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CHAPTER ONE

INTRODUCTION

Introduction

Hypertension is defined as a sustained elevation in the blood pressure of an individual above levels considered normal for the individual’s age, sex, race, body size etc. This definition implies that there has to be a reference value for an individual which is set arbitrarily based on the above mentioned biosocial indices, in other words there are various classifications for the diagnosis of hypertension which actually erupted as a result of different studies by various research groups and which became adopted by the World Health Organization (W.H.O).The American Heart Association (2003) graded hypertension as follows; normal , high normal,  grade 1,  grade 2, grade 3. Awareness of hypertension refers to having been informed of one’s hypertensive status by a health professional.     

 In the 18th century, the health burden was on communicable diseases. Hypertension was not of interest then. Now with the epidemiological transition from communicable to non communicable diseases, hypertension has been recorded as the major type of cardiovascular disease with attendant complications. Hypertension affects 600 million people world wide. It is the most common cardiovascular disease in black Africans and a major cause of morbidity and mortality among Nigerians. Hypertension rarely has symptoms therefore one-third of the people affected do not know they have the disease, as such it is called “The silent Killer” Pathophysiology of high blood pressure reveals that the blood pressure at any time is determined by the cardiac output and the peripheral resistance. (Blood Pressure = Cardiac Output x Peripheral resistance). Hypertension is therefore associated with conditions affecting these two factors such as increased peripheral resistance, fluid and water retention and high renin secretion in some cases.         

Statement of the problem.

Hypertension is no longer a problem of only the developed nations. It is present here with us. Observations at the General Outpatient Department (GOPD) of the Federal Medical Centre, Owerri (FMCO) indicate an increase in the number of patients with  hypertension and  hypertension  related problems/complications over the last few years. Records available  at  the General Outpatient Department F.M.C Owerri from January to March 2009 showed that 149 hypertensive patients were seen and treated at the General Outpatient Department as against 237 hypertensive seen and treated this year between January to March.1  

Considering its ‘silent’ nature, few persons are usually aware of their hypertensive status and also fewer persons seek treatment. This has led to unacceptably high morbidity and mortality from potentially preventable complications such as coronary heart disease, heart failure, strokes and chronic renal failure. 

The reported prevalence of hypertension varies widely in the various parts of the world, as low as 3.4% in rural Indian men and as high as 72.5% in Polish women2. In North America, two national surveys in the United States during the last two decades put the overall prevalence amongst American adults at 28%2,3 , while in Canada the prevalence  is 27.4%3. The awareness level is about 70% and 58% in the United States and Canada respectively2,4. In Europe, the average prevalence rate is estimated to be 44.2%; 37.7% for Italy, 38.4% for Sweden, 41.7% for England, 46.8% for Spain, 48.7% for Finland and 55.3% for Germany3

Data published from Nigeria, Ghana, Cameroon and The Gambia have shown a higher prevalence of hypertension generally and a consistently higher prevalence in urban than in rural areas. Currently, the population specific prevalence of hypertension in Nigeria is not known with certainty. A previous national survey on non-communicable diseases (NCDs) gave an overall crude prevalence of 11.2% (using blood pressure [BP] threshold of ≥160/95mmHg) and awareness level of 33.8%5. More recently, various studies have tried to give a picture of hypertension prevalence amongst different population groups and regions in the country. In Katsina, a study in a tertiary health institution found the prevalence to be 25.7%6.  Lawoyin et al7 had prevalence of 12.4% (Bp threshold of ≥160/95mmHg) in an Ibadan community thereby making

hypertension not only a risk factor for cardiovascular diseases but also a major factor in a large number of chronic disorders having significant mortality and morbidity impact. While Olatunbosun et al8 (also using a Bp threshold of

≥160/95mmH) had a prevalence of 10.3% in a civil service population in Ibadan. In Ile-Ife, Adedoyin et al had a prevalence of 13.3% (Bp threshold of ≥160/95mmHg) and 36.6% (using Bp threshold ≥ 140/90mmHg)9. Amongst workers in Ilorin, Oghagbon et al found a prevalence of 27.1%10. They were predominantly males with age and body mass index (BMI) identified as important correlates to blood pressure. This is higher than what was found in an Indian urban population. Omuemu et al in a study in a rural community in Edo state had a prevalence of 20.2% with an awareness level of 18.5%11. Females were more aware of their high blood pressure status than the males. A study in a tertiary health institution in Enugu amongst medical admissions revealed a prevalence rate of 18.4%12. Overall, hypertension related diseases were more common in males (58.7%) than in females (41.3%) in this study. In a theological institution in Umuahia, Ike found a prevalence of 28.3%13

In Owerri, and other parts of Imo State, there is paucity of information on the current trends in hypertension. This study therefore sought to ascertain the severity of hypertension amongst patients attending a general out-patient clinic in a tertiary health institution 

Aims and Objectives

Aim

To evaluate the effect of hypertension on Women in Nigeria.

Specific Objectives

To ascertain the grades of hypertension amongst female adult patients attending a

General Out-patient Clinic 

To assess the level of awareness of the disease among the hypertensive patients identified during the study.

To identify the possible risk factors associated with hypertension in these individuals.

Research Questions

What are the grades of hypertension amongst female adult patients attending a General Out-patient Clinic? 

What is the level of awareness of the disease among the hypertensive female patients identified during the study?.

What is the possible risk factors associated with hypertension in these individuals?.

Significance of the Study 

The study of hypertension grades, the level of awareness of hypertensive status and associated risk factors has provided information on the current trends of hypertension in Owerri, South-East Nigeria. Assessment of modifiable risk factors from the study will serve as a basis for formulation and implementation of strategies that may reduce these risks factors in the populace. It will also sensitize the primary care physicians to identify high risk patients for appropriate counselling, timely intervention and referral when necessary thereby preventing complications of hypertension and avoidable death. Information derived from the study will possibly serve as a resource for the development of a policy directed towards hypertension prevention and control in Nigeria.

Scope of the study

The study was limited to finding the effect of hypertension on women in Owerri, South-East Nigeria.


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