Arterial Hypertension: The Killer!

In the midst of preparations to attend a funeral in my part of the Republic recently, I had an unexpected call from a close relation.  He requested, this time around, something different from his usual wishes. It had come to his notice that a 42-year-old son of an uncle, who “was no longer resident on our planet”, had been given a referral note to a university hospital, and he thought it might help if I knew what it could be all about.  Assuming the thought was right, we agreed to meet with the young man before attending the funeral. On entering the house after some two hours drive, I didn’t need any introduction, I could spot among a dozen people around the age of forty-and-above, who it was that I was to see, bulky, but tall also. His weight was what I could guess first.  He was around one hundred kilogrammes. His story had been that of a persistent headache for many months. He had been visiting the district hospital, but the pain “refused to subside,” he said. Lately, he would get up several times in the night and visit the bathroom, where he would pass different amounts of urine, sometimes little, but sometimes a lot.  Inspection was what I did most, since the situs was not condusive to any thorough medical examination. I use the digital “Sphyg”, a “vade mecum” wherever and whenever I travel, except to an advanced country, to get an impression of his BP.  I was very impressed, but sadly so.  He had a BP that scaled 235/145mmHg, and a pulse rate of 98/min.  He had been advised to purchase a Sphyg for himself, and had at one time done so, but it kept malfunctioning, he said. He had the sealed letter to the” referral center” in his hand, but courtesy would not let me pry into whatever it said. I advised him to get, as soon as possible, to the center to find out whether they could help him.  A week later, I got a call from him, and it said he had been to the center, and they had given him medication, and had added that he should report in six weeks. They would wash out some DIRT from his blood.  He seemed thrilled as he talked to me, and I was convinced his and MY FUN were divergent. In other countries, hypertension belongs to the domain of what is called “Internal Medicine.” In yet a number of countries, Cardiologists keep themselves busy with the dangerous entity dubbed arterial hypertension. I must add, there ought to be yet another category of countries where “every doctor” should develop an interest in handling effectively, HYPERTENSION. The explanation doesn’t need to come from any specialists, it must come from us all. For example, the Republic of Ghana, with a population of 25 million, has a maximum of 3,000 “practicing doctors”, and don’t be disturbed by the parenthesis. You may compare the statistics with Malaysia, with the same population thickness, but with 24,000 practicing doctors. I am sure most Ghanaians have been bombarded with the figures before.  Our Republic, so concerned in “keeping purity of the health service”, would screen doctors who may have excelled in countries like the United States of America, Germany and France, and declare them not qualified enough to practice in Ghana.  Exemption is when one qualified in the Republic of Cuba. Arterial Hypertension is, or has, become endemic in our Republic. Obesity, which has become so rampant, should be blamed.  That, in turn, has resulted from our eating habits and the lack of awareness to be coupled with any exercise-regimen, as part of our way of life. That would behoove every doctor to be concerned with gathering information about the state of BP of every patient that would come to consult him/her, no matter the reason of the consultation.  The said Physician would do well to keep monitoring the BP, within reasonable intervals, and bring the pressure down to normal, e.g. 125/65mmHg.  A pulse rate that lies between 60 and 100 per minute is internationally accepted as normal.  It is too slow when below sixty, and too fast when above 100.  The regularity of the pulse is important, and an irregular pulse may be referred to the Cardiologist for his assessment and management.  Should the state of the Blood Pressure be any cause for concern?  Yes indeed! A high BP, similar to Diabetes Mellitus, may accompany an individual for a long period of time, without any warning signs. It is true, though, that a persistent headache, may “befriend” hypertension. It is by no means the rule.  The type of arterial hypertension, which accompanies some individuals on the wrong side of the Body Mass Index (BMI), regularly would attain normalcy on exercising and dieting to reach the expected norm. What should be scary for all of us is the wheelchair, which one may, or may not, get out of. The mention of a wheelchair is linked with what is generally known as “stroke”.  In medical-technical parlance, expressions like (CVA) or Cerebro-vascular accident, implying a closure of a vessel resulting from nemesis from arteriosclerosis. With rupture of a big vessel, massive hemorrhage may not be survived, or when survived, sequels may not be “nice,” at all.  The onset is steadily pushing towards the younger age-group, like the late forties, early fifties, and the victims mostly lie on the “wrong side” of the BMI. Interestingly, or disappointingly, the proclamation of the nation having attained “middle Income status”, demonstrates what one would easily recognise in the streets of New York, or Frankfurt/Main, as morbid obesity.  The difference may be that whereas in New York, the favorable doctor/patient ratio is of an advantage, the same cannot be rattled off in the situation of Ghana.  The life-expectancy talked about in political circles may not reflect the reality.  A teacher resident in a middle-sized township in the Eastern Region made the observation of attending funerals in the last ten years, of men and women whose average age did not lie above sixty.  They were not slim, they were ill for a short period, and they were mostly paralyzed and unable to talk.  You won’t get a better description of people who must have suffered what the lay population has learned to call “STROKE.”  Heart attack, or myocardial infarction, is the competitor of a cerebrovascular accident.  Both are “recipients of arterial hypertension.” Arterial hypertension however, is “largely preventable.”

Kofi Dankyi Beeko, MD

Consultant Neurosurgeon dankyikofi@yahoo.com

 

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