Early screening key to managing hypertension

Ahmad Tewungwa, 64, did not know he had high blood pressure until 2018 when he went for a check-up at the Red Cross offices in Busia District, Eastern Uganda. When the results came, they showed he not only had high blood pressure, also known as hypertension, but also ulcers and diabetes.

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However, even after starting treatment, his condition continued to deteriorate until he was referred to Mulago National Referral Hospital in Kampala.

“At the Uganda Heart Institute (UHI) in Mulago, Kampala, I was given medication and after a few days, I felt better. I was discharged and told to return for checkups but because I thought I had been healed, I did not,” he says.

Last year, Tewungwa was admitted as an emergency case at the UHI.
“I could barely breathe, walk or talk and my legs were too swollen to even wear shoes. Although I am now better, the medication I have been prescribed is too expensive, costing up to Shs500,000 a month,” he says. 

Silent killer
It takes time for one to start noticing the symptoms of hypertension. Usually, one will notice when the disease has advanced is manifesting through complications such as headaches, tiredness, shortness of breath, and blurred vision, among others.

According to Dr James Kayima, a consultant cardiologist at UHI, hypertension is more common now as a result of many people eating junk and oily foods that are usually over salted. Such foods often cause an increase in weight; a risk factor of the disease. 

“We see more cases of high blood pressure in patients between the ages of 25 and 35 who are obese. In Uganda, it is estimated that 30 percent of the population (about 13 million people) have high blood pressure which puts a strain on the health system,” Dr Kayima says.

What is hypertension?
High blood pressure is a disease of the blood vessels. Ideally, the function of the heart is to pump oxygen-rich blood to the rest of the body for proper function.  For the heart to be able to pump, it needs to generate pressure.

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It is that pressure that the healthcare worker measures when one goes to the hospital. When the blood vessels against which the heart pumps this oxygen blood starts to become narrow, the heart has to generate a higher pressure for it to perform its duty.

Types
Essential (primary) hypertension is the commonest form of high blood pressure and it occurs when you have abnormally high blood pressure which is not a result of a medical condition. This form of high blood pressure is often due to obesity, family history and an unhealthy diet. The condition is reversible (not curable) with medications and lifestyle changes.

Secondary hypertension on the other hand is caused by a medical condition. It can be caused by conditions that affect the kidneys, arteries, heart or hormonal imbalances. Secondary hypertension can also occur during pregnancy, causing preeclampsia and eclampsia if not controlled. 

“This type of hypertension is treatable by fixing the primary cause. If we find that the cause is a kidney problem and solve it, that blood pressure can be cured.” Dr. Kayima says.

Risk factors
According to Dr Kayima, if your mother or father had high blood pressure, you have a higher risk of getting it compared to someone who had only one parent suffering from the disease.

Dr Kayima warns that the more the fat one accumulates, the higher the risk of getting hypertension.

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Also, someone who lives in a highly stressful environment is prone to developing high blood pressure.

“Age is also a risk factor. For example, 5o percent of people above the age of 50 have high blood pressure,” Dr Kayima says. Eating too much salt and being overweight or obese can also raise your blood pressure.

Complications 
Because the lining of the blood vessels is not as smooth as it should be, one starts developing clots in those blood vessels and together with the narrowing, one can easily get a stroke or lose sight, especially if these small blood vessels in the eyes are destroyed as well.
Uncontrolled high blood pressure in men can cause erectile dysfunction.

Complications in pregnant women
“It is important to note that when a woman suffers from high blood pressure during pregnancy, even after treatment, they remain at a higher risk of developing high blood pressure later in life,” Dr Kayima says.

A pregnant woman can suffer preeclampsia, a multisystem disorder characterised by new onset of hypertension after 20 weeks of gestation or postpartum in a mother who previously had normal blood pressure. 

According to Dr David Nsiime, a gynaecologist at Case Hospital in Kampala, the risk factors of preeclampsia include previous pregnancy with preeclampsia, especially early onset and with an adverse outcome, multiple faetuses and chronic hypertension (if a mother has type 1 or 2 diabetes mellitus). 

Others include chronic kidney disease, auto-immune disease with potential vascular complications (antiphospholipid syndrome, systemic lupus erythematosus), obesity, a family history of preeclampsia in mother or sister, advanced maternal age (above 35 years) and previous adverse pregnancy outcome such as a stillbirth.

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A pregnant woman should watch out for symptoms such as upper abdominal pain, headache and visual disturbances. Extreme cases involve convulsions with reduced level of consciousness
According to Dr Nsiime, management is geared towards ensuring maternal systemic organ function (if not compromised) with the ultimate plan of delivering the placenta and the foetus.

After delivery, there is need for post-delivery long term follow up with the aim of keeping one’s blood pressure normal as well as prevention of recurrence.

The most common challenges in the management of preeclampsia is that it is associated with pre-term delivery with all the notable complications and care; foetal growth restriction, still birth, early detachment of the placenta (while the foetus is in the uterus), and maternal convulsions.
Dr Nsiime says mothers should be educated on regular blood pressure monitoring, screening for hypertension (HTN), cardiovascular disease (CVD), Chronic Kidney Disease (CKD), Diabetes mellitus (DM), Post-traumatic stress disorder (PTSD), depression, appropriate weight, a healthy diet, as well as exercise. 

It is also important that a mother starts early antenatal visits in order to be started on medication which can lessen the risk of getting pre-eclampsia. Being a high risk state, it is better the mother is seen by a gynaecologist.

Potential future treatments
Researchers have been studying the use of heat to destroy specific nerves in the kidney that may play a role in resistant hypertension. The method is called renal denervation.

Early studies showed some benefit. But more-robust studies found that it does not significantly lower blood pressure in people with resistant hypertension. More research is underway to determine what role, if any, this therapy may have in treating hypertension.