How High Blood Pressure won award of “Silent Killer of the year”

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High blood pressure is particularly noted for its stealthy nature, so unlike many diseases, the presence of high blood pressure may not show by tangible signs and symptoms about which the sufferer can be aware.  Sometimes, the first indication of high blood pressure in a victim is severe complications, such as stroke or death, especially among people who do not routinely undergo medical check-up.  Hence the disease has attained the notorious appellation of “the silent killer”.   

Although hypertension sufferers may not feel the presence of the disease, borne over time unchecked, high blood pressure can wreck serious damage on a number of important organs and systems, which often results in severe health problems and death. Severe complications of high blood pressure include the following which will be discussed individually:

1.      Cerebra – Vascular Accident (CVA), commonly known as stroke.
2.      Kidney damage, leading to kidney failure or inability to produce urine.
3.      Congestive Heart failure
4.      Mental deterioration.
5.      Visual disturbances.

The 5 agents of Mr. Silent Killer

 .  Stroke (or Brain Attack)   
This is one of the most sudden and severe complications of high blood pressure.  It is often the cause of sudden death or disability from high blood pressure.  Stroke which is medically known as Cerebra – Vascular Accident (CVA) or brain attack is usually as a result of a rupture of a blood vessel, usually a small artery in the brain, causing lack of blood supply to affected part of the brain. At the same time, collection of blood from the ruptured vessel may cause severe pressure on the brain.  If the affected vessel is fairly large or plenty of blood escapes into the brain tissue, that means the stroke is severe, and depending on the part of the brain involved, the person may die almost immediately or shortly after.  This is the common cause of death in sleep.  Otherwise, any of the functions of the brain may be interfered with, which may show in many ways, including paralysis of one side of the body.
High blood pressure usually causes rupture of small blood vessels in the brain because the brain tissue is very soft, almost as soft as pap (ogi).  As a result, the brain cannot provide support for blood vessels as muscles and other structures do.  Under the pressure that hypertension or high blood pressure exerts on the walls of arteries, weak sections develop in the walls of small arteries in the brain which can easily stretch and rupture, causing stroke.  When stroke happens on the left side of the brain, it is the right side that gets paralyzed, and vice-versa because each side of the brain controls the opposite sides of the body.  Death in sleep as a result of stroke frequently occurs because blood pressure is usually highest when lying down than when sitting or standing, declining in that order.  So, without an immediate predisposing factor, long standing high blood pressure, which has not been diagnosed or properly managed, is more likely to result in death while asleep.
“Often, they behave as if they are mentally ill, unable to carry out simple mental functions like remembering and proper reasoning. In effect, the person changes drastically from what he had been known.  It is usually very sad to see an erstwhile outstanding individual loss his personality”.
Kidney Damage
High blood pressure that is not controlled with medication over a long period of time gradually destroys the structures of the kidneys which form urine.  As a result, uncontrolled hypertension is one of the commonest causes of kidney damage and renal failure.  Unfortunately, nothing can be done to change kidney or renal failure caused by high blood pressure.
The kidneys are the organs that form urine.  Urine is the means by which the body gets rid of most of the toxins and wastes produced by the various tissues and organs in the body.  When the kidneys fail, it means that they can no longer form urine, therefore toxins and waste product pile up in the body.  Obviously, such a person cannot last more than a few miserable days as his or her body cells and tissues are poisoned by the wastes they produce.

Heart Failure
We have earlier observed that with high blood pressure, the lumen of the blood vessels becomes narrower as the vessels are no longer elastic or able to expand.  As a result, the heart has to use extra force to be able to pump blood through the resistant vessels.  In addition, with more weight, the individual’s total body area through which blood has to be pumped increases, requiring more pumping work for the heart.  The workload for the heart is thereby increased.  Very often, this extra labor that the heart has to undertake makes it to become larger in order to be able to cope.
However, there is a limit to which the heart can adapt to carry out the extra labor involved.  Soon, the heart is unable to continue with the extra labor, so it becomes weaker and weaker until it is unable to pump blood around the body effectively.  The heart is then said to fail.  In heart failure, fluids pile up in different parts of the body as the heart is no longer able to pump  blood strongly enough to return all the blood to the heart and for the kidneys to form enough urine to get rid of excess water and waste products from the body. This is called congestive heart failure because the lungs and other parts of the body become congested with fluids and toxic substances.
Consequently, the legs of someone with congestive heart failure may swell with fluids in the form of edema and/or the abdomen may fill up with fluids.  Collection of fluids in the lungs often makes breathing difficult and even minor exertion may make the person feel weak and breathless as the heart is unable to meet the extra demands that any exertion usually imposes.  Once the heart has started to fail, it cannot be cured although with proper medical care the person can still live a long and productive life.  Congestive heart failure therefore leads to a slow but sure death, unless the victim is unable to maintain continuous medical supervision, including complying with routine check up and medication regimen.

Mental Deterioration
Uncontrolled high blood pressure causing rupture of blood vessels in the brain does not always involve fairly large arteries to result in major bleeding and stroke. Sometimes, mini blood vessels known as capillaries are the vessels gradually damaged. Capillaries and the ruptures that occur are usually so small that only very small amount of blood may escape from each site, not enough to cause major problems as stroke.  However, the mini ruptures are usually progressive, spreading to more parts of the brain.  In time, the brain as a whole undergoes various kinds of degenerative changes as a result of inadequate circulation and pressure from the blood that escaped from blood vessels.
For example, the victim may develop premature loss of memory and other mental and physical capacities like someone who is some eighty or more years old, even though he might be in his forties or younger years. Often, they behave as if they are mentally ill, unable to carry out simple mental functions like remembering and proper reasoning. In effect, the person changes drastically from what he had been known.  It is usually very sad to see an erstwhile outstanding individual loss his personality.  Unfortunately, such mental deterioration is not reversible.

Visual Problems
Like the effects on the brain and kidneys, high blood pressure causes damage to the capillaries in the eyes.  This also leads to destruction of important structures of the eye and consequent gradual loss of vision.  As with the brain and kidneys, damaged tissues in the eyes and lost vision as a result of hypertension are not reversible.

Symptoms of Advance State of hypertension
Although hypertension is generally known as the “silent killer” because it may not manifest any symptoms before causing such havoc as stroke or death, advance stages of the disease sometimes show certain symptoms, which unfortunately are easily missed or misunderstood.  The most prominent of the symptoms are:

1.      Headache, especially early morning headache.
2.      Blurred vision, sometimes accompanied by dizziness.
3.      Spontaneous nose bleeding.

Anyone who experiences any or a combination of the above symptoms should immediately go to a doctor for check up as they can also be the only symptoms of an imminent stroke.

From the Book; “Early and Sudden Death; the Price of Affluence among Nigerians”

(Read “The Rise & Rise of Heart Attack in Naija” tomorrow on Asabeafrika)

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