By Chioma Obinna
With over 30 million Nigerians suffering from hypertension, clinicians in the country have been asked to pay more attention to blood pressure variations which is a main risk factor for Cardiovascular Diseases among others.
Speaking at the 2010 Cardiovascular Summit organised by one of the worldâ€™s leading pharmaceutical company, Pfizer recently in Lagos, Dr Benedict Anisiuba, a Cardiologist at the University of Nigeria Teaching Hospital, Enugu in his paper entitled; Blood Pressure Variability and Clinical Outcomeâ€ advised that clinician should no longer ignore random BP variations.
â€œWhile practising scepticism, clinicians should no longer ignore these random BP variations and look for reasons not to treat them. BP variability is telling you something about the risk of the individual. Drugs that reduce BP variation are likely to be more protective than those that donâ€™tâ€.
Anisiuba warned that elevated blood pressure (BP) is the most common and most modifiable risk factor for cardiovascular disease (CVD). He argued that clinicians must recognise that measured BP is an intrinsically variable haemodynamic phenomenon and even when the effects of faulty equipment or poor technique are corrected for, measured BP is still variable.
Noting that every cardiac cycle produces a different BP, he regretted that clinicians largely ignored or at best treated as noise, to be averaged out.
He noted that recent studies have revealed distinct pathophysiologic patterns and clinical significance of BP variability and reactivity which include those related to Modulation of sympatho-adrenal output, vascular reactivity and behavioural aspects.
Anisiuba explained that acute and chronic adjustments in pressure and flow are necessary for the organism to respond adequately to its environment and at the same time conserve cardiovascular energy expenditure, adding that disease states can modify these responses and influence measured BP, leading to BP variation.
â€œAging and hypertension are associated with non-compliant arteries (arteriosclerosis).
Moreover, younger and normotensive individuals exhibit only increased cardiac output with mental stress and dynamic exercise but in aging and hypertension, increased peripheral resistance occurs as well, leading to increased systolic BP. In addition, certain disease conditions cause endothelial dysfunction. Such conditions may also lead to exaggerated vasoconstriction with mental stress and dynamic exercise with subsequent exaggerated BP response.â€
On behavioural aspects and BP reactivity, he warned that anger and hostility, poor coping ability to stressful situations, poor social support and racial differences are all behavioural aspects that can increase BP reactivity. He said variability and clinical outcomes has show that blood pressure fluctuates continuously over time, either spontaneously or in response to a variety of external stimulations. The occurrence of these continuous and often marked blood pressure variations is not only of pathophysiologic interest, but it may also have a clinical relevance.
The Secretary- General, West- African Post-Graduate School of Pharmacists, Dr. Azuka Opara, in his paper titled â€œRational Drug Use in Cardiovascular Disease Managementâ€ said that one of the factors affecting adequate treatment and management of diseases in the country was lack of statistics and improper patients record keeping which was essential for research purposes.
â€œI think professionals need to start keeping records and data of the patients they treat or have treated by taking notes and documenting them. If all of us keep this trend, then we can now collate a national data.â€