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11.09.2013 Opinion

The Menace Of Arterial Hypertension

By Ghanaian Chronicle
The Menace Of Arterial Hypertension
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All medical practitioners in 'third world countries' will come into confrontation with ARTERIAL HYPERTENSION, irrespective of what field they might be engaged in, be they General Practitioners (GPs), or specialists.

This factum is easy to explain, taking the example of the 'Republic of Ghana', with the census result of 2012, listing 25.6 million inhabitants, and concentration with overall Doctor/Inhabitant ratio of 3,500 doctors of medicine within the country. It is a ratio of one Medical Doctor to nine thousand inhabitants [1:9,000], approximately.

The usual modus of appointment with the Physician for follow-up, who has just been diagnosed with arterial hypertension, is that he be seen every half-yearly in the clinic, following the initial contact. He takes medications along, which, at best, should last two months.

In many instances, the practitioner may not have 'had the time' to explain the essence of the tag with 'arterial hypertension' on his patient (owing to the unfavorable (patient/doctor ratio).

The medication,' given, or prescribed', even if free of charge (paid for by some scheme of insurance), or by some charity, would last some hundred days at best, or less.

The patient 'feels free of headache or heaviness in the head', as many a patient has been made to believe, as being 'typical signs of arterial hypertension.'

In many instances, the patient might not return to the practitioner, whom he thanks for having cured him of 'his disease'. But, there are as many, who may return to the practitioner, who measures the BP and discovers that 'his patient is as hypertensive as when he first saw him.'

There are many whom he may not have the chance to meet again, because, they may meanwhile, have died of typical 'hypertensive encephalopathy'.

The physician, if he had been enthusiastic in Greek mythology whilst a medical student, and also since qualifying, would have realised his effort would soon turn to be some ' Sisyphus's task.' There are many he may never set eyes on again, and just as many that he may not succeed in getting the time to explain to them, exactly what they ought to do to have the hypertension, brought down enough, and hope that time would be friendly enough, in the future, for his patients and him.

The lifestyle, starting with the middle class, starts with some breakfast, which is full of salt and oil, plus starch.

The oil, even if not of 'saturated fatty acids', is just quantitatively on the wrong side of the equation. The quantity is for sure, in time, going to pull him to the wrong side of the Body Mass Index [ BMI] .

The fish, 'famously known as 'koobi' (Salted TILAPIA), which accompanies the corn and cassava-based component, is almost always over-salted, for there are citizens of the Republic who don't agree it makes any sense to 'de-salt' it to make it healthier for consumption, but in the process, unfortunately, take away the taste. Delicious, but dangerous, seems preferred.

Lunch is usually taken in a foreign eatery, but inside the Republic. It is disproportionate in its 'essentials'.  Dinner comes late, because the worker has it tough coming home AFTER WORK, and inadequate transportation – infrastructure must take the blame.  The last meal of the day is usually taken late.

Ladies have a lot to gain, when it comes to appealing to men, and that is when they look big!!  Funny enough, men equally stand on the wrong side of the BMI, which spells disaster quite often. They are concerned about otherwise looking 'HIV-positive'. They feel neighbours would suspect them 'of being HIV-positive', if they should look what they call 'too thin'.

DIABETES MELITUS, as we would know, is often silently hidden behind arterial hypertension, until the victim might begin to spew sugar into his urine, and begin visiting the 'comfort room' more often at night than he previously MIGHT HAVE DONE, or find the LITTLE CREATURES visiting where one left some urine drops – one may become loaded with more 'complications' than one imagined in one's earlier days.

The practitioner's 'Sphygmomanometer' does not worry anybody by only being a long word, but it also shows on the screen, 190/120, and in case one may have forgotten, it says mmHg.

In a previous exercise, we rehearsed, how, more than a century ago, an Italian Physician, by name of Riva Rocci, found out for us, the units in which we might measure the BP.

A Russian Physiologist/Physician, by name of Nikolai Korottkoff, contributed to this discovery. We could find out whilst at home that we should be happy if our Blood Pressure (BP) were, for example, 125/65mmHg, or 135/85MM.

One ought to be reminded that a standard of 135/90mmHg is accepted in most places as the very norm, and if kept constant, would surely ward off hypertension-related health discomforts.

Your pulse rate is pulled into 'the debate' in some way, but it is normal if it lies between 60 beats up to 100 per minute.  Below sixty is too slow, and above hundred is too fast.  The pulse rate gets 'pulled into the debate of arterial hypertension indirectly'.

It will drive everybody crazy, and send people to see the Physician before their appointment might be due, if the individuals 'would suddenly hear the beating of their heart' (palpitation) whilst trying to fall sleep.

It would be a good idea to let 'your doctor know.' Cerebral Stroke and the complications thereof, is 'often' the cause of death following cerebral complications in the Republic of Ghana.

The incidence increasing in municipalities is a very common observation in other parts of the world.

The difference may be that societies are structured in such a way that preventive measures are instituted with more seriousness than one would see 'in our communities.'

Cerebral stroke is when a blood vessel ruptures, spilling blood into the brain tissue, or when the vessel may be occluded (blocked), such that blood may not flow any further.

The 'cerebral emergency that it may throw behind leaves the victim either dead, or when he/she may survive, may remain maimed for a long period of time, or forever.

This way, it shortens the lifespan, or the joy of it. The reminder of the need to take care of the Blood Pressure, which protects the brain and the heart, would both aid anybody grow healthier, and longer.

Continuation of the title 'The Menace of Arterial Hypertension follows.

Kofi Dankyi Beeko, MD. Consultant NEUROSURGEON

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