The Silent Killer

I was sitting down in the back of a Peugeot 505 station wagon, arriving Abuja from Kaduna. The weather was unbearably hot and I was sandwiched between to obese men at the back seat. I was completely stressed out and so were the other seven occupants because we had been in a traffic hold-up for the past one hour. These days, hold-ups on Abuja roads are the norm, ever since several security check points had been erected because of the terrorist bomb blasts that had rocked the nation’s capital city months ago.

We were all visibly frustrated by the situation, and the fellow next to me by my left hand side had been the most vocal.

“I don tire for this country oh. Hypertension go kill person one da,” he said.

“Bros,” I responded, “why are you prophesying doom for yourself?”

“I know what I am talking about young man. I am just coming from Kaduna where I saw a doctor who told me that my blood pressure was high. Why e no go high with all this stress!”

For a while no one spoke again. We all looked out through the windows at the youths hawking all sorts of wares to frustrated passengers, while we crawled forward, a few meters at a time.

“I noticed you were reading a medical book throughout the journey,” the same guy asked me, breaking the silence.
“Yes. I am a medical doctor,” I answered.

“You doctors are rich. What are you doing, suffering with us in this taxi?”

I laughed. “My friend doctors are human beings too. My car broke down a few days ago and I had to make this trip.”

“Too bad.Ok if you don’t mind sir, can I ask you a question?” he asked.

“Sure. Go ahead.”

“As I said earlier, my doctor told me I had high blood pressure. Can you tell me more about this hypertension thing?”

“Hypertension is the term used to describe high blood pressure.Blood pressure is a measurement of the force against the walls of your blood vessels as your heart pumps blood through your body.Blood pressure readings are usually given as two numbers -- for example, 120 over 80 (written as 120/80 mmHg). One or both of these numbers can be too high.”

“He told me my reading was 160 over 100. I was confused. What is the normal blood pressure?”  “Normal blood pressure is when your blood pressure is lower than 120/80 mmHg most of the time.High blood pressure (hypertension) is when your blood pressure is 140/90 mmHg or above most of the time.”
Causes, incidence and risk factors

“When he told me about hypertension, I doubted him. I have been in good health. I have never had cause to be admitted in the hospital. I only went to see him for a prescription of sleeping tablets because lately, I had difficulty sleeping. So what causes high blood pressure?” he asked.

“Many factors can affect blood pressure. For example how much water and salt you have in your body, the condition of your kidneys, nervous system, or blood vessels, the levels of different body hormones,” I answered.

“How about age?”

“You are more likely to be told your blood pressure is too high as you get older. This is because your blood vessels become stiffer as you age. When that happens, your blood pressure goes up. High blood pressure increases your chance of having a stroke, heart attack, heart failure, kidney disease, and early death.”
“Well, though I am 53 years, I still consider myself a young man,” he said, smiling. “What else can cause it doctor?”

“You have a higher risk of high blood pressure if you are obese,  often stressed or anxious, drink too much alcohol, eat too much salt in your diet, have a family history of high blood pressure, have diabetes, or smoke cigarettes.

“Most of the time, no cause of high blood pressure is found. This is called essential hypertension.High blood pressure that is caused by another medical condition or medication is called secondary hypertension. Secondary hypertension may be due to chronic kidney disease, disorders of certain glands in the body, pregnancy, medications such as birth control pills, diet pills, some cold medications, and migraine medications, or narrowed blood vessels that supply blood to the kidney.”

Symptoms

“This is interesting,” he said. “From what you are telling me it seems I have to do further investigations to see what is causing my blood pressure to go up. You know what is most confusing to me? The fact that I have never had any symptom to suggest that something was wrong. Or maybe I don’t know what the symptoms are.” By this time, we had passed the cause of the hold-up; a military security checkpoint. Sometimes I wondered just how effective these checkpoints were in fishing out terrorists.
I turned to respond to my neighbour.

“Most of the time, there are no symptoms. For most patients, high blood pressure is found when they visit their health care providers. Because there are no symptoms, people can develop heart disease and kidney problems without knowing they have high blood pressure. That is why they call hypertension ‘the silent killer.’

“In severe cases of hypertension where the blood pressure is very high, symptoms may appear. For example, if you have a severe headache, nausea or vomiting, bad headache, confusion,
changes in your vision, or nosebleeds, you may have a severe and dangerous form of high blood pressure called malignant hypertension.”

Signs and tests

I noticed he wasn’t the only one listening to me as I spoke. Every now and then, almost all the passengers looked back at me as I explained hypertension.

A middle-aged woman sitting upfront with the driver turned to ask me a question.

“Eh, sorry for intruding oh, but I also have a question. There are times my blood pressure reads something like 110 over 60. At other times it reads 130 over 70. Is this normal? Does it mean I have hypertension?”

“It is normal for your blood pressure to be different depending on the time of day,” I responded.“Your health care provider will check your blood pressure several times before diagnosing you with high blood pressure. Blood pressure readings taken at home may be a better measure of your current blood pressure than those taken at your doctor’s office because at home, you are most likely to be relaxed.

There are several home electronic blood pressure measurement devices on sale at medical equipment stores. Be sure to get a top quality one.”

My friend asked, “So what tests will I be asked to do to manage the condition?”

“Your doctor will perform a physical examination to look for signs of heart disease, damage to the eyes and other changes in your body.

Tests may be done to look for high cholesterol levels, heart disease and kidney disease.

You may do special x-rays such as x-ray of the heart (echocardiogram), urine tests and other blood tests.”

Treatment

“Some people say that hypertension has no cure. How can it be treated then?” the woman upfront asked.

“The goal of treatment is to reduce blood pressure so that you have a lower risk of complications. Your doctor will recommend lifestyle changes to bring your blood pressure down to a normal range. You can do many things to help control your blood pressure, including eating a heart-healthy diet, including potassium and fibre, drinking plenty of water, exercising regularly -- at least 30 minutes of aerobic exercise a day.

“Also, if you smoke, quit. Limit how much alcohol you take, limit the amount of sodium (salt) you eat. Reduce stress --- try to avoid things that cause you stress. Stay at a healthy body weight . 

Being overweight does not help to control high blood pressure.”
“My brother, how does one avoid stress in a country like this, eh?

When everywhere there is go-slowly, hold-up, checkpoints…eh Stress is a part of our lives oh.”

Many occupants of the vehicle nodded in agreement. I had to agree with them too.
“What about drugs? My doctor prescribed some drugs for me after making the diagnosis.”

“There are many different medicines that can be used to treat high blood pressure. Often, a single blood pressure drug may not be enough to control your blood pressure, and you may need to take two or more drugs. It is very important that you take the medications prescribed to you. If you have side effects, your health care provider can substitute a different medication.”
Complications

“Most of the time, high blood pressure can be controlled with medicine and lifestyle changes.When blood pressure is not well controlled, you are at risk for a chronic kidney disease, heart attack and heart failure, stroke, problems with your vision and other problems. If you have high blood pressure, you should have regular appointments with your doctor. Even if you have not been diagnosed with high blood pressure, it is important to have your blood pressure checked regularly, especially if someone in your family has or had high blood pressure.”

By the time I finished speaking, we had arrived at Jabi motor park, our destination. We said quick goodbyes and I immediately found a taxi to take me to my house. It had been a stressful journey for all of us. Learning to manage stress is very important. Some unfortunately keep having high levels of stress that affect their health negatively. As the taxi took me home through yet another traffic hold- up, I whispered a silent prayer for a healthier, stress-free Nigeria.