At the third public lecture of the City Club, Surulere, Lagos, which had its topic as: “Heart Attack”, the unexpected happened about 45 minutes into the programme. One of the elderly members (name withheld), who sat on the high-table collapsed, almost falling off his seat. But for the intervention of the medical team on ground conducting a routine medical examination on participants., the old man might have died.
The medical team, led by the first female Professor of Cardiology in Nigeria/Professor of Medicine, Janet Ajuluchukwu, revived the old man and later conveyed him in an ambulance to a hospital for further medical attention.
Giving an insight into what happened, timely intervention of the medical team, and knowing precisely what to do, Ajuluchukwu said it was a case of heart attack, which coincided with the topic at hand. She said: “The beauty of it is that this man was here today and we, the team, worked hand in hand to get him back on his feet. If it was at home and there was no immediate attention/intervention, that is, by-stander intervention, the worst could have happened. A first responder must know what to do in terms of First Aid.”
Ajuluchukwu said heart disease and stroke remained the first and third leading causes of death in Nigeria. “Heart attacks are once described as uncommon in the country, but there is a worrying rising trend. In 1971, a British medical Journal publication by Olufemi Williams showed that only 10 victims of heart attack were identified among 8,000 autopsies performed over 10 years in Ibadan.
“More cases are occurring nowadays, but it is still not as common as it is in the industriaised countries. Our study showed that while heart attack caused 4.2 per cent deaths, stroke caused 50 per cent deaths among our hypertensive patients. The worry is that the risk factors are on the rise globally and in Nigeria,” said Ajuluchukwu.
She said, for instance, hypertension, also known as high blood pressure, is a major risk factor for heart attacks and strokes in Nigeria. Its prevalence has increased fom 11 per cent in 1990s to 25 to 30 per cent currently in different parts of Nigeria.
Ajuluchukwu said Kano has the highest rate while Ikot Ekpene has the least. A natural observation by researchers indicated that Kano residents eat a lot of suya with fats embroiled in salt laden spices while Ikot Ekpene residents eat lots of vegetables, fruits and unadulterated palm oil.
She said: “Hypertension is divided into two main categories: essential or primary hypertension and secondary hypertension. Over 90 per cent of all diagnosed hypertension cases are essential, meaning that the underlying mechanism is unknown. In the remaining six to eight per cent, hypertension is secondary to another disease.
“Several factors can either exacerbate high blood pressure or contribute to complications and more serious consequences from the hypertension. These include: Black racial background, males, postmenopausal women, earlier age of onset, diastolic pressure consistently >115, smoking, diabetes mellitus, high cholesterol levels, obesity, cardiac enlargement, compromised blood flow to the heart and congestive heart failure,” she explained.
According to her, prevention of risk factors and good management of hypertension are important. “The goal of prevention and management of hypertension is to reduce disability and death by the least intrusive method possible. These goals may be reached with lifestyle modification, nutrition/diet, or pharmacologic intervention,” said Prof Ajuluchukwu.
She said lifestyle changes have the potential to prevent hypertension, lower blood pressure, and reduce other cardiovascular risk factors.
Ajuluchukwu said: “Even if lifestyle changes alone are not satisfactory in controlling hypertension, these changes, along with nutrition/diet and health may be able to adequately treat the situation, or just lifestyle changes may reduce the number and dosage of anti-hypertensive medications needed. Lifestyle modifications for prevention and management of hypertension include: losing weight if overweight. Limiting alcohol intake: There are many good health reasons to consider in avoiding alcohol altogether. Increase aerobic activity (30-40 minutes four or more times per week). Sedentary individuals with normal blood pressure have a 20 to 50 per cent increased risk of acquiring hypertension.”
Ajuluchukwu warned that people should, “reduce sodium to no more than 2.4 grams of sodium or six grams of sodium chloride per day. It is good to eat noodles alone with stew or sauce rather than with the seasonings the pack comes with. The seasonings are high in sodium (salt). Maintain adequate intake of dietary potassium. High levels of potassium intake in the diet may protect against hypertension and even help to control or improve hypertension and maintain adequate intake of dietary calcium and magnesium.
“Low dietary calcium intake has been associated with an increased incidence of hypertension in most epidemiologic studies. Increasing the calcium intake may lower blood pressure in some individuals with hypertension, but the therapeutic effect of calcium supplementation is only minimal. Evidence suggests an association between lower dietary magnesium intake and higher blood pressure,” she said.
She continued: “Cigarette smoking is a significant risk factor for cardiovascular disease. Blood pressure rises with every cigarette smoked. The risk of cardiovascular disease returns to normal after having quit smoking for two years. Reduce intake of saturated fats in the diet and high cholesterol foods.
“Although altering ones intake of fats does not seem to have much effect on hypertension, abnormal cholesterol ratios are a major independent risk factor for coronary artery disease. Reduce caffeine; mental/emotional stress can acutely raise blood pressure and if prolonged, could contribute to chronic high blood pressure.
“Relaxation therapies and biofeedback have been studied with mixed results, some showing mild, others significant decreases in systolic and diastolic blood pressure. Exercise regularly. Blood pressure can be lowered with moderately intense physical activity, and 30-45 minutes most days of the week. Regular aerobic physical activity can reduce the risk for cardiovascular disease and mortality. Even sedentary individuals with a normal blood pressure have a 20 to 50 per cent increased risk of developing hypertension.”
She added that it was important to note that the concept of risk factors support ‘increased tendency’ for occurrence and invariably causal. “However, the higher the number of risk factors possessed by an individual, the higher the likelihood of the disease. The good news is that identifying and treating the modifiable ones, such as hypertension, can change the equation to a positive outcome or prevention,” she explained.
