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Hypertension: A danger that strikes unexpected

BY: Zadok Kwame Gyesi
A nurse checking the pulse of patient
A nurse checking the pulse of patient

When growing up, Elsie Nana Obeng (not her real name) dreamt of becoming either a banker or lawyer. But as fate would have it, she could not acquire the needed education to enable her live her dream. She managed to complete Senior High school, following the death of her parents.

Elsie, now 35 years old, is an orphan. She lost her father to stroke, resulting from complications of hypertension in 2005, when she was about to complete Junior Secondary School (JSS) now Junior High School (JHS). Her father lived with the condition for three years before giving up to the ghost, she disclosed.

With her father gone, she had to be raised together with three other siblings by her mother single-handedly at Agona Swedru in the Central Region. She was the second born among the four siblings.

Before Elsie could start tertiary education however, her mother also died in 2010, and with her banking and law dreams. Her mother, she indicated, also died from hypertension. 

Now orphan and with huge responsibility to help take care of her other younger siblings, Elsie could not further her education since there was no one to take care of her educational bills. She and her elder brother, who was just two years older than her had to engage in temporal (menial jobs) to take care of themselves and that of their two younger siblings. They received very little support from their parents’ families.

Elsie is now a shop attendant in one of the popular supermarkets in Accra where she works to earn a living. Even though she is just 35 years old, she tells me she had been diagnosed with hypertension, a condition she says constantly reminds her of what killed her parents.


For Elsie, hypertension, has become a grave enemy to her family.

“It looks as though we have been cursed. All my siblings have hypertension; it is has become our inheritance,” she bemoaned.

Elsie’s story underlines the high incidence of hypertension among the Ghanaian population. One major health problem in Ghana which has become a leading cause of hospital admissions and death is hypertension. In fact, the statistics are dire and health authorities are very worried about the situation.

The worrying trend

Hypertension, according to the Ministry of Health (MoH), is the second leading cause of outpatient morbidity among adults beyond 45 years and accounts for more than two-thirds of all medical admissions in the leading teaching hospitals and over 50 per cent of all deaths in Ghana.

The Ministry of Health describes hypertension as a “silent killer” if not controlled, as approximately 34 per cent of the adult population are hypertensive, with many more affected people unaware of their status or undiagnosed.

Hypertension, which is commonly referred to as high blood pressure (BP), is a condition in which the blood vessels persistently receive high pressure. The higher the pressure in the blood vessels, the harder the heart has to work in order to pump blood.

This condition is not peculiar to Ghana alone but Africa in general, as countries struggle with both communicable and non-communicable diseases.

Nearly 1.3 billion people globally suffer from hypertension, increasing their chances of stroke, kidney and heart related diseases.

According to the World Health Organisation (WHO), some 17.9 million people died in 2019 from cardiovascular diseases, accounting for one in three global deaths, with hypertension a major factor.

Similarly, the Ghanaian Society of Cardiology (GSC) say uncontrolled and undiagnosed hypertension is driving huge numbers of preventable deaths and disabilities from cardiovascular diseases and non-communicable diseases locally and globally.

What makes the prevalence of the disease a major concern is the fact that although hypertension control is achieved through effective and continuous treatment, official figures in Ghana show that only 36 out of every 100 diagnosed people are currently taking their medications, which itself indicates a possible significant roadblock in access to and availability of treatment.

The scarring statistics

The Ghana Health Service (GHS) has sounded an alarm about the high incidence of hypertension and diabetes among the public, including children, within the Accra Metro space since the outbreak of COVID-19 pandemic in Ghana.

The acting Director of the Non-Communicable Disease (NCD) Directorate of the GHS, Dr. Efua Commeh, is quoted of having said that 11,046 cases of hypertension were recorded in 2019, while 9,248 were recorded in 2020.

Diagnosis

Hypertension can be easily diagnosed by monitoring blood pressure, and treated with low-cost drugs, but half of the affected people are unaware of their condition which is left untreated.

"It is far from being a condition of affluence, it's very much a condition of poverty," Majid Ezzati, professor of global environmental health at Imperial College London, told a news briefing, adding that "Many parts of sub-Saharan Africa, parts of South Asia, some of the Pacific island nations, they are still not getting the treatments that are needed."

Education

A Research Fellow at the Kintampo Health Research Center (KHRC) in the Bono East Region, Dr John Amoah, is one of the research scientists in Ghana who has been advocating for more education on hypertension prevention in Ghana.

“High blood pressure usually causes no symptoms underscoring why it’s been labelled the silent killer. People who have high blood pressure typically don't know it until their blood pressure is measured,” he explained.

He noted that apart from genetic risk factors for hypertension, there are modifiable risk factors linked to lifestyle, pointing out that unhealthy diets, physical inactivity, tobacco and alcohol consumption, uncontrolled diabetes, and being overweight, all contribute to hypertension.

He explained that hypertension is quite high in the adult population of the country, noting “it is risky because of its health implication.”

For Dr Amoah, “if someone has hypotension and the person does not seek medical care to control it, it could lead to a lot of risky health issues such as kidney failure, heart attack, stroke, some form of disability and death.”

He said one of the best ways for people to check their status and work at it was for them to go to professionals to check it, saying “the most important thing that we always ask people to do is, whether you have it or not, you have to go and check. So when they go and check and they have it, then they'll be put on medication and healthy lifestyle behaviours.”

He expressed the concern that the rising cases of hypertension among both the adult and young population of Ghana was partly due to lifestyle (people not eating well) behaviours and lack of exercises.

“Generally, hypertension is caused mainly by lifestyle behaviours to start with. People are not exercising; people are living sedentary lives: from their homes to their office; they are in their vehicles, back they are also in their vehicles, going to church and markets they are in their vehicles. The issue is people should be doing certain form of exercises. Physically, a lot of people are inactive,” Dr Amoah, explained.

He cautioned against the high intake of sugary and salty foods, noting that many people are consuming a lot of salt, oil, fat and sugar in their diets.

“Now, when people are eating, they want their food to be tasty so they add a lot of salt and too much salt isn't good for our health. High salt intake, high fat intake and our usual fast food that contains species, and these species are made with a lot of salt,” he observed.

He said high consumption of alcohol as well as smoking all contribute to hypertension, adding that “too much alcohol is not good. It could lead to hypertension, other kidney and liver issues.”

Dr Amoah expressed the concern that hypertension is increasing in Ghana and other parts of Africa due to the lack of education on the disease.

“There lack of education for people to go and check their status is part of the reasons why the condition is going high,” he noted, pointing out that the disease poses a lot of risk factors to the victims.

“It can also cause damages to organs like the heart, liver and kidneys. In some cases, people who have high hypertension cannot be able to see clearly. So there is a form of blindness creeping in. It's very risky,” he explained.

Ways to bring figure down

The KHRC Research Fellow expressed worry that hypertension in young people, particularly those in senior High Schools (SHS) was going up, citing a study he conducted recently in four SHS in the Bon East Region.

He explained that although young people do not usually experience the risk factors of hypertension at younger ages, such factors show up when they advance in age.

“So this is how it goes; typically, young people don't get hypertension at that age but the danger is that the risk factors normally starts at the youthful age. Now you'll realise that most children can sit by the TV from morning to evening especially on weekends without doing anything. That's, the child is living a sedentary lifestyle, physically inactive,” Dr Amoah observed.

“I did a study among four secondary schools mostly teenagers and it was raised that majority of the students were physically inactive, their food intake was also not good, they ate many unhealthy foods,” he noted.

For him, the findings of the study indicated that 11 per cent of the students in SHS that he used for the study, who were between the ages of 16 and 19, were hypertensive.

Admonishment

He has, therefore, called for more education within the schools across the country to help educate the school children on hypertension and what to do to prevent the disease.

For Dr Amoah, it is better to draw the attention of the children to hypertension at tender ages than to wait for them to develop it before educating them on the disease.

He expressed concern about the unhealthy foods that many young people eat, saying such junk foods usually increase their risk factors of getting hypertension.

“So we need to do more of education in the newspapers, radio stations, TV and on social media about hypertension,” he called for, saying people can do simple exercises at home, reduce their salt, sugar and fat intake as well as consume more fruits and vegetables in their diets.

Dr Amoah further advised the public against smoking and alcoholism, saying reducing such behaviours could highly help people to stay away from hypertension.

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