mostly in the productive age group.

“For World Heart Federation, our vision is that by 2030, we should have a 30 percent reduction in cardiovascular mortality and morbidity worldwide and one of the ways we can do that is if we control hypertension. It is the most important risk for cardiovascular disease.

“We are trying to drive the change by giving the way for health equity for everyone and then leveraging on innovation and technology, not just telemedicine but also telehealth to make sure that people have timely access to health care. So, cardiovascular health must be placed on the central stage, whether it is a talk on climate change or other programmes like infant and maternal mortality,” she said.

WHL’s president-elect, Professor Gianfranco Parati, in a keynote address, described hypertension as the largest epidemic ever known to mankind and, therefore, the need to improve awareness, treatment and control of the disease, particularly in low and medium income countries, where two thirds of people with hypertension live.

He stated that improving treatment adherence by simplification of treatment, improving tolerability, having home blood pressure measurement, empowering patients through education and digital health and mobile health technologies for simplifying blood pressure telemonitoring are important to ensure hypertension control.

In addition, Professor Parati said while acknowledging risk factors such an unhealthy diet with high salt and low fruit and vegetables intake, tobacco and alcohol use and physical inactivity, other emerging risk factors like urbanisation, pollution and low birth weight should not be overlooked.

He called on African countries to accelerate all necessary changes in healthcare management that might lead to a quick reduction in cardiovascular risk for hypertension, by including hypertension in all NCDs programmes, ensure allocation of funding and resources, writing and adopting clinical guidelines for hypertension and the integration of its management into existing policies such as HIV/AIDS.

Others include encouraging home measurement of blood pressure with validated devices, ensuring availability of essential equipment and medicines, investments in quality research and population level interventions, provision of universal coverage for hypertension as well as task shifting and task sharing to ensure enough hands to diagnose and treat the disease.

Representative of African Stroke Organisation, Professor Rufus Akinyemi, said holistically, care from the womb to the tomb must be a continuum. This, he said, include ensuring mothers deliver safely and have babies with good weight that can then become adults, less prone to hypertension and healthy enough to contribute to national development.

Professor Kolawole Wahab of the Nigerian Hypertension Society, in a remark, said the burden of stroke is escalating in Nigeria, calling for a change in how to tackle it to ensure the 80:80:80 target for hypertension control by 2030.

The target is to ensure at least 80 percent of persons in the population are screened for hypertension, placed 80 percent of people with hypertension on treatment and at least 80 percent of those on treatment achieve good blood pressure control.

Dr Paul Olowoyo, a neurologist at the Federal Medical Centre, Ido Ekiti, in an overview of ACHIEVE, which experts are canvassing should replace the traditional approaches for hypertension management, called for a symbiotic relationship among all stakeholders, including persons with hypertension and the government, to stem the wave of hypertension in Africa.

“For instance, we need governments and non-governmental organisations to come up with free medication supplies as they being done for Tuberculosis and HIV; we need to extend care of hypertension to the primary healthcare level. We want to utilise the availability of mobile phones to improve adherence to treatment and knowledge on prevention of its complications.”

In his remark, Ghana’s Minister of Health, Kwaku Agyeman-Manu, said getting rid of the hypertension menace depends on specific African governments implementing solutions and recommendations suggested by experts and taking the disease more seriously than before.

Permanent Secretary, Federal Ministry of Health, Olufunsho Adebiyi, represented by Dr Abiodun Adeoye, put the prevalence of hypertension at over 30 percent, with the disease accounting for 11 percent of all deaths due to all non-communicable diseases and 22 percent probability of dying between the ages of 30 and 70 in Nigeria.

He said recommendations from the conference will make significant progress in achieving the global target of 80:80:80 for hypertension and at least 25 percent reduction in unconditional probability of dying prematurely from cardiovascular diseases and other non-communicable diseases.

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