Read-to-Live Series: 5 deadly causes of high blood pressure & hypertension

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The basic cause of high blood pressure is a major reduction in the hole or lumen and/or elasticity of blood vessels, especially arteries, resulting in their inability to expand adequately when the heart pumps blood into them.  As a result, both the systolic and diastolic pressure within the vessels rises above normal.  A number of conditions may lead to reduction in the elasticity of arteries or the size of the inner hole of arteries, including aging, general level of anxiety, and overweight, which are explained below in the 5 new findings.

As most individuals advance in age, like all body tissues and processes, their blood vessel walls undergo deterioration, including gradual reduction in the elasticity of the walls of the arteries.  Consequently, the arteries slowly lose the ability to expand adequately, causing gradual increase in blood pressure.  Hence, as individuals grow older, usually after age 50, their blood pressure gradually rises and may reach disease level, that is 140/90 or above.  Therefore, many people do develop high blood pressure as they age, even without other factors that often lead to development of high blood pressure.  However, with persistent worry or high anxiety and/or overweight, people are more likely to develop high blood pressure much earlier than they otherwise would.
General Worry or High Anxiety 
Anytime we are in a situation of sudden risk to our safety and need to defend ourselves against an immediate danger, such as being confronted by a snake or a wild animal like the tiger, the body releases a certain chemical known as adrenaline, which increases the blood pressure by constricting the blood vessels and at the same time increasing the heartbeat.  This increases the general functional level of the body, which enables the person to fight or run away as necessary.  This is part of the body’s inbuilt defense mechanism of fight or fright that enables us to deal with situations of emergency. 
However, even in less dramatic conditions, such as worries or anxiety associated with everyday life and certain occupation like being the Chief Executive Officer (CEO) of a business enterprise or a top civil servant, the body produces a certain amount of adrenaline to enable us cope with the stress involved.  Over time, the resultant continuous constriction of blood vessels gradually leads to high blood pressure.  Hence individuals experiencing stressful daily life, including being a top executive and other high stress occupation are particularly prone to developing high blood pressure, even before they are 40 years old.

Of all the factors that contribute to high blood pressure, overweight or obesity probably tops them. One does not need to be massively fat to be considered overweight.  Once someone is as much as about 15% above his or her Ideal Body Weight (IBW), the person is considered overweight.  Obesity is an advance stage of overweight.  To avoid the confusing technicalities of defining and calculating ideal body weight, overweight and obesity respectively, we can draw on our familiar experiences to have a good idea of who is overweight.
In simple terms, by the time the man’s abdomen starts to bulge conspicuously or his “big man belle” has begun to show, he is probably overweight.  By the time his “big man belle” makes him look like a pregnant woman, he is obese.  When a woman starts to look full all over and/or carries an abdomen as if she were pregnant, she is probably overweight.  When a woman has lost shape and looks more like a sack, she is probably obese.  Unfortunately, among Nigerians, overweight is generally considered a desirable evidence of good living, as already pointed out.  This so-called evidence of good living is in fact the result of deposits of large amounts of fat in different parts of the body, which may tilt the scale way into the level of obesity by the time people start to say “this is getting too much”.
“When a woman starts to look full all over and/or carries an abdomen as if she were pregnant, she is probably overweight.  When a woman has lost shape and looks more like a sack, she is probably obese.  Unfortunately, among Nigerians, overweight is generally considered a desirable evidence of good living, as already pointed out”. 
As fat is deposited in conspicuous places, so it is also deposited in or around organs and tissues which we cannot see from the outside, including the inner lining of blood vessel walls.  Fatty deposits in the inner wall of arteries reduce the size of the arterial channels and this has the same effect as if the arteries were constricted.  That raises the blood pressure.  Gradually, calcium is deposited in the fatty material and this is known as plaque.

Consumption of a Lot of Salt
The table salt is an important part of our diet because salt is an important part of many body secretions and it is needed for many important chemical processes in the body, including appropriate retention and movement of fluids among different tissues and organs.  When we consume more salt than the body needs, the excess is excreted with different body fluids, such as sweat, tears, urine and faeces.  Sweat is the principal means by which we lose salt from the body.
Salt has the inherent ability to attract and retain water.  The amount of salt consumed by the individual depends on personal taste and habit.  When we form the habit of consuming a lot of salt, the body finds it difficult to excrete all the excess salt, especially as we grow older, engage in less physical activities and therefore sweat less.  Excess salt in the body leads to retention of more fluid than needed, which eventually increases the volume of blood in the circulatory system.  This in turn increases the blood pressure. This is why many of the medicines for the reduction of blood pressure also make people to urinate more frequently so as to lose more salt and water in the process.

Lack of Medical Check-Up
Although failure to undergo medical check up does not by itself contribute to development of high blood pressure, it is the root cause of failure to realize in time that one has developed the condition until serious damage has been done.  As already discussed earlier, high blood pressure is notoriously known as the “silent killer”.  There may be no sign and symptoms to alert anyone to the presence of high blood pressure in an individual until something drastic like stoke or even death has occurred.  Before then, however, a lot of damage must have been done to various organs and systems. For example, damage to the kidneys is common among high blood pressure sufferers long before the condition is diagnosed.
Very often, it is by accident that someone is found to have high blood pressure, either during an unrelated health condition or in a casual check of the blood pressure.  I have made it a routine to take my blood pressure machine with me almost anywhere and to check my relations, friends and acquaintances whenever convenient.  Consequently, I have found many of them who were going around with dangerously high blood pressure without knowing.  These are people who never bother or have the opportunity for a routine medical check up.  Obviously, not many people have the luck of having an over zealous community health relative like myself to discover their raging high blood pressure.
The fact is that in our traditional culture, people do not go to the hospital or doctor, traditional or Western, unless they are sick. This has nothing to do with the knowledge or access to such facilities; it is just part of the way we have always lived.  In spite of the wealth and education of most middle class Nigerians, the same attitude is common.  This reminds me of the sprawling estate I was once shown in my state capital, which was said to belong to a late Deputy Inspector General (DIG) of Police.  He was said to have died very young, maybe in his late thirties to early forties but I have no way of telling exactly how old he was since I did not know him personally.  He was reported to have said in a social function barely a week before he died suddenly without evidence of any illness.  “Those of us who are athletic have been built to last!”  And he died barely one week after that memorable statement.
The indication was that he probably died of massive stroke from hypertension or as a result of heart attack.  It would be “un-Nigerian” for such a man of relatively youth, vivacious energy, immense socio-economic power and a huge sense of invincibility to think of going to the doctor for check up like a weakling when he did not feel ill.  It would be difficult to convince such an individual otherwise.  It would have mattered very little how much knowledge or access to medical services he had.  A man of the status of a DIG cannot be said to be uneducated or uninformed. Most middle class Nigerians are well suited for the factors that could have made it difficult for the late DIG to seriously consider routine medical check up.  Without routine medical check up, most cases of high blood pressure remain undetected until havoc is done.
Even when told that they have high blood pressure, most Nigerians do not take the disease seriously simply because they do not feel ill, have any pain or some other symptoms of an illness.  They therefore do not believe that anything is seriously wrong with them.  Consequently, they often miss medical appointments because they were either too busy or they conveniently forgot.  By the same token, they do not comply with their medication regimen. Many get tired of taking medicines “when not sick”.  The common attitude is that if something is actually wrong, obviously western medicine cannot really help.  This is based on the cultural belief that the right medicine is supposed to cure the disease.  The belief is that if you have to take any medicine continuously for the same disease, it is certainly not the right medicine for the disease.  And this mindset reminds me of the case of a cousin of mine.
His high blood pressure had progressed to congestive heart failure (see the section on “Heart Failure” for explanation) before I traveled overseas for post-graduate studies.  He was a successful clothes merchant and had an old friend of his who became a medical doctor and was taking very good care of him.  I was then a Nurse Tutor and I had taught him all about his condition and the need for him to always comply with his check up and medication regimen.  I returned from my studies to find that my cousin had recently been moved to a popular native doctor in a village because he wanted to be cured of the disease, instead of having to take medicines all his life.   I immediately rushed to the village because I knew that without proper medication he would not last long.  In the village, I was told that he had moved to some other native doctor elsewhere, probably because his condition must have worsened.  I could not trace him and he died barely two weeks later.
Although my cousin was economically well off to qualify him as middle class by my earlier definition, he had no formal education, which posed additional problem for his understanding.  His major problems, however, were cultural and attitudinal, and these are about the same for most Nigerians, middle class or not.  It is just as difficult to convince most middle class Nigerians of the need to go to the hospital or doctor when they are not sick or take medicines religiously all their life, especially when not in obvious distress.  Even when in distress, our cultural attitude as already pointed out is that a medicine that actually works should be able to cure the disease for which it is meant. Even when educated enough to understand, there is always the tendency to believe that somehow, there must be some cure to the so-called chronic diseases, like hypertension or high blood pressure.
This problem becomes more daunting with high profile native doctors and the so-called men of God who make reckless proclamation of their ability to cure and prevent all types of diseases, including high blood pressure, AIDS and heart attack.  They have become more convincing as most of them have some medical background and the money that enable them use the mass media and precise medical terms.  This situation borders on irresponsibility on the part of government and other regulatory authorities to allow obvious misleading of the public by such false claims.
Our cultural attitudes are so painfully pervading on the issue of health and illness that even those who are supposed to know by virtue of their learning still behave otherwise.  For example, I have known some nurses who advised patients to go to native doctors because they claim, “Oyibo medicine no good for this kain sickness”.  I am talking about such simple conditions as fracture.  What about some highly educated Nigerians, including medical doctors, who frequent native medicine men and women for divination and other spiritual support, even in health related matters? Although we may be rationally aware of certain facts, our pre-established cultural orientation often determined our behavior, even when contrary to rational information.  This is a case of a gap between intellectual awareness and attitudinal disposition, which is common in health-related behavior.

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

(Read “How to manage Big Man Belle in good & bad times” tomorrow on Monday at Asabeafrika)

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