 All right, welcome back. This is the Breakfast and Plus TV Africa. We are looking at health issues. Specifically yesterday was the World Hypertension Day. We'll be looking at all of that this morning. In the wake of VTOL, the Hypertension Day that is which has, as a theme, a measure, your blood pressure accurately control it, leave longer. A medical expert, including the World Health Organization, Nigeria Medical Association Enemy, and the Najin Heart Foundation, NHF, have warned that the prevalence of hypertension in the country is on the rise. Now, these days set is due to prevailing insecurity in poor socioeconomic condition. Specifically, Executive Director of the NHF, Dr. Kingsley Akiri, said the prevalence of hypertension is estimated to be between 30% and 40% of Nigeria's over 200 million population, which is in the range of 60 to 80 million Nigerians. We're looking at the impact of all of this. We have a public health practitioner from the market doctor, Dr. Gehtundi Ayo Oyalo. Thanks, Oyalo. Thanks for joining us on the breakfast this morning. Good morning, everybody. Yeah, good morning. Thanks for joining me. Yeah, it is indeed a pleasure. Striking number of statistics there, about 60 to 80 million Nigerians have hypertension. It is also a limit that most of them are not actually seeking treatment because they're not even aware that they have hypertension. Tell us what the incidence is like in the country. Okay, so good morning, everybody, again. So we already have the incidence. I mean, Dr. Kureya said between 30 to 40% of the population, and that's the data we have, but we know that most of the time, data in Nigeria isn't very accurate because the data you have is probably from people coming into the hospitals, not even from screening exercises, going on across the country. So because hypertension is a silent killer, most people is referred to as a silent killer because you're not likely to have any symptoms. You're not likely to feel anything. By the time people start to feel symptoms, then it means that there is already an advancement of the condition. So I mean, it's difficult to say this is the exact number, but we know that because of the factors that are skewed towards us, being that we're black, when you're black, the incidence is higher. Of course, it's also higher in men. So because we have all of that, we know that there will be a lot of people that are hypertensive. Whether they now know they are hypertensive or not is another kettle of fish, so that's what I have to say. So let's get to, because at this point in time, we have to find out the causes and how we can prevent or manage a situation. So what are the likely causes of this? A lot of people will think that, I mean, if you're into a lot of thinking and all of that, you probably might just have a tendency of becoming hypertensive. But you're a practitioner. Can you currently take us through what would be the likely causes of being hypertensive? So the causes of hypertension are varied, you know? And there are some causes, there are some things we call the risk factors, because you cannot, for some people, it's inherited, it's hereditary. It's just part of their genetic makeup. So they're gonna be hypertensive, probably, because someone in their family, other people in their family have been hypertensive. But even in these cases, for those that is genetic, there are ways that they can prevent, you know, being hypertensive or, let me say, manage, you understand, getting to the extremes of being hypertensive, manage the symptoms and signs and the, what do I call it, the complications that may arise. However, generally speaking, we have things like being overweight, you know, as a cause of hypertension, being obese. We have lack of physical activity. I mean, when I mean physical activity, we know that a lot of people now fall out, walking, jogging and all of that. But I must say that each person needs to have a definite way of exercising. It's not one cup fits all. So the fact that someone walks for one hour doesn't mean that the other person who can walk for one hour and be sufficient for the person. So we really need to be specific in the kind of exercises, kind of physical activity we're doing. The other thing that I will say is too much salt in the diet. And we know in this part of the world in Nigeria, we take a lot of salt and we're saying that we should not add salt to food once it's on the table because a lot of times, you know, even though we put salt in food, then we add it to the table. Too much alcohol is also one of the causes of hypertension and we'll aggravate it in someone who already has hypertension. So we're advocating because I know this will be a salt point for a lot of people. We're advocating that we should not have more than one to two drinks per day. Then stress. Stress is also a cause of hypertension and in the country where we know that stress, virtually everybody is stressed for one reason or the other, whether the reason or the other even concerns you. But when you look at the economy, you look at the diesel, Egypt, petrol, traffic, I mean, there's a lot of stress factors. Assault strike and all of that. And that is to say that before hypertension used to be seen in people older than 40, but this has reduced now. We're having people in their tatties being diagnosed as hypertensive. Then of course, they already age. The tendency that someone will also be hypertensive. Then there are other diseases like kidney diseases and renal diseases that could cause hypertension. But I think generally I've glossed through the causes of hypertension. All right, Doctor, are you all right? Let's talk more about hypertension. Maybe it's to get better clarity. Hypertension, high blood pressure. Does it inevitably mean that if you have high blood pressure, automatically you are hypertensive? So high blood pressure is somewhat classified. It's somewhat classified. And if I go in for the sake of those who are listening, I don't think the classification is important for them. I think it's the number that is important for them. And we normally say in the medical client that people should know their number. People should know their number. And we are saying that in 2022, your normal blood pressure should be, we measure it saying a number over another number. They're saying high blood pressure should be, should your blood pressure measurement should be about 120 over 80. 120 being the higher measurement. That's a systolic, we call it a systolic. But that's not, the name is not important now. That's the upper number should be 120 or lower. And the lower number should be 80 or lower. So 120 over 80 should be the end. If you fall above 120, maybe you are still overing 130 over 80 over 85, then you are having an elevated, it's not yet high potential, but you are having an elevated blood pressure. And in this situation, there are still things you can do that can bring the blood pressure down to normal. Things like exercising, adjusting your lifestyle, adjusting your diet, all of those things can be done to bring the blood pressure down to 120, 80. But when we have blood pressure above 130, 90, 130 to 139, 130 to 140 over 90, then we can definitely say that the person is hypertensive and the person needs care. And when I mean care, the person needs adjustment of lifestyle and medications as well to be able to control the blood pressure. So maybe we need to get to the fundamental. I mean, what exactly is hypertension? So simply putting it simply is just to say increase in the pressure of the blood. Increase in blood pressure. And I would just say use the example of a water pipe. You know, if you're using a water pipe and it's, let me say diameter is wide, or if the water pipe is big, if the pipe is big, then when you pump in water, the pressure will be low because I mean, there's a lot of space for it to pass through. But in hypertension, it means that when you put in water into that pipe, the ball maybe may have become thinner and it takes a lot of pressure for the water to come out. So it's actually gushing. You know, the way water comes out, when you put up like a pressure pump, it's gushing. That is when we call, what do we call hypertension? When that happens in the blood system, that is hypertension. Normally the blood should move around the body without any pressure, you understand? But all within, let me say all within a particular pressure range, we should be lower than 120, 80. We should be around that. But whenever there is an increase in this pressure, then that is when we can see there's a condition called hypertension in the person. So you talked about lifestyle adjustment and, you know, living better lives as it were. But specifically now, you also talked about medication. Is it something that you have to be placed on for the rest of your life, or it's something that goes away after a particular time? Okay, so I'm really happy to talk about this because a trend that we're not going to see in Nigeria is that people share medications for hypertension. You know, a brother, a sister comes to visit a brother and says, oh, I've been told I have high blood pressure, or in the normal parlance, they said I have BP, you know? And the brother brings out a pack of drugs and says, this is what I'm using. You to go and get it, you know, and start using it. So we have people just prescribe them to each other, you know, by using the packets of medications and, you know, just getting to the pharmacy and taking those medications. I want to say that that is not how to treat high blood pressure. I think the first thing is that it must be diagnosed by a medical practitioner and there are lots of primary healthcare centers, private hospitals, available where you can actually see a doctor and get a proper measurement and assessment because apart from the measurement, the doctor will also want to know what the cost is. Sometimes the cost of the high blood pressure can be treated. So sometimes it's not just about taking the blood pressure drugs that maybe someone close to you, a friend or a relative is using. Sometimes they may need to actually treat what is costing it and once that is treated, your blood pressure will return to normal. The other thing to note is that blood pressure cannot be treated at once. It's not an infectious disease like malaria or chest infection that once you've been given the dose and you take it, that's the end. No, blood pressure has to be, it's a medication you have placed on and that you will probably take throughout your life but the medications will not be taken the same way and that's why it's important that if you have been diagnosed as being hypertensive, you need to visit your medical practitioner regularly at least once in a month because as the money you try your blood pressure, if it's decreasing, if you're doing well with the medication, they may adjust the medication and reduce it and who knows if they're able to treat the cost. Now, after some time, you may be able to manage it with lifestyle adjustment. So for some people, if you are regular with your medical practitioner and you are able to monitor it and treat it, you may be able to revert back to manage it with lifestyle adjustment but if that is not the case, the medications you are using needs to be monitored and sometimes if we find that the blood pressure is not being treated properly, we may decide to increase the medications. Sometimes we may decide to change the medication altogether. Sometimes we may also need to monitor the side effects of the medication. If you're having side effects with the medication, you may need to monitor it or counsel you on how to use the medication. But Doctor, let me button, yeah. Let me button. You talked about- It's managed with the practitioner. Okay, you talked about side effect. That's one of the reasons some people may not want to take the drugs religiously as it is. They feel that it hampers some sort of their lifestyle as it is, you know. I've heard of people talked about libido issues and some people have talked about how it makes them sweat more, how it makes them pee more. So what are these side effects of using them, hypertensive drugs? It's different. And it's different from one drug to the other. And besides, it's also different ranging from one person to another, you know. So two people can take exactly the same drugs and they will not know, then they won't have the same side effects. But I would like to say that the side effects that these drugs cause, that is the reason why you need to visit your medical practitioner at regular intervals so that you can review the side effects and sometimes change or adjust the dosage. So for a side effect by some people who will say, oh, I normally, my urinates more when I take the medication. So we advise, instead of taking the medication at night, then take it in the morning. You know, some will say, oh, when I take the medications, I feel dizzy. So we'll say, okay, instead of taking it in the morning, then take it at night, you know. And those some people who have maybe individual problems, you can change, sometimes you may need to change the medication altogether because we're also looking at the quality of life of people whilst they have hypertension. But the bottom line is, besides irrespective of the side effect, your heart has to be beaten first for you to be alive, to be able to even feel a side effect. So we look at this and we weigh the options before taking the decision. Can we, okay. Can you buttress the point of who is at risk of, you know, having all of this, you had talked about the risk factor. So can you elaborate? On those who are at risk of becoming hypertensive over having a high blood pressure or whichever. Okay, so I'd said that most of those who are hypertensive, that being a Black person in the first instance is a risk factor. So it's high-petention racist now? Yeah, so high-petention is more common in Blacks than in Whites. So high-petention is more common in Blacks than in Whites. Any reason for that? So it's genetic and it's quite complex, but it's just genetic, just like when you say cancer is more common in Whites than in Blacks. You can put it through a lot of things. Even in Blacks, you can probably look at our diet that has high salt intake. We can look at obesity, saying that most of the time we like women around there, the kind of foods we eat. We can look at all of those factors, but basically, underneath it is genetics. All right, talking about lifestyle adjustment, you talked about, I took some jottings. You talked about too much alcohol intake. You talked about poor dieting and high cholesterol. Let's talk about this cholesterol pattern. Most people tend to not understand it, and they say they try to burn cholesterol or calories. At the end of the day, they mix both of them up. Elaborate, please. Okay, so for cholesterol, I mean, for some people, before you know that you have high cholesterol, you have to be tested. And that's why we always say, see your physician. You know, see your physician, because those are not things you can just look at so on and say, oh, you have high cholesterol. You know, generally, people like to say, oh, this person is fat, or this person is overweight, or this person would have high cholesterol. No, it doesn't show on the face. There are slim people who have high cholesterol. And cholesterol, because I know it's a topic that a lot of people talk about, I'll be honest, they're not able to really explain the reasons behind it. So too, who are familial high cholesterol? That means they have a lot of cholesterol in their blood, and that is how it is in their family. Even when they don't take anything fatty, they don't take anything that should predispose them to have high cholesterol. It runs in their family, and they always have that. So it's when the monitor the report results of their tests with their doctors, that is when the doctor will be able to say, okay, this is actually familial, this is genetic. So we are not bothered about it as it were. For the other group of people, what high cholesterol does, like I told you, it's just like looking at the blood vessel like a pipe. Like a pipe, that water is flowing through it. You will find out that after some time, there will be a lot of settlement on the pipe. You know, a lot of them dead, dust, and all of that along the pipe. And it can eventually block the pipe. So that is what happens with cholesterol. There are deposition of facts on the walls of the blood vessels, and these are facts deposition. And they now clog the blood vessel and does not allow blood to flow very well. And for this reason, they become hypertensive because the pressure in the blood vessels increase. So for people who have high cholesterol, there are medications available for them to use to be able to reduce the level of cholesterol they have in their system. But more, better, is use of lifestyle adjustments, like adjustments of diet, physical engaging in physical activity, minding our weight. All of those things are very critical and important when we talk about cholesterol. And to add, when you want to, there are a lot of fatty foods and this and that, but any fatty food that you enjoy, that is sweet, that is so, that you just love the things like shrimp, things like roundabouts, things they call orishirishi. So people when they go and eat, they have to eat all the parts of the cow. They have to ask for this, they'll point at the stew, or pick that one, not that one, the other one. All of those things have cholesterol in them. So that's just a simple way to know that. Things that are fatty and they are really sweet and nice, very tasty, you know. A lot of them contain cholesterol. I'll say it's probably sounding that we should be tilting towards things that are not sweet and nice and probably bitter. No, that they should be taken in moderation. Oh, okay. They should be taken in moderation, yes. All right, so just before Justin jumps in right here, how can one actually tell that they're, I mean, how do you now tell that you're probably hypertensive? What are the signs and symptoms? Of course, you know that with malaria, COVID and what have you, you can actually say, okay, okay. So I have malaria, I have COVID or something because you can see the signs and symptoms. For hypertension, we normally refer to it as a silent killer. So most of the time, there may be nothing. You may not feel anything. But we recommend that as people get to the age of 30, they should begin to check their blood pressure. At least once a month, at minimum. And if you see the thing for this year says, measure your blood pressure accurately. The word accurately is very important. That means the world is also moving into the era of self-care. So it's important, the device for measuring your blood pressure is a device that anybody can use, especially, I mean, if you're educated at least up to primary six level, you should be able to use it. So I mean, an automated blood pressure meter can be used to measure the blood pressure. But there are a lot of things to be done to be sure that you measure your blood pressure accurately. And when you find it elevated, when it's above 120, 80, it's time to go to the hospital and get to see a doctor and discuss about it. That way, you can prevent the complications because most of the people get to know their hypertensive when they have the complications. And the commonest complication we see around here is stroke. So most people get to know when they have a stroke. So I think it's important we measure accurately. That seems the first step to take. All right, Doctor, are you okay? Oh, yeah, Lord, let's talk more about, you talked about complications and all of that. Let's try and correlate it to blood sugar and all of that. What do we need to know? So if you want to, generally, we said people should know their numbers. So one, you need to know your weight. It's important that everybody knows their weight. It's important you know your height. So when you know your weight and height, there is a way we can get an index called the BMI. There's a metabolic index, which can be done for you by any health worker. Besides that, they will begin to measure our blood pressure. So that means a device is used to measure the blood pressure. But I mean, as we advanced in age also, we need to know our blood sugar level, which is measured by another device, a glucometer. That can be done at most pharmacies now. It can be done at most pharmacies now and it can also be done in the health care centers. And for those who are educated, like I said, it can be done right at home. So it's something that can be learned. The device can be bought and it can be done at home. So those are the things that we need to know. And using all of that dose, seeing our doctors with all of those numbers, they'll be able to advise better what to do. All right, you talked about not really showing visible symptoms, but they have been talks about headaches, nausea, vomiting, and dizziness, and maybe blurred vision. Yes, okay. So people talk about nausea, headache, blood vision, and all of that. Those are also, they are unconstitutional symptoms. Yes, they could be for hypertension, but those are symptoms you could also have if you have a high fever. Those are symptoms you could also have if you have malaria. Those are symptoms you could have if you have any other disease. And that's why we say blood pressure is a silent killer. You may not have any of those symptoms and be hypertensive. And that's why some people just come down with a stroke without all of those symptoms. So we don't like to tell people that, oh, it's when you have a headache, then you have blood pressure. It could even be a problem of your eyesight that is causing the headache. So the not yet is that people should check their blood pressure even when they don't feel any sign or symptom. All right, just before I let you go, the final question would be at what point in time do you seek a second line treatment? So I've said that the aim is to have 12080, 12080, anything above that, you see a doctor. All right, thank you so much. We happen speaking with Dr. Yetunde Ayo, or Yalo, she is the founder, and market doctor. She is a public health practitioner. Thank you so much for the thoughts that you have shared this morning. Thank you for having me. All right, it is still the breakfast away from hypertension. We'll take a break, we'll come back. We'll give you updates on what happened in canvas data, of course. The train resumption, the Kaduna Abuja Bound, we have a guest who will tell us more about preparations and of course measures being put in place. In a moment, to join us again.