By Chioma Obinna
Dr. Kingsley Akinroye is Executive Director, Nigeria Heart Foundation, NHF, and Vice President, World Heart Federation, WHF. In this chat, the renown cardiologist expresses worry on possible negative effect of the astronomical increase in cost of managing hypertension in Nigeria. He observes that the rising incidences in number of Nigerians with the condition require urgent attention from government and organisations. He says, before now, a patient needs not more than N10,000 to manage the condition per month but, in recent times, the cost has risen to as high as N30,000 to N40,000..
Hypertension, commonly known as high blood pressure, HBP, is a lifestyle disease and, worldwide, it has been established that cardiovascular diseases are the world’s largest killers, claiming 17.3 million lives a year. In Nigeria, the number of people suffering from cardiovascular diseases is on the rise and now becoming alarming, with a prevalence of not less than 25 percent of adults Nigerians suffering from hypertension.
Before now hypertension prevalence in adult population is between 25 and 30 percent but the figure is scaling above 30 percent. This is as a result of so many factors. These can be attributable to risk factors such as high salt intake in the population, lack of physical activity, poor intake of fruits and vegetables, consumption of unhealthy diets that can lead to overweight and obesity, closely linked to that is access to care, I mean access to cheap drug that can be used to control the blood pressure, BP. Once, one is diagnosed of hypertension, it tends to be almost forever.
How cost effective is the management of hypertensive?
Most of the drugs used for hypertension are manufactured outside Nigeria and the cost of importation is exorbitant, even the cost of the few ones that are manufactured here is still relatively high.
Another problem faced by Nigerian patients is that they have to pay from their pockets. In the past, if you have to take your drug daily for about 30 days, N10, 000 would have been sufficient for you but, with the recent economic challenges, the cost has escalated. The cost is now up to N30, 000 or N40, 000 per month. These and other factors joined together could be the reason for the increase in the prevalence of hypertension and consequences of hypertension. The consequences of hypertension are increasing in the population. The number of people coming down with kidney diseases is increasing. The number of people coming down with stroke is also increasing in the population. These are all consequences of hypertension and consequences in the number of people coming down with HBP.
What are the implications if the situation is not addressed?
The implication is that the life span of Nigerians is reducing. The working population is also reducing. The majority of people with HBP belong to the workforce of the population. Definitely, there will be a reduction in the number of people in the workforce of the country. So it is not a good story that we are losing the productive workforce of the population. Unfortunately, we don’t have accurate data because we do not have a national survey to specify the number of people coming down with stroke but you can look at some hospital data. But we do certainly know that the number of people with hypertension is rising. When people are diagnosed of HBP, they start taking their drugs but, after some time, they drop due to their inability to afford them. And when that happens, some may end up with complications such as heart attack or stroke. Some even die in the process.
What is the link between water, salt and HBP?
Generally, salt is available in all foods. Every food product we eat contains salt. The ability to identify the content of one will give people choices on what to take. Even water contains salt. Ideally, what we say is that you must be able to reduce your salt intake, take water that has low salt.
Virtually in the last 20 years, companies that manufacture water have increased. That is an area that should be researched and that also could be used even as screening for their licences.
We now have guidelines for salt in South Africa. In Nigeria, it took us 20 years to get tobacco law passed and two years after, the implementation has not started. Science is constant, policy is very good but it does not end in policy. NAFDAC should also be vigilant in ensuring that we have good water.
The more salt you take, the higher your blood pressure rises. We feel that in Nigeria, it is advisable that people limit their salt intake to three grams per day because where people are known to have blood pressure, the moment they reduce their salt intake, the blood pressure tends to fall.
Nigerians should look into their diets, take low salt and exercise regularly. Enough of sitting down without activity, avoid tobacco and its environment because it also increases blood pressure. Don’t even smoke. Tobacco goes to the blood pressure and acts at that cellular level in terms of causing damage to the blood vessel and that tends to increase blood pressure. Avoid food or activity that will make you add weight. Stay within the limit of their body mass index, BMI.
Checking blood pressure
It is either you go to health practitioner, a doctor or pharmacists or do it yourself. For an adult who does not have high blood pressure, maybe three times in a year but if you have been diagnosed of high blood pressure, try to check it at least once a month. A normal blood pressure should be less than 120 Systolic (top number) and less than 80 Diastolic (bottom number) while Prehypertension is 120–139 or 80–89 while high blood pressure stages are Stage 1 140–159 or 90–99 and Stage 2 160 or higher or 100 or higher.