Premium

Blame your ancestors for high blood pressure Dr Robert Madenge

HEALTH

Dr ROBERT MADENGE who is  head of cardiology at Nairobi Hospital spoke to ESTHER DIANAH about diet, women and hypertension.

Is Hypertension and High Blood Pressure the same?
They are literally the same condition. It is the pressure that drives blood through your blood vessels. So, if the pressure is low, blood may not get where it is going, if it is too high, it can then cause damage to those vessels.

When does it become a problem to take blood pressure?
The diagnosis of high blood pressure is something that needs to be done very carefully, because blood pressure can be affected by so many things. There are circumstances under which blood pressure should be taken. Blood pressure should never be taken when just walked into a place, you need to rest for 10-15 minutes, that allows all the changes in blood pressure. Also, if you take tea or coffee, you should wait for at least 45 minutes before you take the blood pressure because caffeine will raise your blood pressure. One should also empty their blood before taking blood pressure. There are also people who get anxiety while in the hospital environment.

What are some of the symptoms of high blood pressure?
We do not rely on symptoms for high blood pressure. If you wait for symptoms, you are going to be in trouble. Pressure coming up in your system is usually silent most of the time.

But Care seeking behaviour doesn’t do very well in our communities, until you feel pain…..
Not relying on symptoms is the real problem with high blood pressure, but about 10 percent of people might feel something, the majority don’t feel anything. Some people feel some headache, but the reason we cannot rely on that is because 9 out of 10 may not feel that. So, if you tell people if you don’t have headache, you might not have high blood pressure, then a lot of people will get in trouble. So sometimes when you wait for symptoms, it presents in a catastrophic way. Most people are undiagnosed and do not know they have hypertension. A previous survey showed that about 20 percent of people with diabetes are on treatment, and women a bit more than men. We have a lot of poor outcomes driven by high blood pressure in society; stroke and heart attacks.

There are reasons why someone’s blood pressure can go high, but what causes it to be a disease? A constant high…
If you look historically, in 1929, someone went to Nyanza and looked at a group of people aged 15 to 70, and for over a two-year period, they did not find a single case of high blood pressure but found other diseases. If you go there now, you will find that at least 4 of those people will have high blood pressure. So, when you compare then and now, you wonder what happened, they said civilization caused the high blood pressure, this was a researcher.

I would call it colonization. It is westernization that has caused it, if you look at our culture, our dietary habits, physical activity habits at that time, what were our stress levels and management at that time, and what has civilization done to all those things.
We did not eat processed food, we didn’t have a lot of sweetened things, we ate fresh vegetables and farm produce. Number one thing causing high blood pressure is diet.

Women seem to be highly affected by high blood pressure, why?
Incidentally, obesity and body mass index is significantly associated with high blood pressure. It is interesting that in men you find a 27 per cent incidence of hypertension and obesity in Kenya it would be 27. In women, you find about 38 per cent incidence of obesity and 38 per cent incidence of high blood pressure. In other words, there is more obesity for women but there are other factors to consider like contraceptive pills and there are those conditional circumstances like pregnancy. There is something positive in this that you find there are more women on treatment than men. I think women are more in contact with the healthcare system than men. Men have been culturalized in Kenya in a certain way; that they are not dependent on people.

Can we talk about high blood pressure and not low blood pressure?
Incidentally, when you talk about high, you must talk about low. But we have very few problems with low blood pressure; low blood pressure also depends on context. You have to define the context; for instance, if you have high blood pressure and end up with low blood pressure, it becomes a question of, are you taking extra medication than you should? Low blood pressure is not a major issue.

Is hypertension curable?
For blood pressure, we talk about three things; detection, treatment and control. So, for the majority of the people we talk about control, because the things that bring blood pressure are not just lifestyle, we can also blame it on your ancestors. There is a bit of genetics that allows people’s blood pressure to go higher than it should as years go by. For some people after the age of 45, genetically their blood pressure goes high, for those people, despite the fact that they can benefit from lifestyle intervention, they may still need a little medication to take care of the changes in their blood vessels due to that genetic component. For those with secondary high blood pressure; caused by a specific disease, the treatment of high blood pressure will be treating that particular disease, those with secondary causes can be cured, and this is about 5 per cent. The other curable hypertension are those caused by lifestyle, diet, weight, lack of physical activity, smoking and alcohol.