A. B1,ADEMOLU A.O2,OGUN Y3,OKE D1,KADIRI S. 4 CORRESPONDENCE TO PRIMARY AUTHOR DR ADEMOLU A.B. (firstname.lastname@example.org) 08033575940
- Department of Medicine, Lagos State University Teaching Hospital,Ikeja.Nigeria
- Department of Paediatrics, Olabisi Onabanjo University Teaching Hospital.Sagamu.Ogun State.
- Department of Medicine, Olabisi Onabanjo University Teaching Hospital.Sagamu Ogun State.
- Departmentof Medicine. University College Hospital,UCH,Ibadan,Oyo State Nigeria
HYPERTENSION IN IKORODU:A COMMUNITY SURVEY
OBJECTIVE/BACKGROUND:Increasing evidence of hypertension and its sequelae was observed amongst the inhabitants of a rural community in ikorodu.It is with this background that we review the prevalence of this condition in the community.The aim of this pioneer study in a rural community,maya, ikorodu is to determine the prevalence of hypertension. METHOD:The blood pressure of 54 maya dwellers(mayaites)aged between 25-72years were taken with a mercury sphygmomanometer after obtaining consent through their opinion leader. The exercise lasted for 3 hours with each of the participants taking turns. RESULTS:The prevalence of hypertension was 61.1% among these rural dwellers with a male to female ratio of 1:1. DISCUSSION:The literature that put the prevalence of hypertension in rural communities in Nigeria as 5-7% needs to be reviewed as this appears to be obsolete based on this study. CONCLUSION:Since hypertension cannot be eradicated,then concerted effort should be put in place by our government towards primary prevention.Banning the use of tobacco will be an efficacious national health policy towards primary prevention of hypertension. Key Words:Hypertension,prevalence,rural community,systolic hypertension.
The scourge of hypertension is worldwide from the time of Hippocrates till date it has gradually and consistently emerged and affected millions of worlds population with variable morbidity and mortality. Over the years,decades and centuries the definition of hypertension has changed with reduction in the value to the presently acceptable value of systolic of 140mmHg and diastolic of 90mmHg according to JNC-7th definition sustained by JNC-8th.Presently about 1 billion of worlds population are hypertensive using the JNC-7 criteria,see table one.The world health organisation and international society of hypertension criteria is also shown in table two. TABLE 1 JNC-7 BP classification Systolic Diastolic Normal 160 or >100 TABLE 2 WHO/ISH 1999. _____________________________________ Category Systolic Diastolic Optimal180 >110 ISH >140 &METHODOLOGY The blood pressure of 54maya dwellers were taken in a day after obtaining consent through their opinion leader .The exercise lasted for 3hours with each of the participants taking turns,the mercurial sphygmomanometer was used to measure the blood pressure at heart level.The community maya is in ikorodu north local government council development area of lagos state.It is a new site and a developing area that has experienced continuous in flow of inhabitants in the past few years due to overpopulation and increased cost and standard of living in the Lagos metropolis. Demographic data was collected by allotting numbers to each participant and each participant asked to state their age and sex against their allotted number at the beginning of the exercise.The data was analysed with respect to age,gender and decades of life.None of the participant took alcohol nor smoked a least 24hours before measurement of blood pressure and no medication was taken at least 4hours to the exercise.
A total of 54 participants were recruited with age range 25 to 72years.Of these 28(51.85%) participants were male while 26 (48.15%)participants were female. Thirty three participants were hypertensive representing a prevalence of hypertension of 61.1% amongst these rural dwellers.Of these hypertensives 16(48.49%)were males and 17(51.51%)were females.Hence the hypertensive prevalence in males was 29.6% while 31.5% in females. Further analysis of the hypertensives showed that 32(96.97%)had diastolic hypertension,24(72.73%)had systolic hypertension and one(3.03%)had isolated systolic hypertension grade one in a 50year old female hypertensive.Also 23(69.70%)of them have both diastolic and systolic hypertension.See table 3.
TABLE 3: PERCENTAGE OF HYPERTENSIVES VERSUS TYPES OF HYPERTENSION
(BLUE— HYPERTENSION IN FEMALE RED— HYPERTENSION IN MALE) Genderwise,10(30.30%)males had both diastolic and systolic hypertension,while 13(39.39%)were female with both.Equal numbers of males and females hypertensives have diastolic hypertension which is 16(48.49%)per gender.In contrast,14(42.42%) female hypertensives had systolic hypertension compared to 10(30.30%)male systolic hypertensives. Analysis of age group(in decades of life)with respect to hypertension showed that their was none in the third decade of life(20-29years).In the fourth decade of life(30-39years)4(12.12%)hypertensives were found and all four were female. In the fifty decade of life(40-49years)13(39.39%)hypertensives were found.In the sixth decade(50-59years)10(30.30%)hypertensives were found.In the seventh decade(60-69years),4(12.12%)hypertensives were discovered.In the eighth decade(70-79years)2(6.06%)were found. See table 4.
TABLE 4 DECADES OF LIFE WITH PERCENTAGE OF PREVALENCE OF HYPERTENSION
|DECADES OF LIFE||PERCENTAGE OF PREVALENCE OF HYPERTENSION|
The pulse pressure range was from 12 to 74mmHg with a mean pulse pressure of 46.85mmHg.The mean arterial pressure range was from 100 to 143 among the hypertensives with a mean of 114.696.
The literature that put the prevalence of hypertension in rural communities in Nigeria as 5-7% needs to be reviewed as this appears to be obsolete based on this study. This study is the pioneer study on hypertension in ikorodu a suburb of lagos with an alarming prevalence of 61.1% despite the rural nature of the geographical location of the study area.It is worth noting that this prevalence is even higher than the 20% quoted for urban area in Nigeria.In China a previously reported urban-rural difference in the prevalence of hypertension was not noted in a follow up study, perhaps due to a rapid increase in the prevalence of hypertension in rural China(18).A World Bank aided pilot project in two districts of Tamil Nadu in India, aimed at preventing cardiovascular diseases, has found that people in rural areas, especially those aged above 30 years, are becoming more prone to hypertension, resulting in heart ailments. This may be the trend in Nigeria especially with this findings which puts two out of three adults as having hypertension in a rural community compared to one in three found among African americans and worldwide. The male to female ratio was approximately 1:1 with a very slight female preponderance,not only these all the hypertensives in the fourth decade of life were females this raises the question why females under 40years are more prone to hypertension .Could this be the effect of oral contraceptives or child bearing?More studies are suggested. The third decade of life had no hypertensives in this study.The fifth decade had the highest record of hypertensives 39.39% which is not unusual compared to previous studies on hypertension.In the sixth and seventh decades of life.two out of three participants in that age group were hypertensive while, the two participants in the eighth decade of life were both males and were both hypertensive supporting the fact that hypertension prevalence increases with age. The only case of isolated systolic hypertension was in a 50year old woman,isolated systolic hypertension, when combined with other risk factors such as poor diet and lack of exercise, can lead to health challenges, such as stroke,Heart disease chronic kidney disease,dementia(19). Diastolic hypertension was found in all the hypertensives except the one with isolated systolic hypertension while only 24(72.73%)had systolic hypertension.This shows diastolic hypertension was commoner among these rural dwellers than systolic hypertension. The hypertensive with the lowest pulse pressure of 12 is in the fifth decade of life(46years)while the one with the highest pulse pressure of 74mmHg is in the sixth decade of life(65years).The mean of the mean arterial pressure was 114.696 this might explain why cerebrovascular accident is not a common finding amongs hypertensives living in this rural area since cerebrovascular accident tend to occur at higher mean arterial pressure when autoregulation is disrupted usually at mean arterial pressure above 145,the highest was 143 in this study.Further studies are suggested on the relationship between mean arterial pressure and cerebrovascular and cardiovascular risk factor(20). The role of lifestyle modification in the non-pharmacological management of hypertension cannot be overemphasized in these rural dwellers in a developing country like ours were financial constraints is a major issue in drug procurement and medical treatment policy is out of pocket. There is sufficient empirical evidence to support five areas of lifestyle modification to decrease the risk of developing HTN. These include weight control, increased physical activity, limited alcohol intake, no tobacco use, and reduced dietary saturated fat and sodium. Smoking causes a significant rise in BP and contributes to increased cardiovascular mortality. Cardiovascular mortality increases in African Americans when the average consumption of alcohol is greater than one drink a day yet binge drinking (more than five alcoholic drinks at one sitting) occurs in 14.5% of African Americans, and 4.5% are considered to be heavy drinkers (21).Habitual ingestion of high levels of dietary salt (NaCl) is associated with increased blood pressures.Although not unique to any one racial/ethnic group, increased BP sensitivity to salt ingestion continues to be postulated as a key factor in African American hypertensives,It therefore follows that these rural dwellers should take a cue from African Americans by not smoking,limit alcohol intake with salt.
Since hypertension cannot be eradicated,then Concerted effort should be put in place by our government towards primary prevention.Banning the use of tobacco will be an efficatious national health policy towards primary prevention of hypertension by encouraging no smoking policy in public places.For hypertensives,health policies like placing very high import duties on alcohol and heavily taxing the locally made ones along with subsidising anti hypertensive drugs will help reduce the morbidity and mortality associated with the disease both among the rural and urban dwellers. ACKNOWLEDGEMENT:I appreciate all those who in one way or the other contributed to the success of this research article. DISCLOSURE:Nothing to disclose.
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