In recent times, we have heard of many stories and have had experiences of our young men and women in their 30's, 40's and 50 dying suddenly. Many families narrate stories such as:  "My uncle was not even sick; he was laughing and joking with us yesterday and today he's dead! Something behind it!" Or, "My good, good son is paralyzed on one side, he can't talk, they put something in his chair, oooh my people!" "The doctor says I have heart problem, and I don't know where that came from."

What is going on?  Is it "African Sign," as many Liberians usually say?  Or is it High Blood Pressure (hypertension), "the silent disease" that is killing our young population? Some experts have weighed in on this question. For example, Dr. Joseph Njoh, MD, a professor at the A.M. Dogliotti College of Medicine of the University of Liberia and internal medicine consultant at the JFK Medical Center in Liberia, said high blood pressure is the killer. He didn't utter a word about "African sign." Further, in 2011, the World Health Organization (WHO) named the following diseases-Influenza, Pneumonia, Diarrhea, HIV/AIDS, Malaria, Stroke and heart disease- as the top killers among the fifty (50) diseases in Liberia. WHO did not mention African Sign as a killer.

Neither did Dr. Abraham Borbor, Chief of Internal Medicine at JFK Medical Center, Monrovia, Liberia, mention African Sign in his 2010 Landmark Study, instead, pointed at high blood pressure as a killer in Liberia. (See Reference 1). In his 33 month retrospective chart review of all patients discharged from JFK Medical Center from August 2007 to May 2010, he reported the following findings: Out of the 2,606 patients discharged, 382 patients were stroke victims. Ninety-two percent (92%) of the 382 stroke patients had high blood pressure.  Alarmingly, out of the 382 stroke patients, 43% went home, meaning 57% died at the Hospital (JFK). He also reported that 53% of those stroke patients were between the ages of 20 to 59.  This report is from only one hospital; just think about stroke patients at other hospitals as well as those stroke patients who did not make it to a hospitals.

What is blood pressure?  Blood pressure is the force of blood pushing against the walls of the arteries as it carries nutrients and oxygen throughout the body. Normal blood pressure is 120/80 or below. On the other hand, when blood pressure increase to 140/90 or above (i.e., higher than normal), then it is called High Blood Pressure.
High blood pressure, often, has no signs or symptoms. However, if the blood pressure is very high, one may experience severe headache, blurred vision,   dizziness, nose bleed and erectile dysfunction or impotence. 

The increase in the pressure of blood flow over time will cause the walls of the arteries to become harden and narrower. If not corrected over time the following will occur: 1) the arteries will become clogged, causing the blood vessel in the  brain to burst, resulting into Stroke; 2) the narrowness of the arteries will reduce the oxygen supply to the heart muscle, resulting into chest pain and heart attack; 3) the  narrowing   and  stiffness  of  the  arteries  will reduce the  supply of nutrients and oxygen   in the eyes   and  kidney , resulting into Blindness or Kidney failure. The  constant  higher than normal pressure can cause the heart  muscle  to become  weak, leading to congestive  heart  failure, resulting into constant coughing, getting tire easily, legs  swelling,  feeling short of breath, etc. `

What are some of the things that may cause high blood pressure?

1. Obesity/ being overweight  increases the strain on the heart muscle to pump blood,

    and also lack of exercises weakens the heart muscle, making it ineffective in pumping blood.

2. Sodium in salt causes the body to retain excess fluid, resulting into an abnormal rise in blood pressure. Highly salty food often consumed by Liberians include salt  port, salt fish, smoke fish  corn beef, luncheon meat magi cubes etc.

 1. Use of tobacco, alcohol or drug: Alcohol may negatively interfere with blood pressure medication. Alcohol example, beer has empty calories that cause weight gain. Smoking damages the arteries, thereby making it difficult for the blood to flow normally and carry oxygen and nutrients to the rest of the body.

2. Stress: Stress causes sudden rise in blood pressure and may damage arteries.  Prolong stress may also cause the patient to experience depression, anxiety and risk behavior such as drinking, smoking, and excessive eating.

3. Certain medical conditions (i.e. diabetes, high cholesterol, thyroid disease) may increase high blood pressure.

Strategies to prevent and control high blood pressure:

1. Regularly, visit your doctor for checkup, and know your family history.

2. Prescribed medication: Avoid fake or outdated drugs.  Make sure you fill your prescription at a drug store or pharmacy. 

3. Do not be embarrassed about the issue of erectile dysfunction associated with uncontrolled high blood pressure. It usually resolves if the blood pressure is controlled.

4. Some high blood pressure medication may have side effects that may interfere with sexual function. Please consult your doctor to adjust or change your medication.

5. Do not stop taking your medication because your blood pressure reading is normal.  This is because stopping medication abruptly may increase your pressure and send you into hypertensive crisis.

6. Do not mix high blood pressure medication with herbs or "country medicine." Doing so may cause harmful interaction especially to your kidney, a vital organ that clears toxic waste from your body. If your kidneys fail, you will need a dialysis machine. Currently, the Liberian health care system does not have a dialysis facility.

7. Everyone should have a blood pressure device at home, and keep a record of your blood pressure reading. This information will help your doctor determine your blood pressure status and your progress.

  KNOW YOUR BLOOD PRESSURE READING AND WHAT IT MEANS: 
Blood pressure is measured with two numbers:  One number on top of the other.  The top number (systolic pressure) is generated as the heart pumps blood throughout the body. The bottom number (diastolic) is generated as the heart relaxes.
Blood pressure readings fall into four general categories: 1) normal, 2) Prehypertension, 3) stage 1 hypertension, and 4) stage 2 hypertension (i.e., High Blood Pressure).
                                            Pressure chart for adults

1. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7).
The JNC 8 Guidelines recently released are being reviewed by health institutions.

2. Borbor, a: Stroke, the whip of death in the young: Journal of the Liberia Medical & Dental Association, 2010 Sept, Vol.16, No.1, pp. 15-17.
National Recommendation:

1. Organize a training program for health workers as high blood pressure educators who should use the airways to communicate in English and various dialects to increase public awareness.

2. Develop a simple nationwide high blood pressure assessment tool to identify at risk patients and those patients with undiagnosed high blood pressure.

3. A follow-up research study and national goals- and- intervention strategies on high blood pressure reduction, according to the points raised by Dr. Borbor in his landmark study. Such an endeavor will help provide answers for prevention and intervention.