Introduction
Hypertension or high blood pressure is one of the most serious health problems illnesses in the world today. It contributes directly or indirectly to millions of deaths occurring each year round the world. Nigeria is not an exception. In fact, high blood pressure is the commonest cause of sudden death amongst Nigerians today. The American health association called hypertension as a condition in which a person’s blood pressure is higher than it should normally be when all variables including age, sex and health conditions are taken into consideration, when blood pressure is forced out into the smaller ones. If follows that, if the arterioles (small artery) join an artery to a capillary are much narrower than normal, the pressure in the arteries rises as the heart exerts more force (Akinkugbe & Falose, 2007).
The Federal Ministry of Health estimates that one to every ten (1:10) Nigerian, has high blood pressure and it is estimated that several million of those with this disease have it, high blood pressure is the most common cardiovascular disease that is affecting the heart and blood vessels, high blood pressure, if not controlled can damage vital organs of the body such as the heart, brain, kidney etc. leading to heart attack, stroke and kidney failure. These are serious condition that can lead to premature, unexpected and sudden death. Blood pressure is measured at two levels, when the heart is contracting the pressure is called systolic and when the heart is relaxing it is called diastolic (Achala, 2008).
Conceptual framework
Waugh and Grant (2014) described hypertension as any elevated blood pressure in the arterial wall.They also express further changes that take place in the blood vessels in hypertension and amount of muscle and elastic tissues in the wallsof the arteries’ increase that are later replaced by fibrous tissues. They assumed that the small and medium arteries become thicker, hard and inflexible which result to (arteriosclerosis) hardness of arteries and the lumen is reduced while large arteries loss their elasticity and get diluted, when elasticity is lost, smooth blood flow changes to pulsating flow in the arteries.
Clobanian, Bakis and Black (2013) state that hypertension is an abnormal rise in blood level. Rise in blood pressure depends on physical activities, stress, age and certain diseases. According to Kaplan, William and Weein (2006), any abnormal increase in blood pressure is known as hypertension. Achala (2008) on communicable and non-communicable diseases and prevention, state that hypertension or high blood pressure is the commonest of the disease that affect the heart and blood vessels. The American heart association called hypertension the silent killer. Amol (2011) said high blood pressure as a condition in a person’s blood pressure that is higher than its normal when all variables health conditions are taken into account.
Classification of high blood pressure
Park (2005) said that hypertension can be divided into primary (essential), hypertension when the causes are unknown according to part, its prevalence rate is 90-95%. Part stated that secondary hypertension is when some other disease processes or abnormality is involved. According to him (park), it accounts for 10 percent or less of the cases of hypertension. Primary hypertension (essential hypertension). This could be due to hereditary and without specific medical cause and it occurs more often in the black race according to park. Secondly hypertension according to park that is the type of hypertension that is caused by detectable disease of the heart and arteries e.g.
- Arteriosclerosis or hardening of the arteries, this is a disease that reduces the elasticity of the affected arteries and its fatty deposits tend to obstruct blood flowing through them.
- Kidney (renal) disease: Obstruction to normal kidney blood flow or narrowing of the arteries that supply the kidneys and damage to the kidney and progressive impairment of kidney function or kidney failure and other kidney disease.
- Glandular disturbance: over activity of the thyroid gland or pituitary gland, about 15% of all cases of hypertension may be attributed to secondary hypertension.
- Pregnancy: Transient condition for some women.
- Heart disease: heart failure (the heart can’t adequately pump blood), heart disease (the heart tissue doesn’t get enough blood) and hypertension hypertrophic cardiomyopathy (enlarge heart) are all associated with high blood pressure. Benign (chronic hypertension) the rise in blood pressure is usually slight to moderate and continue to rise slowly over many years. Malignant (accelerated hypertension) this is a rapid and aggressive acceleration of hypertension disease.
Causes of hypertension
Crosta (2014) outlined the following as causes of hypertension they include:
- Hereditary of genetic factors
- Age
- Sex: more prevalent in men of young adulthood and early middle age, after age 55. It is more prevent in females according to Bloom (1981).
- Poor diet or too much of junk food.
- Alcohol consumption in excess
- Kidney disease
- Tobacco smokers or drug users such as cocaine
- Diabetes and heart disease
- Lack of physical exercise
- Obesity – people who are obese
- Stress
- Birth control pills especially those contain estrogen
- Pregnancy can boost pressure and even medication that constrict blood pressure
- Emotional tension for unknown reason can cause high blood pressure.
- Excessive dietary sodium intake
Risk factors of hypertension
According to Park (2005) the risk factors are divided into two categories:
- Non-modifiable risk factors
- Age
- Sex
- Genetic factors
- Ethnicity
- Modifiable risk factors
- Obesity
- Salt intake (excessive) for “salt sensitive” people
- Saturated fat (excessive fat)
- Alcohol (excessive consumption)
- Lack of physical activity
- Environmental stress (physical emotional)
- Low social – economic status
- Other factors such as noise, vibration, temperature and humidity.
Signs and symptoms
According to Kearney (2009), there is no guarantee that a person with hypertension will present any symptoms of the condition according to him, people who are ignorant can last for years, however he stated that extremely high blood pressure may lead to some following symptoms:
- Poor exercise tolerance – fatigue
- Severe headache
- Dizziness
- Nausea
- Fatigue or confusion
- Problem with vision
- Memory loss
- Chest pain
- Breathing problem
- Blood in urine.
According to Liushengle (2010), other signs and symptoms also include
- Nose bleeding (epistaxis)
- Faintness, headache especially frontal headache, visual problem, ringing in the ears, edema of the legs, insomnia fatigue and persistent rise in blood pressure.
Diagnosis
According to Akinkugbe and Falose (2007), cases such as electrocardiograms (ECG) and echocardiograms will be used in order to measure electrical activity of the heart and to assess the physical structure of the heart. The diagnosis of high blood pressure is important. So, effort can be made to normalize blood pressure and prevent complication. It often doesn’t have any symptoms so you usually don’t feel it. For that reason, hypertension is usually routine visit, and is diagnosed a measure of 140/90mmHg with device called sphygmomanometer and compared to a chart of valve when it is greater than 140/90mmHg is considered to be hypertensive.In order to perform a more thorough diagnosis, it requires sphygmomanometer measurement at least one week apart, often entail three separate visits to the physician’s office.
Initial assessment of the hypertension patient should include a complete history and physical examination exceptionally. It the elevation is extreme or if symptoms of organ damage are present then a diagnosis may be made and treatment started immediately, once the diagnosis will attempt to identify the underlying cause base on the risk factors and other symptoms present. Secondary hypertension is more common in adolescents and has multiple factors including obesity and a family history of hypertension. Laboratory test can also be performed to identify possible causes of secondary hypertension and to determine whether hypertension has caused damage of the heart, eye and kidneys. Additional test for diabetes and high cholesterol are usually performed because these conditions are additional risk factors for the development of heart disease and require treatment (Liushengle, 2010).
Prevention and control
According to Robert (2009), careful health teaching about hypertension should be done to create awareness, health education of the people at risk of hypertension as well as encourage individuals especially the educated ones to purchase the instrument sphygmomanometer for monitoring one’s blood pressure. American Heart Association (2010) commented on the above topic that the following should be adopted:
- Reduce body weight
- Regular physical exercise e.g. swimming, walking and cycling.
- Avoid fast and miracle (free) diets.
- Low salt consumption and avoid too much intake of sugar
- Intake of rich food with potassium, magnesium and calcium.
- Reduced large consumption of alcohol drink.
- Eating of high vegetarian diet
- Avoid drugs that can boost pressure
- Anti stress therapy (sleep) and quit smoking
- Reduce coffee intake
- Monitor your blood pressure at home
- Eating less of junk food and more of fresh vegetable fruits.
- Consumption of low-fat dairy products
- Cutting down of alcohol consumption.
- Low sodium diet in Caucasians can reduce hypertension and people with normal blood pressure.
- Increasing public awareness and increasing the frequency of screening for the condition and health education.
Complication
Liushengle(2010) listed out the following complications of hypertension.
- Hypertensive heart disease e.g. Coronary artery disease left ventricular hypertrophy heart failure.
- Cerebrovascular disease e.g. arthrosclerosis, stroke, hypertensive encephalopathy.
- Speech loss
- Sudden death
- Cerebral hemorrhage.
- Angina pectoris
- Kidney failure (uremia) or kidney damage
- Temporary blindness
- Retina of the blind.
Treatment/remedy
The aim of treatment should be, to reduce blood pressure to ≤ 140/90mmHg. (Some medical professionals recommend well below 120/80 mmHg) and the treatments is a lifelong matter, you must take all these precaution and medicine even if you are better. DASH (Dietary Approaches to stop hypertension) is a diet promoted by the National Heart Lung and Blood Institute, a major feature of the plant is limiting intake of the sodium and is also generally encourages the consumption of nuts, whole grains, fish, poultry, fruits, vegetables and eat less saturated fat, while lowering the consumption of red meat, sweet and sugar i.e. food rich in potassium, magnesium and calcium as well as protein.
Apart from dietary and lifestyle modification and drug can also be prescribed. The prescription of the drugs includes; ACE inhibitors, alpha blocker and anti-otensionII receptors, antagonist, beta blockers, calcium channel blocker, diuretics e.g. (hydrochlorothiazide) direct rennin inhibitors and glyceryltrinitrate which has the activity of vasodilators. The recommendation BP goal is ≤ 140/90 mmHg with thiazide diuretics being the first line medication. According to Luishengle (2010) common treatment for hypertension includes
- Atenolol
- Azor
- Calcium chloridine
- Diovan
- Fish oil
- Hydrochlorothiazide
- Lisinophil
- Norvase
- More vitamin supplements.
Note: Regular check–up, some drugs are preferable to others depending on the characteristics of patients (diabetics, pregnant women etc.) if the blood pressure is successfully lowered it is wise to have frequent check up and to take preventive measure to avoid a release of hypertension and also see your doctor before starting any new exercise programme or anti-hypertensive medication (National Heart, Lungs and Blood Institute, 2010).
According to Weller (2005), the benefit of lowering blood pressure includes:
- Lowering of blood pressure 35-40 percent (%) reduction in heart attack.
- Greater than 50 percent reduction in heart failure.
- Less impressive reduction in kidney failure.
- Reduction of stroke and eye damage which are complication of hypertension.
References
Achala, E. (2008).Communicable and non-communicable diseases and prevention.London: Crest Books.
Akinkugbe, O. &Falose, A.O. (2007).Clinical medicine in tropics series, Ibadan: Blackwell scientific publication.
American Heart Association (2010).High blood pressure, factors that contribute to it.Retrieved on 12th June, 2015 from http://www.ameriac an-heart.org/presenter/hme.
Amol, B. (2011).Toohey’s medical for nurses. Edinburgh: English Language Book Society.
Clobanian, A.V.,Bakris, G.I. & Black, H. R. (2013).Seventh report of the jointNational committee of prevention, detection, evaluation and treatment of hypertension. London: Appleton
Crosta,P. (2014). Fundamentals of communicable and non-communicable diseases.Owerri: Ewuzie Inc.
Kaplan, N., William, B.&Weein, J.(2006).Clinical hypertension (7thed.). New York: Sage Publication
Kearney, D.M. (2009).Management of hypertensive conditions in young adults.Washington D.C.:Creta Inc.
Liushengle, L. (1990).Epidemiology of hypertension and cardiovascular disease.Edinburgh: Educational Book Society
Park, K. (2005).Preventive and social medicine (5thed.). New Delhi: Nagar Jabalpu
Robert, B. (2009).Medical sociology. Luton: Appleton
Waugh, A. & Grant, A. (2014). Ross and Wilson anatomy and physiology in health and illness (12thed.). Churchill Livingstone: Elsevier Inc.
Weller, B. (2005).Baillie’s nurse dictionary for nurse and health care worker (24thed.). Berlin: Jupahan
National Health Lung and Blood Institute (2010).Your guide to lowering blood pressure with dash.Retrieved on 2nd November, 2015 from http://www:nhib.Gv/health/public/heart/hbp/dash/new: dash. Pdf.