• ‘Salient killer’ linked to undiagnosed, poorly managed hypertension
By Doris Obinna
hypertension, or high blood pressure, is a condition where the force of blood pushing against the walls of the arteries is consistently too high. This can put extra strain on the heart and other organs, increasing the risk of heart disease, stroke, and other health problems.
World Hypertension Day (WHD), marked annually on May 17, is to raise awareness and promote hypertension prevention, detection and control. It is designated and initiated by The World Hypertension League (WHL), which is an umbrella to organizations of 85 national hypertension societies, and leagues. The day was initiated to increase the awareness of hypertension.
The WHL launched its first WHD on May 14, 2005. This was especially important because of the lack of appropriate knowledge among hypertensive patients. This year, the WHL marked its 20th anniversary, and was observed with the theme, “Measure Your Blood Pressure Accurately, Control It, Live Longer!”
As Nigeria joined the rest of the world on Saturday to mark the WHD, medical experts have raised concerns about the alarming rise in sudden deaths, often referred to as “salient killer,” many of which are linked to undiagnosed or poorly managed hypertension.
A public health expert, Dr. Sunday Olalekan, disclosed that regularly checking blood pressure is crucial for early detection and management of hypertension.
“Hypertension is diagnosed when blood pressure readings are persistently 130/80 mmHg or higher. The heart pumping blood through the arteries creates blood pressure, and hypertension occurs when the pressure is too high.
“High blood pressure can damage blood vessels and organs, leading to various health complications. Hypertension is a common condition, affecting a significant portion of the population worldwide.”
Also, World Health Organisation (WHO) Regional Director, South-East Asia, Saima Wazed, in her 2025 message, stated that WHD marked annually is to raises awareness and promotes hypertension prevention, detection and control and this year on its 20th anniversary, it is being observed with the theme, “Measure Your Blood Pressure Accurately, Control It, Live Longer!”
According to her, hypertension continues to be a major public health challenge, a silent killer that affects over 294 million people across the WHO South-East Asia Region. “Modifiable behavioral risk factors such as tobacco and alcohol use, high salt intake, physical inactivity, unhealthy diets, and mental stress continue to drive its prevalence.
“Hypertension remains a leading contributor to premature mortality from heart attacks and strokes in our region. Worryingly, the unmet need defined as the gap between those with high blood pressure and those adequately diagnosed, treated, and controlled remains as high as 88 per cent. This indicates that nine out of every 10 people with hypertension are not receiving optimal care.”
She continued: “Our Region has made bold commitments to address the burden of hypertension through the endorsement of SEAHEARTS, ‘Accelerating Prevention and Control of Cardiovascular Diseases in the South-East Asia Region.’ SEAHEARTS has proven to be a powerful platform, enabling countries to scale population-level interventions that reduce tobacco use, decrease salt intake, eliminate trans-fat, and improve treatment coverage at primary health care.
“By December 2024, the countries of our region collectively placed more than 46 million people with hypertension on protocol-based management in primary health care, as a step to bridge the unmet need.”
Prevalence in Nigeria
According to the American Heart Association (AHA), about 55 per cent of black adults have high blood pressure, also known as hypertension. “Black people also have higher rates of more severe high blood pressure than other ethnic groups and it develops earlier in life.
“Historical and systemic factors play a major role in these numbers. These factors include adverse social determinants of health, the conditions in which a person is born and lives. The factors include lack of access to health care and healthy foods and other issues.
“There is a lower rate of taking blood pressure medications among Black people, partly due to lack of access to those medications and a distrust of the health care community based on historical discrimination.
“The estimated prevalence of hypertension in Nigeria is around 30-32.5 per cent, with some studies showing even higher figures. A meta-analysis in 2018 estimated a prevalence of 31.2 per cent, with 29.5 per cent for men and 31.1 per cent for women. Another study found a prevalence of 32.5 per cent between 1995 and 2020, indicating an increase in hypertension rates.”
Building on three core priorities
Wazed urged all stakeholders to build on the momentum. “I urge member states and stakeholders including governments, health care professionals, academic institutions, civil society organizations, and development partners to align around three core priorities:
“Strengthen risk factor reduction: Intensify and implement initiatives promoting healthy diets, physical activity, tobacco and alcohol control, and reducing salt and trans-fat consumption.
“Accelerate integration of SEAHEARTS approaches in primary health care: Expand the integration of the WHO HEARTS technical package into every level of primary health care, with an emphasis on including healthy lifestyle counseling, uniform use of standardized treatment protocols, availability of validated blood pressure measuring devices, equitable access to medicines and robust monitoring systems.
“Integrate services across sectors: Strengthen collaboration between health programs, including maternal and child health, mental health, and infectious disease services to build a seamless continuum of care for hypertension and related NCDs.”
“With strong political will, community engagement, and innovative approaches, we can reduce the burden of hypertension and move closer to achieving our global goal of reducing premature mortality from non-communicable diseases by one-third by 2030.
On this WHD 2025, let us reaffirm our commitment to act strongly and collectively. Let us work together to ensure that every individual has the opportunity to live a longer, healthier life, free from the preventable complications of hypertension,” she added.
Risk factors
“High blood pressure, or hypertension, is often called the ‘silent killer’ a condition that quietly creeps up, often without symptoms, and wreaks havoc on the body over time. With millions of people worldwide affected, understanding the risk factors that contribute to high blood pressure is key to prevention and early intervention.
“Family history plays a powerful role in determining an individual’s risk for hypertension. If your parents or close relatives have struggled with high blood pressure, your chances of developing the condition increase significantly. Genetics can influence everything from how your blood vessels function to how your body handles sodium, a major contributor to high blood pressure. While you can’t change your family history, being aware of it can empower you to take control of the other factors within your reach.
“Again, aging is inevitable and so is its effect on our blood vessels. As we get older, our arteries lose their elasticity, making it harder for blood to flow freely. This natural stiffening contributes to rising blood pressure. While older adults are most commonly affected, high blood pressure isn’t limited to them. Alarmingly, even children can develop hypertension, especially in the presence of obesity, a poor diet, or other underlying health conditions.
“Also, gender also plays a role in the prevalence of high blood pressure. Up to age 64, men are generally at a higher risk than women. But the tables turn after age 65, when women become more susceptible. Hormonal changes, particularly after menopause, may contribute to this shift. Understanding how blood pressure risk fluctuates with age and gender can help individuals be more vigilant at different life stages.
“Statistics reveal a stark disparity in high blood pressure rates among different racial and ethnic groups. Black adults, particularly men, have among the highest rates of hypertension worldwide. Hispanic and Asian communities also face elevated risks. The reasons are complex and deeply rooted in historical, systemic inequities, access to healthcare, cultural norms, and dietary habits. These disparities underscore the importance of targeted education and community health efforts.”
Measuring, diagnosing BP
“Measuring your blood pressure is the only way to find out if you have high blood pressure. “An average based on two or more readings taken on two or more occasions by a healthcare professional is recommended for a proper diagnosis.
“To diagnose high blood pressure, also known as hypertension, you need to have your blood pressure checked in a health care setting.
“How taking blood pressure works i.e; a reading is taken with a blood pressure cuff; the cuff is placed around the upper arm before being inflated; the inflated cuff squeezes the brachial artery and stops blood flow for a moment and air in the cuff is slowly released. If a manual device is being used, the person taking blood pressure listens with a stethoscope. If it’s an automated device, a digital display shows the blood pressure.
Being recorded as two numbers
“Systolic blood pressure (upper number) shows how much pressure your blood is pushing against your artery walls when the heart beats.
“Diastolic blood pressure (lower number) shows how much pressure your blood is pushing against your artery walls while the heart is resting between beats,” Olalekan explained.