Hypertension: snatching lives, suddenly, silently

In times past when death was mentioned, it simply had to do with an elderly person who had lived through all the stages of life and passed on to glory or a person who had been bedridden by ill-health for years and finally given up the fight.

Apart from accidents, sudden death from sickness was not reported quite often.

Unfortunately, the same cannot be said of recent years as death presently, and most of the time, has whisked away persons seen hours, seconds, and even minutes earlier.

Health experts have blamed the development on many health complications, one such is hypertension, otherwise known as high Blood Pressure or BP, a disease that takes many by surprise and has earned the nickname “The Silent Killer”

Kwame Annor, (not his real name), told GhanaPlus.com that his mother; Mrs Annor had excused herself in the middle of their afternoon meal to visit the washroom, a few steps away from their eating area.

All they heard seconds afterward was a loud thud. She was confirmed dead at a hospital less than five minutes’ drive from their home with acute left ventricular failure as the cause.

“Sorry we lost her,” the doctor uttered that dreadful sentence, Kwame recalled.

His mother was hypertensive, however, her sudden death and also in the middle of a meal she herself had prepared was something that never crossed anyone’s mind.

Every ear that heard of her passing instantly became the biblical doubting Thomas; they have had encounters with her in months, weeks, days, hours, minutes, and even seconds earlier.

“My mother was hypertensive, yes we knew that. She was on medications but her sudden death on that fateful day was something we never envisaged. She was fine and nothing showed that she was going to leave us on that day,” Kwame Annor said.

Awura Ama’s mum

Kwame is not alone. Awura Ama of Brofoyedur told GhanaPlus.com, her father had left home early morning on that fateful day to check up on her younger sister a few blocks away only to be told not long after that he had been rushed to the hospital.

Apparently, his father had fainted while there. He was rushed to the hospital but was pronounced dead on arrival.

An autopsy report said he died from a myocardial infarction (heart attack) resulting from untreated hypertension.

Prior to his death, neither she nor her siblings had knowledge of their father’s hypertensive status.

 “Am sure my father was not aware because he is very particular about his health and the things he consumes”.

 “It still sounds unbelievable whenever I think about his death. He was fine when he left the house”.

Naana’s experience

Ms Naana Lartey, a seamstress was, however, fortunate, she survived the medical emergency but is not perfectly whole to date as she was left with a stroke, one of the complications associated with the condition.

She tells us, she discovered she had been living with the condition nearly three years ago, a month after her late mother’s funeral.

The festive season was approaching, it was her cocoa season, a period to cash in and she wasn’t ready to let go of that opportunity.

And so right after the funeral, she heads back to Accra to pursue her venture not given rest even a morsel of chance.

As the season drew near, with much pressure from her clients, coupled with a lack of rest from all the errands during the funeral, her body couldn’t hold up any longer, ill-health set in but she declined all persuasion from her daughter to go to the hospital for medications at the pharmacy.

By noon, on the said day, her health was deteriorating and she had no option but to be rushed to the hospital.

Apparently, she was losing strength in the right part of her body, ie. her right arm, right leg, and right side of her face due to high BP.

After a series of vital checks, questioning, and laboratory examinations, she was quickly admitted and medications administered to put her to sleep to bring her BP under control.

The subsequent days saw a less inactive right arm, and leg, a slightly twisted mouth, and face as well as partly affected speech.

“I was surprised when the nurse asked me if I still have some of my BP medications at home. Me!  Hypertension! Stroke!, I am a very active person. I do everything myself, I go up and down a thousand and one times in a day, because of my work”.

 “I eat well. Sleep I will say a little less at the time because of my mother’s death and also the festive season but is that enough to give me hypertension and stroke? Ms Lartey quizzed.

She said her case brings to four; the numbers of BP cases in her family, all of them were unaware until they were hit by a stroke.

She explained as of today, the only way she is able to tell her BP is high is when she is unable to sleep.

Like, Kwame and Awura Ama’s parents, many more lives have been lost due to the condition, thousands are enduring its unending complications like Ms Lartey and millions are living with the condition unaware.

Hypertension/ BP/ High Blood Pressure 

andmedical.com.au     

A Physician Specialist at Margret Marquart Catholic Hospital, Kpando, Dr Vishnu N.L Abayateye explained hypertension is a condition in which blood vessels have persistently raised pressure.

According to him, it occurs due to the narrowing of blood vessels, causing blood to exert excessive pressure against vessel walls and forcing the heart to work harder to maintain pressure.

It is diagnosed if one measured on two different days, the systolic blood pressure readings of  ≥140 mmHg and/or the diastolic blood pressure readings of  ≥ 90 mmHg (140/90mmHg) instead of 120/80 mmHg respectively.

Nicknamed “The Silent Killer”, the consequences of the condition medical experts have explained can be dire if it is not treated.

It can lead to heart attack, stroke, aneurysm, heart failure, kidney problems, eye problems, metabolic syndrome, changes in memory, dementia, diabetes, and many more.

Dr Abayateye said “Hypertension is the leading cause of stroke, heart failure, and chronic kidney diseases”.

Complications associated with hypertension (www.heart.org)

Statistics

World Health Organisation (WHO)’s 2021 report said some 1.13billion of adults worldwide were living with the condition, in the year 2015, the majority of whom were from low and middle-income countries.

World Heart Federation’s (WFH) recent report also said hypertension is the number one cause of death globally and affects one billion people worldwide.

Again, WFH in its country mapping with Stroke Association Support Network – Ghana (SASNET-Ghana) estimates some 34% of Ghana’s population between 30 and 70years are living with hypertension.

“A bit more than half of the estimated number received a diagnosis. However, only 36 out of every 100 diagnosed persons were currently taking their medications”, the report added.

Also “More than 600,000 people, including 400,000 females and 200,000 men, are diagnosed with high blood pressure every year in Ghana with many more affected people remaining undiagnosed,” the Director-General of the Ghana Health Service (GHS), Dr Patrick Kuma-Aboagye, said on September this year”.

Hypertension is said to be a global public health concern and a  major factor in the surge in non-communicable diseases namely, cancers, heart and respiratory diseases, and diabetes among others in developing countries.

Dr Abayateye explained, “Over the past few decades, hypertension has transitioned from being almost unheard of among the rural poor into a genuine public health concern as up to a quarter of rural Ghanaians were estimated to have high blood pressure, although its prevalence tends to be higher in urban areas,”.

Symptoms

He noted the condition mostly has no symptoms hence the nickname “the Silent Killer”.

However, when symptoms occur they are usually none specific and can include headache, nosebleeds, vision changes, dizziness etc.

“Hypertension is usually asymptomatic and that’s why it is sometimes referred to as ‘the Silent Killer’. This also contributes to why some patients don’t appreciate why they should take their medications since they don’t experience any symptoms,” he said.

Causes

Speaking on the causes, Dr Abayateye said there are no known causes but excessive salt consumption, a diet high in saturated fat, low intake of fruits and vegetables, physical inactivity, consumption of tobacco and alcohol, and overweight persons are at a higher risk.

Persons 65years and above, of African descent, with co-existing diseases such as diabetes, and kidney diseases as well as persons with a positive family history like Ms Lartey, Awura Ama, and Kwame Annor are all at risk.

The disease comes in two forms, primary and secondary hypertension.

“Hypertension may be primary, in which case an exact cause is not known but certain risk factors have been identified; or it may be secondary, which develops from multiple causes commonly due to diseases of the kidney, endocrine or vascular systems,” Dr Abayateye explained.

Dr Abayateye’s reaction to the story

Reacting to the tales of Kwame and Awura Ama’s parents, he said sudden death could occur in a case of hypertensive emergency leading to the damage of one or more vital body organs.

“This can happen when you develop a hypertensive emergency with associated damage to one or more of vital organ systems in the body like a massive stroke, heart attack or a tear in a major vessel like the Aorta(Aortic dissection)”

He explained although, Kwame’s mother was on medication, she was required to regularly visit the hospital for proper monitoring of her condition adding being on medication alone was not enough.

“If one medication reaches the maximum dose and is not bringing the blood pressure down, you may need to add on to bring the blood pressure to target so is possible that such a person was probably on medication but was not within targets”.

“You need to be on the medication, go for regular reviews, do your lifestyle thing and make sure that your blood pressure is within target,” he emphasized.

In Ms. Lartey’s case, Dr Abayateye said most hypertensive patients present it the first time with complications since they might have been living with it for years unaware.

“For most conditions like diabetes and hypertension, usually, most people will present the first time with a complication but it doesn’t mean that it has not been there, it is very likely that it has been there for some years but because the person has not been checking the blood pressure and it doesn’t give the person any symptoms they will not know.

Answering her question concerning less sleep, Dr Abayateye said sleep deprivation and insomnia have been associated with the condition.

“During normal sleep, there is a decrease in BP relative to wakefulness. This decrease is referred to as “nocturnal dipping”. Diminished nocturnal dipping of BP is a strong, independent predictor of cardiovascular risk. In short, hypertensives who lack sleep are more likely to experience complications of high BP. They are therefore advised to have enough sleep while they can”.

Treatment of Hypertension

Speaking on the treatment, Dr Abayateye said primary hypertension can’t be cured, patients can be treated using lifestyle interventions and medications to enable them to live a normal life.

For some secondary hypertension, once the cause is identified and addressed it can be completely cured.

He explained treatment is done with a multi-disciplinary team including, Physicians, Dieticians, Clinical psychologists and Physical Therapists, etc.

“Hypertension is a lifelong disease that is manageable but generally not curable. Unfortunately, there is no cure yet for primary hypertension. Patients are required to be on their antihypertensive medications for as long as their BPs remain uncontrolled unless the patient starts showing symptoms of hypotension. In this instance, the dosage of the antihypertensive may be reduced or rarely withheld for a while.

Advice

Dr Abayateye advised patients of the condition to comply with their medications and attend their reviews regularly adding that achieving BP control plays a vital role in preventing cardiovascular complications of hypertension.

The Physician Specialist admonished a risk-free lifestyle for those who do not have it yet and advised a BP check-up at least once every six months to enable early detection and its associated help, subsequently.

“You stop things that increase your risk, for instance, smoking cigarettes is a major risk factor, alcohol too, if you want to drink alcohol, do moderate, try and manage your stress, if you have a stressful lifestyle.

Dr Abayateye recommends at least 150minutes of physical exercise every week also.

“The other one is diet, reduce your salt intake. Do more fruit and vegetable and if you need to take animal products, do boiled or smoked fish not fried, and reduce your meat intake considerably, the renowned health practitioner advised. 

Infographics credit : WHO

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Source: GhanaPlus.com