From observations made in this study, it can be concluded that undetected cases of hypertension exist among young adults in Ibadan and that complications and target- end organ damages are also present in hypertensive individuals in this age group. This study has provided a greater insight to the urgent need for a change in attitude toward young adults attending hospitals in Ibadan and possibly elsewhere in the country, especially in screening them for hypertension as part of clinical examination.
81 5.4 Recommendations
Based on the findings and conclusion drawn from this study, the following recommendations are made:
1. Family physicians, who are on the front line of disease prevention, should begin implementing routine blood pressure measurements for young adults whenever they visit the hospital or clinic, irrespective of the purpose of visit or complaint, in order to detect previously undiagnosed hypertension early.
2. Those who are diagnosed to be hypertensive should be fully evaluated to prevent target organ complications and treat those who may have it.
3. Health workers should devise means of adequately following up hypertensive patients, such as keeping records of scheduled appointments and making reminder phone calls or sending reminder text messages or mails when appointments are due, so as to minimize patients’ non-adherence to treatment.
4. National policy makers should enact and enforce relevant healthy dietary laws to ensure that food manufacturers use healthy fat for foods being manufactured in the country.
This will ensure consumption of healthy foods at all times and also regulate the increase in fast food joints.
5. Train family physicians who are front-line doctors that will play major roles in case finding for a chronic disease such as hypertension and diabetes mellitus.
6. Health-educate young adults on checking blood pressure periodically, the need to cultivate healthy lifestyles and take health-related issues very seriously.
82
7. Increase funding for research on hypertension, and other non- communicable diseases especially in young adults. There is a great need to encourage further studies on hypertension in young adults, particularly analytical studies and prevalence that would help establish cause and effect relationships between blood pressure and associated variables.
83
REFERENCES
1. Harrison R. Disease Presentation and Health Screening. In: Paul PM, Paulman AA, Harrison JD, editors. Taylor’s manual of Family Medicine, 3rded. Philadelphia:Lippincort Williams and Wilkins; 2008. 2-18.
2. Bloomfield P, Bradbury A, Grubb NR, Newby DE. Cardiovascular disease. In: Nicholas AB, Nicki RC, Brain RW, editors. Davidson’s Principles and Practice of Medicine 20thed Philadelphia: Churchill Livingstone; 2006.608-615.
3. Ogden J. Screening. In: Health Psychology: 2nded. Buckingham: Open University Press.
2008. 211.
4. Joint National Committee on Prevention, Detection, evaluation and treatment of High Blood Pressure. The Seventh Report of Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure (JNC VII)J. Amer Med. Assoc. 2003;
42(280): 2560-2572.
5. Padden OM. Hypertension. In: South-Paul JE, Matheny SC, Lewis EL, editors. Current Diagnosis and Treatment in Family Medicine: New York: Lange Medical Books/McGraw Hill; 2004, 192- 199
6. Isezuo AS, Opara TC. Hypertension Awareness Among Nigerian Hypertensives in a Nigerian Tertiary Health Institution. Sahel Med J. 2005; 3(2): 93 — 97.
7. Worley H. Chronic Disease Beleaguer Developing Countries. Population Reference Bureau. January 2006. Retrieved in March 2009 from www.prb.org
84
8. Logan AG. Screening for Hypertension in Young and Middle-aged adults.Canadian Task Force on Periodic Health Examination.Canadian Guide to Clinical Preventive Health Care. Ottawa: Heath Canada, 2004: 636 - 648.
9. Gan SKE, Loh CY, Seet B. Hypertension in Young Adults — An Under-Estimated problem. Singapore Med J. 2003; 44 (9): 448 — 452.
10. Akinkugbe 0.0. (ed). Hypertension. In: Non-Communicable Diseases in Nigeria
(Series 1).Federal Ministry of Health and Human Services, Lagos. Ibadan: Spectrum Books.
1992.2—4.
11. McWhinney JR. Hypertension. In: A Textbook of Family Medicine. 2nd’ Edition. New York: Oxford University Press. 2007. 18
12. Unpublished Records. Medical Records Unit, Oluyoro Catholic Hospital, Oke -ofa, Ibadan, Oyo State. June-December 2009
.13. Juliet Addo, Liam Smith and David A. Leon. Hypertension by American Heart Association, 2007;50: 1012-18
14. Cooper RS, Rotimi CN, Kaufman JS, Muna WFT, Mensah GA. Hypertension Treatment and Control in sub-Saharan Africa: The Epidemiological Basis for Policy. Br. Med J, 2003; 316: 614—617.
15. Ukoh VA. Hypertensive Admissions at the University of Benin Teaching Hospital, Benin-City, Nigeria - A Preliminary Audit.NigClin Review, 2005; 9(1): 27 - 32.
16. Dosumu EA, Hypertensive Heart Failure: A Report of Three Cases. West Afr. J Med, 1999; 18(2):147 - 149.
85
17. Akinkugbe, O.O Current Epidemiology of Hypertension in Nigeria. Archives of Ibadan Medicine. 2001; 1(1): 3-7.
18. Kadiri S. Current Concepts in the Management of Hypertension.Dokita Edit J (Heart and Lungs Edition). 2002; 26(1): 93 - 96.
19. Cooper RS, Rotimi CN, Ataman S, McGee D, Osotimehin B, Kadiri S, Muna W, Kingue S, Fraser H, Forrester T, Bennett F, Wilks R. The Prevalence of Hypertension in Seven Populations of West African Origin.Am J Public health.1997; 87: 160—168.
20. Isezuo AS, Omotoso ABO, Araoye MA, Carr J, Corrah T. Determinants of Prognosis among Black Africans with Hypertensive Heart Failure. Afr J Med Sci. 2003; (32): 143
— 149.
21. Williams GH. Hypertensive Vascular Disease. In: Wilson JD, Braunwald E, Isselbacher KJ, Petersdorf RG, Martin JB, Fanci AS, Root RK.editors. Harrison’s Principles of Internal Medicine.12thed. New York: McGraw-I-Jill Incorporated. 2001 ; ( 1): 1414—
1429.
22. Newton WP, Ives TJ. Hypertension. In: Sloane PD, Slatt LM, Curtis P, Ebel MH. editors Essentials of Family Medicine. 3rd ed. Baltimore, Maryland: Williams and Wilkins Co.
2008; 473 —482
23. World Health Organization, International Society of Hypertension Writing Group. In Kaplan N, Mendis S, Poulter N, Whitworth J.editors: 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) Statement on Management of Hypertension. J of Hypertension. 2003; 21(11): 1983 — 1992
86
24. Little P, Barnette J, Barnsley L, Marjoram J, Fitzgerald-Barron A, Mant D. Comparison of Agreement Between Different Measures of Blood Pressure in Primary Care and Day Time Blood Pressure. Br Med J. 2002; 325:254 — 257.
25. McManus RJ, Ma J, Roalfe A, Oakes RA, Bryan S, Pattison HM, Hobbs FDR. Targets and Self-Monitoring in Hypertension: Randomised Controlled Trial and Cost-Effective Analysis. Br Med J. 2005; 331: 493 — 496.
26. Okubadejo NU, Fasanmade AU. Concomitant Hypertension and Type II Diabetes Mellitus in Nigerians: Prevalence of Obesity and its Indices Compared to Normotensive Diabetics. Nig Med J. 2003; 45(4): 79 - 83.
27. Yusuf S, Hawken S, Ounpuu S, Bautista L, Franzosi MG, Commerford P, Lang CC, Rumboldt Z, Onen C, Lisheng L, Tanomsuo S, Wangai P, Razak F, Sharma Am, Anand SS (on behalf of the Interheart Study investigators). Obesity and Risk of Myocardial Infarction in 27,000 Participants from 52 Counties: A Case-control Study. Lancet.2005;
366: 1640 — 9.
28. Deen D. Metabolic Syndrome: Time for Action. Am Fam Physician. 2004; 69(12): 2875- 88.
29. Luke AH, Tayo BO, Cooper RS. Heritability of blood pressure in Nigerian Families.
J Hypertension 2002; 20(5): 859-863.
30. Rotimi CN, Cooper RS, Cao 0, Ogunbiyi 0, Ladipo M, Owoaje E, Ward R. Maximum-Likelihood Generalized Heritability Estimate for Blood Pressure in Nigerian Families. J Hypertension 2004; 33(1): 874 — 878.
87
31. Appel LJ, Moore TJ, Obarzanek E, Volmer WM, Svetkey LP, Sacks FM. A Clinical Trial of the Effects of Dietary Patterns on Blood Pressure. DASH Collaborative Research Group. N Engl J Med. 2007; 336 (2): 1117 -1119.
32. Speer JS, Felmar EA. Nutrition and Family Medicine.In:Rakel R.E editor Textbook of Family Practice. 6th ed London: W.B. Saunders Company. 2002: 1114 —1123.
33. Cognitive and Emotional Health Project: The Healthy brain. Demographic and Social Factors.The United States Department of Health and Human Services. Retrieved on 22/06/2010 from http//trans. nih.gov/ htm.
34. Adedoyin RA, Mbada CE, Awofolu 00, Oyebami OM. The Influence of Socio Economic Status on Casual Blood Pressures of Adult Nigerians.Eur J Cardiovasc Pre Rehabil. 2005;
12(3): 271-3.
35. Akinkugbe FM, Akinwolere AO, Kayode CM, Blood Pressure Patterns in Nigerian Adolescents. West Afr J Med. 1999; 18(3): 196—202.
36. Kalat JW. Stress and Psychosomatic Illness. In: Introduction to Psychology. 5th ed.
California: Brooks/Cole. Wadsworth. Publishing Company. 2002; 201 —204.
37. Kalat JW. Stress and Psychosomatic Illness. In: Introduction to Psychology. 5th ed.
California: Brooks/Cole. Wadsworth. Publishing Company. 2002; 463 —467.
38. Williams RB. Specific Psychosocial Factors Linked to Hypertension. J Amer Med Assoc.
2003; 290 (2): 2138-2192.
39. Oke DA, Bandele E.O Misconceptions of Hypertension. J Nat Med Assoc. 2004; 22: 45-50.
88
40. Drukteinis IS, Roman MI, Fabsitz RR, Lee ET, Best GL, Russell M, Devereux RB.
Cardiac and Systemic Heamodynamic Characteristics of Hypertension and Pre hypertension in Adolescents and Young Adults.The Strong Heart Study.Circulation.2007;
115:221 —227.
41. Adelekun TA, Akinsola AA. Hypertension-Induced Chronic Renal Failure: Clinical Features, Management and Prognosis. West Afr J Medicine. June 1998; 17(2): 104-108.
42. Elias PK, Robbins MA, Budge MM. Mental Function Declines When Blood Pressure Rises in Young Adults. J AmerHt Assoc. April 2007; 28-32
43. Edwards CRW, Bouchier TAD editors. Systemic Hypertension. In: Davidson’s Principles and Practice of Medicine. l6th ed. Edinburgh: Churchill Livingstone. 2003; 316—322.
44. Imarhiagbe F, Ogunrin 0, Ogunniyi A. Cognitive Performance of Hypertensive Elderly Nigerians: A Case-Control Study. Afr J Med Sci. 2005; 34(3): 269 —273.
45. Oke DA, Mbakwem AC. Erectile Dysfunction in 101 Consecutive Hypertensive Patients and 86 Normotensive Controls. Nig Med Practitioner. 2004; 45(6):98 — 101.
46. Okeahialam BN, ObekaNC.Sexual Dysfunction in Female Hypertensives. J Nat Med Assoc. 2006; 98(4): 638 — 40.
47. Holder KK. Interventions to Improve Blood Pressure Control in Patients with Hypertension.J AmerFam Physician. 2007; 76 (3): 373 — 374.
48. Weiten W. Adhering to Medical Advice (Stress, Coping and Health). In: Psychology Themes and Variations. 6th ed. California.Thomson Wadsworth. 2006; 204-550.
49. WHO/International Society of Hypertension (ISH). Guideline for the management of mild hypertension. Bull of the WHO 2003; 71: 503 - 517.
89
50. Messerli FH, Grossman E, Goldbourt U. Are Beta-blockers Efficacious as First Line Therapy for Hypertension in the Elderly? A Systematic Review.JAmer Med Assoc. 2008;
279: 1903 — 1907.
51. Medical Research Council Trial of Treatment of Hypertension in Older Adults: Principal Results.MRC Working Party.Br Med J. 2002; 304: 405 —412.
52. Coronary Heart Disease.The United States Library ofMedicine.Retrieved on 20/09/10 fromwww.nlm.nih.gov/medlineplus/ency/artile//007115.htrn.
53. Coronary Artery Disease Treatment.Medical Heart and Vascular Institute.Retrieved on 22/09/10 from www.clevelandclinic.org/heartcenter.
54. Dickerson LM, Carek PJ, Quattlebaum RG. Prevention of Recurrent IschaemicStroke.AmerFam Physician. 2007; 76(3): 382 — 388.
55. Hypertensive Retinopathy. Handbook of Ocular Diseases Management.Retrieved on 22/09/10 from www.revoptom.corn/handbook
56. Hypertensive Retinopathy. Eye MDLink.com.Retrieved on 22/09/10 from www.
eyemdlink.com
57. Hypertensive Retinopathy.Merck Manual Professional.Retrieved on 23/09/10from www.merck.com
58. Kidney Failure.Retrieved on 23/1/11 from www.medicinenet.com.
59. Wood M. Chronic Renal Failure and its Progression. Retrieved on 23/03/11 from EdREN (website of the Renal Unit of the Royal Infirmary of Edinburgh) at www.renux.dmed.ed.ac.uk/EdREN/index.html.
90
60. Phillips NA. Female Sexual Dysfunction: Evaluation and Treatment. J AmerFam Physician, 2000; 62(1): 127 —142.
61. Cutler SI, SmithW, Cutler HG. Treatment of Sexual Dysfunction.U.S.Pharmacist.2002;
23(5): 67-74
62. Sox HJ. Preventive Health Services in Adults.NewEng J Med. 2004; 330: 1589 — 1595.
63. Araoye MO. Sample Size Determination. In: Research Methodology with Statistics for Health and Social Sciences, 1st ed. Ilorin: Nathadex Publishers. 2003; 117- 118.
64. Xavier B, Jordi S, Manolis K, Jean-Paul Z, Tauleria D, Javis D, Burney P, Anto JM Socio-Economic Status and Asthma Prevalence in Young Adults: The European Community Respiratory Health Surveys. Amer J Epid. 2004; 160(2): 178 – 188
65. DiMatteo MR. Enhancing Patient Adherence to Medical Recommendations. J Amer Med Assoc. 2004; 271: 79 — 83.
66. Munger MA, Van Tassel BW, LaFleur J. Medication Non-Adherence: An Unrecognized Cardiovascular Risk Factor. Medscape General Medicine. 2007; 9(3):58.
91 APPENDIX I
THE JNC 7 CLASSIFICATION OF BLOOD PRESSURE FOR ADULTS 18 YEARS AND ABOVE