A man aged 54 arrived at the medical outpatient department straight from work with the main complaints of severe headache and blurred vision. He came from Ng’ong’ona village, which is nearby the hospital I worked at in Dodoma.
He appeared sick. His blood pressure was measured and found to be 200/110 mmHg; this reading indicated that the blood pressure was very high. His preliminary diagnosis was hypertension.
Thus, just at the outset I told him that most of the time hypertension comes with no obvious symptoms, so regular checkups is necessary and that he doesn’t have to wait for symptomatic phase of complications.
He wasn’t a fan of medicines
Then after briefing him about the findings, and the consequent plan upon the condition, he asked, “What can I do to get it lowered without taking medicines?” After a lengthy conversation, he at least seemed to be more willing to adhere to lifestyle changes rather than to start taking the medication.
But I told him that he has to do both, start taking medicines and adhere to lifestyle changes.
From his facial expression, I knew that the man was not going to adhere to taking medicines since he insisted, “Don’t give me many pills.” Additionally I advised him to get his blood pressure measured for consecutive five days and to record it somewhere whereby he agreed to do so.
But I made sure that he makes a well informed decision, however he kept on asking, “kwani hizi dawa natumia kwa muda gani?” [ Meaning, for how long do I take these medicines? ] I told him that it’s for life, I humbly insisted “Hypertension is not malaria, henceforth you have to take them every day unless your doctor tells you otherwise but do not stop taking them on your own.”
In order to alley his fears, I gave him a little comfort. “in case you progress well, your doctor may decide to reduce the number of medicines or cut down the dose or frequency whenever possible.”
But what is hypertension?
Hypertension refers to sustained elevation of blood pressure above normal range, but according to World Health Organisation (WHO), it is defined as blood pressure (BP) readings higher than 140/90 mmHg.
The known risk factors so far are family history, overweight, smoking and increasing age.
There are two types of hypertension, ‘secondary hypertension’ for which there are known causes such as kidney diseases, hormonal/endocrine diseases, some blood vessel diseases and others but in ‘essential hypertension’ there are no known primary causes.
It’s said that secondary hypertension makes about 5 per cent of the general population whilst essential hypertension makes about 95 per cent.
Treatment modality depends on the level of your BP and your risk of developing cardiovascular diseases. If you are having secondary hypertension where there are underlying causes, your BP will be controlled by removing the cause.
In general, lifestyle modification such as exercising regularly, quitting smoking, reducing the intake of alcohol and having a healthier diet is good for your blood pressure, however, medicines may also be needed especially when your BP is much higher than normal and if your risk of cardiovascular diseases is high.
My advice to you is that do not stop medication without your doctor’s instructions, take them regularly as prescribed to you, know the name and the dose of the medicines you are taking and importantly report any side effect like dizziness, drowsiness, persistent cough and headache among others.
Moreover, the penalty of poor adherence will be high but by the same token the reward for strict adherence will be great, just endure.
I know it’s not easy to embark on that journey of taking life-long medicines, but do talk to your doctor about it and I’m sure he/she will find a better way to make it bearable and friendly.
The author is a Medical Doctor and a Public Health Activist now based in Dar es Salaam.