Low Level of Public Awareness Affecting Hypertension Management in Nigeria – Consultant cardiologist

Consultant Cardiologist, Dr Folashade Alli

Dr Folashade Alli is a board-certified consultant cardiologist, with over 30 years of experience. Her career is devoted to the diagnosis and treatment of heart, vascular, and thoracic diseases through early detection, education, and prevention in Nigeria. She is also passionate about leveraging responsible technology to advance healthcare. In this exclusive interview with Patrick Iwelunmor, she shares her thoughts on the prevalence and management of hypertension (high blood pressure) in Nigeria. Excerpts:

Can you provide an overview of the current prevalence of high blood pressure in Nigeria, and how it compares to global statistics?

The prevalence of hypertension in Nigeria has increased significantly, rising from an estimated 8.2 per cent in 1990 to 32.5 per cent by 2020. This trend aligns with the findings of the 2017 REMAH study, which revealed that 38 per cent of Nigerians are affected by hypertension. This poses a major health challenge for Nigeria, particularly as it is Africa’s most populous nation.

Globally, high blood pressure affects approximately 1.13 billion people, with two-thirds of this burden concentrated in low- and middle-income countries (LMICs). The World Health Organisation (WHO) identifies the African region as having the highest global incidence of hypertension, at 27 per cent, with Nigeria’s growing rates contributing significantly to this regional statistic.

What are the primary risk factors contributing to the high rates of hypertension and cardiac arrests in Nigeria?

Several sociodemographic and lifestyle factors contribute to the high rates of hypertension. Age is a significant factor, with the risk of high blood pressure increasing as people get older.

Education and lifestyle choices also play a role. Interestingly, higher education levels in Nigeria are associated with a greater likelihood of developing hypertension, potentially due to lifestyle changes linked to higher socioeconomic status, such as increased consumption of processed foods. Physical inactivity, exacerbated by urbanisation and a sedentary lifestyle, is another major risk factor. Alcohol consumption also contributes to the risk, highlighting the need for effective policies to manage alcohol use.

Additionally, familial traits, drug use (particularly psychedelics among young people), and intercurrent infections affecting the kidneys (such as glomerulonephritis) also contribute to the development of hypertension. Increasing air pollution and the use of various substances (such as shisha) among young people are further risks for high blood pressure and sudden cardiac arrests. These factors, along with poor healthcare provision, late presentation, a lack of public awareness, and a shortage of qualified medical personnel, contribute to delays in diagnosis and intervention, leading to a large number of hypertension patients dying from sudden cardiac arrest and related complications. This outcome is largely preventable if all these contributing factors are continuously addressed.

Promoting physical activities such as walking, cycling, and the use of non-motorised transport is crucial, but Nigeria’s inadequate infrastructure, which lacks safe areas for pedestrians and cyclists, hampers such efforts. Dietary habits also play a significant role; the consumption of processed foods, often linked to urban lifestyles, increases the risk of hypertension. Promoting healthier dietary choices is essential in addressing this issue.

Increased consumption of processed foods leads to a higher inflammatory state in the body, contributing to atherosclerosis (arterial stress and stiffening), high levels of bad cholesterol, and increased blood pressure. Physical activity helps lower inflammation and improve vascular health, while a sedentary lifestyle exacerbates inflammation and poor circulation. A poor diet combined with inactivity leads to higher blood pressure, and if left unchecked, this significantly raises the likelihood of heart disease and sudden cardiac arrest.

Can you discuss any specific regional or demographic differences in the prevalence of high blood pressure and cardiac arrests within Nigeria?

Hypertension is more common among urban residents than those in rural areas, and its prevalence varies across Nigeria’s geopolitical zones. Research shows that hypertension is more prevalent in southern Nigeria than in the northern regions. For instance, the southeast region has a significantly higher occurrence, with an odds ratio of 4.26 compared to the north-central region, indicating geographical differences in hypertension risk.

Demographic trends also show that males are slightly more affected than females pre-menopause, but after menopause, the prevalence is the same in both genders. The prevalence of hypertension increases with age, and although it was previously reported to occur in middle age, it is now being diagnosed in much younger age groups. This shift may be multifactorial, including changing definitions of normal blood pressure and other factors mentioned earlier.

How can public awareness and education be improved to better address hypertension and prevent cardiac arrests in Nigeria?

Enhancing public awareness and education about hypertension is critical for its prevention and management. Effective counselling and health education, particularly targeting modifiable risk factors such as lifestyle choices, are essential. Engaging nurses and community health workers in these efforts, in line with task-sharing strategies, can broaden their reach and impact.

Additionally, religious institutions can be leveraged to raise awareness and provide health education about hypertension. Both state and local governments must be involved in community awareness campaigns and advocacy for improving the cardiovascular health of the population. Non-governmental organisations must also collaborate with the government and the World Heart Federation to address the growing concerns surrounding hypertension and cardiovascular diseases, which often lead to cardiac arrest.

How does the healthcare infrastructure in Nigeria impact the diagnosis and management of high blood pressure and related cardiovascular conditions?

Nigeria’s healthcare infrastructure significantly affects the diagnosis and management of hypertension and cardiovascular conditions. Access to healthcare services is often limited, especially in rural areas, where facilities may lack essential diagnostic tools and equipment for effective hypertension management. Inadequate training and inconsistent adherence to treatment protocols among healthcare providers further exacerbate these issues.

Additionally, the high cost of medications and diagnostic tests poses a substantial barrier to effective treatment for many Nigerians. These challenges underscore the urgent need for improvements in healthcare access and infrastructure to better manage hypertension and cardiovascular diseases.

What are the most common challenges faced in the treatment and management of hypertension in Nigeria?

The treatment and management of hypertension in Nigeria are fraught with challenges. One major issue is the low level of public awareness about hypertension, which hinders early diagnosis and effective prevention. Economic constraints, such as the high cost of medications and diagnostic services, also limit access to necessary care. Additionally, systemic problems such as inadequate funding, inefficiencies, and corruption within the healthcare system compound these challenges. These factors collectively impede effective hypertension management and highlight the need for targeted interventions to address these obstacles.

Are there any recent initiatives or programmes in Nigeria aimed at reducing the incidence of high blood pressure and improving cardiovascular health? If so, what have been the results?

Yes, the Hypertension Treatment in Nigeria (HTN) programme is a recent initiative aimed at reducing the incidence of high blood pressure and improving cardiovascular health in Nigeria. This programme seeks to address gaps in hypertension assessment and management by adapting, implementing, and evaluating the World Health Organisation’s (WHO) HEARTS technical package across 60 primary healthcare facilities in the Federal Capital Territory.

The HTN programme recognises that stronger primary healthcare services for hypertension can reduce the burden on secondary and tertiary care facilities, where such services have historically been provided in Nigeria. The programme has shown promising results, achieving over 90 per cent treatment rate and a 50 per cent hypertension control rate among 21,000 registered patients between January 2020 and December 2023.