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

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

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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

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.

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.
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.
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
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
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.
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
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
.  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.
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
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.
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.
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.
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.
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
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.
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
From the Book; “Early and Sudden Death; the Price of Affluence among
(Read “How to manage Big Man Belle in
good & bad times” tomorrow on Monday at Asabeafrika)