Saturday, September 25, 2021

The Need To Check Rising Cases Of Hypertension

A patient checking his blood pressure

As the world marks World Hypertension Day (WHD), the need to enforce mandatory limits in consumption of foods high in trans fat remains the key to reducing the rising cases of cardiovascular diseases and hypertension.

World Hypertension Day is a day designed and initiated by the World Hypertension League (WHL) to increase the awareness of hypertension as a silent epidemic. This is crucial because of the lack of appropriate knowledge among hypertensive patients. WHD was first commemorated on May 14, 2005. Since 2006, the WHL has dedicated May 17 every year as World Hypertension Day.

Hypertension affects more than 30 per cent of the adult population worldwide, more than one billion people around the world. It is the main risk factor for cardiovascular diseases, especially coronary heart disease and stroke, but also for chronic kidney disease, heart failure, arrhythmia and dementia.

The burden of hypertension is felt disproportionately in low- and middle-income countries, where two-thirds of cases are found, largely due to increased risk factors in those populations in recent decades. Accurate blood pressure (BP) measurement is essential for the proper diagnosis and management of hypertension.

This year’s theme is ‘Measure your blood pressure accurately, control it, live longer’, focusing on combatting low awareness rates worldwide, especially in low to middle income areas.  It also promotes usage of accurate blood pressure measurement methods.

In Nigeria, it was estimated that there were about 20.8 million cases of hypertension among people aged at least 20 years in 2010, with a prevalence of 28.0 per cent. There is, however, a projected increase to about 39.1 million cases of hypertension by 2030 in people aged at least 20 years, with a prevalence of 30.8 per cent.

Hypertension which is a silent killer is anticipated to be closely linked to the consumption of foods high in trans fat in Nigeria. 

A senior registrar, Nephrology, Department of Internal Medicine, Delta State University Teaching Hospital, Oghara, Dr. Roli Ajuya said consumption of foods high in trans fatty acid is a major risk factor in the rising cases of hypertension being experienced in the country.

She explained that hypertension or elevated blood pressure is a serious medical condition that significantly increases the risks of heart, brain, kidney and other diseases. “There are controllable and uncontrollable risk factors for hypertension. For the controllable factors, sedentary lifestyle, alcohol intake, smoking, diabetes, obesity, high salt diet, consumption of cholesterol-containing diets, foods high in saturated fats (the bad fats), trans fat, contribute largely to  high blood pressure” he said.

Ajuya defined trans fat as a form of fat that is hazardous to the health as they are hydrogenated oils that have been chemically altered to make the oils have a longer shelf life, thereby making it unsafe for consumption. She pointed out that trans fat was like reusing oil for frying, so the more you re-use it for frying, the more the oil becomes hazardous to our health.

Bad cholesterol, according to her, is also implicated in the development of hypertension with trans fat consumption being a risk factor in the development. Speaking on the sources of trans fat in food, Ajuya highlighted pastries, fries, fast foods, red meat, pork meat and use of industrially produced partially hydrogenated oils (PHOs). She however called for the use of non-hydrogenated vegetable oils, and consumption of fish and chicken as a way of promoting healthy living.

Similarly, a senior registrar nephrology and hypertension, Department of Internal Medicine, Federal Medical Centre FMC, Keffi, Dr. Maji Usman recommended the use of dietary approach to stop hypertension (DASH) through the consumption of diet high in calcium, potassium, white meat, fruits and vegetables. 

According to him, eliminating trans fat food will contribute largely to the reduction in the rising cases of hypertension as artificially modified trans fat increases the bad fat in the body and reduces the good fat in the body.

“This makes the blood vessels stiff, and subsequently leading to atherosclerosis which is the build-up of fats, cholesterol and other substances in and on the artery walls. This build-up is called plaque. The plaque can cause the arteries to narrow and even block blood flow. The plaque  accumulation can lead to the formation of blood clots due to the slowing down or stoppage of blood flow.  These clots can break away from their area of formation and be transported in the blood stream to distant parts of the body where if they reach narrower blood vessels can lead to total blockage of blood supply to the organs supplied by those blood vessels.  Indeed, the backed up pressure built by the blockage of these vessels can also lead these vessels to swell and eventually burst causing severe organ damage.  Examples of vessels that can be blocked include vessels supplying the heart, the brain, the eyes, kidneys, liver etc.  This thus leads to a  wide range of medical complications that result from the consumption of trans fat,” he pointed out.

The World Health Organization from recent data revealed that over 500,000 people die yearly from cardiovascular diseases which is attributable to consumption of trans fat.

“The low awareness on the dangers of consumption of trans fat food amongst Nigerians is very poor, what we have done clinically is to attend to patients with risk factors but there is need for more advocacy and regulation on the gram content of trans fat in food products,” Usman said.

Saying various countries of the world have adopted measures to reduce the trans fat content in foods expressed concern that Nigeria is yet to adopt a policy on this and called on the government to put in place regulations to checkmate the consumption of trans fat. 

On this World Hypertension Day, it is important for people to invest in their health as prevention is far better than cure. Having regular exercise, regularly monitoring your blood pressure, reducing alcohol intake, smoking and other drugs that increase sympathetic activity are key.

Also, a resident doctor in the Internal Medicine Department, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Dr. Michael Okorie, also said trans fat consumption leads to an increase in low density lipoprotein and decrease in high density lipoprotein. He recommended that in a bid to reduce consumption of trans fat food, it is imperative to read up on nutrition fact labels on food before purchase as it is a means of confirming the trans fat content in each food product.

He said, “Trans fat is seen in synthetic foods, so being knowledgeable about this especially at the point of purchase is important. Read the labels to be sure of the gram content of trans fat before purchasing the food, also go for safe oils, adopt a dietary behaviour that maintains a healthy diet plan that contains whole grains, low dairy products, fruits and vegetables, adopt the use of non-hydrogenated vegetable oils, instead of partially hydrogenated or hydrogenated vegetable oil or saturated fat, and reduce the use of hard margarine and choose soft or liquids instead of hard products”.

Okorie added that a recent study related the consumption of trans fatty acids directly to hypertension, as trans fat acid causes an increase in Angiotensin-converting enzyme (ACE), hence the need to reduce trans fat in food.

The executive director of Corporate Accountability and Public Participation Africa (CAPPA), Akinbode Oluwafemi called for a stronger regulation to eliminate the consumption of trans fat, saying it would largely reduce the cases of hypertension.

In his words, “With the established adverse effect of consuming trans fatty acids in foods, it is pertinent to have a regulation that will checkmate the consumption of these harmful products and clearly indicate the presence of these products in foods”.

The Network for Health Equity and Development (NHED) is working with a coalition of national and international public and civil society stakeholders to mobilize scientific evidence specific to Nigeria to aid NAFDAC, the Federal Ministry of Health and policy makers at all levels to recognize the dangers posed to the health of the population by unregulated consumption of foods high in trans fatty acids.  The organizations are also providing additional technical expertise to NAFDAC and other agencies to assist the early and effective enactment of appropriate regulations and their enforcement.   

It is pertinent that the draft of the ‘Fat and Oils Regulations 2019’ and the ‘Pre-Packaged, Ice and Labelling Regulations of 2019’ are approved expeditiously by the NAFDAC governing council and appropriately gazetted as a means of reducing the consumption of trans fat in foods through regulation of food industry practices and reducing rising cases of hypertension among the populace.

Prudence Eboagwu-Ijah
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