Hypertension – why the approach to tackling the silent killer has changed

Sierra Leone Telegraph: 21 May 2016

Globally about 22% of adults over the age of 18 suffer from hypertension, according to statistics from the World Health Organisation in 2014. But in Africa, this figure is higher and sits at 30%.

In Sierra Leone there is no record of the number of people actually dying every year from hypertension. But there is little doubt that in a country with one of the highest adult mortality rates in the world, and among the poorest, hypertension must count as one of the major killer diseases in the country.

A Sierra Leonean doctor disclosed to the Sierra Leone Telegraph that in his opinion, more than 50% of the population in Sierra Leone could be suffering from hypertension.

blood pressure4A study done in 2014 in the Gambia and Sierra Leone, found 46.2% of females were hypertensive, compared to 43.2% of men who were also hypertensive – a major contributor to Cardiovascular disease (CVD) in both countries. (Prevalence of hypertension in the Gambia and Sierra Leone, western Africa: a cross-sectional study.

Cardiovascular disease (CVD) is a broad term for a range of diseases affecting the heart and blood vessels. A heart attack or stroke may be the first warning of an underlying disease.

In Sierra Leone, there is no national public provision of routine blood pressure check up for citizens, nor is there a concerted effort to prioritise and help citizens manage and control this killer condition.

But as Bob Mash and Zelra Malan write in theconversation.com, there is global change in the approach used in tackling hypertension. This is what they found:

Traditionally, someone who suffered from hypertension – or high blood pressure – would only receive treatment when his or her blood pressure was measured and the reading was found be higher than normal.

But this meant that the condition was often picked up only when the person had a stroke or a heart attack – and in many instances this was too late.

As a result of this, the thinking on when to treat hypertension has changed in the past few years.

Research has shown that hypertension should not only be diagnosed on the basis of one blood pressure reading, as this reading could vary and be raised by other triggers such as stress.

blood-pressureInstead, doctors make use of a risk assessment tool that measures the overall cardiovascular risk of a patient.

The tool estimates the risk that a person faces over the next ten years of having a heart attack.

They do this by looking at the risk factors patients are exposed to: what is their age and gender? Do they smoke? Are they overweight or obese and do they have high cholesterol levels or diabetes?

The tool determines a patient’s risk of developing cardiovascular disease in the next ten years and guides doctors on whether or not they should prescribe high blood pressure treatment to reduce the patient’s risk.

This is because hypertension rates and associated risky lifestyle behaviours are on the rise – especially in the developing world.

Globally about 22% of adults over the age of 18 suffer from hypertension, according to statistics from the World Health Organisation in 2014. But in Africa, this figure is higher and sits at 30%.

In South Africa, 28% of the adult population suffers from hypertension compared with 23% in Brazil and 25% in China. And among adults older than 50 the rate of hypertension is as high as 70%.

Hypertension is one of the leading causes of cardiovascular diseases such as stroke, heart attacks, heart failure, peripheral vascular disease and kidney disease.

blood pressure5Why treatment methods have changed

The challenge with hypertension is that there are usually no warning signs or symptoms for someone suffering from hypertension. Hypertension is often referred to as the “silent killer”, as a heart attack or a stroke may be the first warning sign.

But patients do classically have a combination of other risk factors. These include having an unhealthy diet, not exercising, and smoking and drinking too much. And it is the effects of these behavioural risk factors that may show up in patients as hypertension, raised blood glucose, raised cholesterol, and being overweight and obese.

As a result, it is estimated that in South Africa only 26% of men and 51% of women are aware that they suffer from hypertension.

The research shows that in South Africa hypertension is the leading reason that people seek help from primary care facilities such as clinics. It is also the most common diagnosis in primary care in the country.

blood pressure3

Changing your lifestyle can help

Treating hypertension is not only about taking tablets. Someone with raised blood pressure can also reduce it by changing their behaviour. There are several guidelines that should be followed:

  • Reduce salt intake as it raises blood pressure. The South African government has recentlylegislated salt intake, ruling that salt content in common foods such as bread should be reduced. As an extra measure, people should not add extra salt to their food and avoid very salty processed foods such as packet soups, stock cubes or gravies.
  • Lose weight. People who are overweight or obese have a higher risk of suffering from hypertension. The key is to eat healthily, exercise and reduce meal portions. Instead of large amounts of starchy food, fruit and vegetable intake must be increased and fatty foods and sugar reduced.
  • Drink less. Alcohol also increases blood pressure so it is important to only drink in moderation. Men should not exceed two drinks a day and women one drink a day.
  • Exercise more. At least 150 minutes of exercise a week translates into 30 minutes a day, which raises the heart rate.
  • Smoke less. A person who smokes can reduce their cardiovascular risk further by cutting down or stopping smoking altogether.

Even when patients are on treatment for hypertension it is still important for them to try to change their behaviour as this reduces the amount of medication they need to control their blood pressure.

But most importantly, diagnosis is important. Many people are unaware of their cardiovascular risk and raised blood pressure. People should check their blood pressure at least once every five years to ensure that it is normal. This can be done at a clinic or even a pharmacy.

About the authors

Bob Mash is in the Division of Family Medicine and Primary Care, Stellenbosch University; and Zelra Malan is Senior Lecturer, Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University.


  1. I ask that all those who are suffering from high blood pressure to see their medical doctors for checkup, blood work and prescription. It is quite likely that you will be asked to either buy Linsinopril or chlorthalidone, specifically for women.

  2. Good article.

    But of utmost importance is to check your blood pressure (BP) regularly and take the medication prescribed by your doctor………..on a daily basis.

    This is a big problem in Sierra Leone. Patients on blood pressure medicine, think they can take it as and when they feel like or when they have a headache. No, no, no. These medicines should be taken everyday so that your BP is kept low all the time.

    Another factor in Sierra Leone is fake drugs. People on BP medication often are good at taking the drugs but the BP never comes down and they lose interest and stop taking them. Some are on 2 or 3 different types of BP medication daily, and bought on a regular basis at a high price in the pharmacies.

    A friend always bought his 2 types of BP medication from the most expensive pharmacy in Freetown and he said that, all he did was fall into a deep sleep when he took the medicines. Of course he stopped taking them, asked a relative to send some from overseas and he has been fine since.

    Another problem is recognising the symptoms. The commonly known presenting factors are ‘Aidart’ – headache and ‘turnaid’ – dizziness. Most people present to their doctor when they have Aidart or Turnaid – simple enough.

    But what is the unusual symptoms that people show look out for? Toothache, fast heart beat and nose bloods are rare but may signify a dangerously high BP indeed. Many go to their dentist and nothing is found and just ignore it with disastrous consequences.

    My fellow Sierra Leoneans, BP is not caused by witchcraft. Many people when diagnosed with raised BP never accept, but move from one ‘Murrayman’ to another trying to find out whether the wife or husband or neighbour or friend has bewitched them.

    They remain in denial for years until a stroke or heart attack or kidney failure brings them down. By then, ‘wata don pass flour’ – it is too late and they are disabled for life. Life then becomes extremely expensive, they are in constant ill health, they are unable to walk or work and they may need dialysis which is unavailable in Sierra Leone.

    So for all those with BP, take heed, lonta. Go and get yourself checked and take your medication.

    What is normal BP? Any reading on your BP machine equal to or less than 140/90 is fine. Slightly higher can be rectified with good diet, losing weight and exercise.

    Any reading 160/100 or more is a cause for concern and you MUST see a doctor. Best to also invest in a BP machine so you can keep an eye on the BP at home.

  3. The valuable report cannot be underestimated. Sensitizing the people on the effect and danger of hypertension which many people in Sierra Leone people are rather ignorant about is a valuable contribution for safeguarding the health of the people.

    Indeed, hypertension is silent killer. The feeding habits of most Sierra Leoneans makes the propensity for Hypertension among the population. The “shokocho yokocho” style of cooking of popular traditional dishes such as casada lif, petete lif with palm oil, is a cause of hypertension disease.

    Health experts have warned against excessive consumption of palm oil, especially burnt palm oil. Some industrial food products containing processed palm oil like most biscuits, cakes, chocolate and margarine labeled vegetable oil are advised not to be eaten often. Their effect on our health is harmful.

    Palm oil can be a healthy ingredient to our diet in its raw state; the way people in the hinterland use it, with boil cassava, potatoes or spilled over cooked rice. It is more beneficial to our health, asserts the New England Journal of medicine in a report on palm oil in 2006. But not too much of it either.

    The study found out that the consumption of much palm oil and other types of oil like groundnut oil has a strong connection with heart disease, cholesterol, obesity and liver dysfunction and a cause of hypertension in many cases.

    People must eat plenty of vegetables and fruits, and reduce the use of salt and fatty food. Eating moderately and doing regular exercise. A thirty minutes walk on a daily basis at a moderate pace is good exercise.

    What we call “white cassava or potato leaf” free from oil are some of the healthiest dishes our bodies can appreciate, and as a matter of fact, are cheaper dishes.

    Another precaution can also be to refrain from excess consumption of meat, especially red meat, red meat is breeding agent for cholesterol, and a higher quantity than necessary of cholesterol is harmful to health, which often is the origin of heart attacks and strokes in hypertensive patients.

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