DR. IVAN EDWARDS: The Silent Killer Is At Work In Uganda – we must mitigate it

During my recent visit to Uganda, amidst cherished moments with family and friends, I found myself inadvertently slipping back into my doctor’s role. Despite being on vacation, I couldn’t ignore the requests from loved ones to check their blood pressure. Each time, I reluctantly obliged, even though my intention was to refrain from treating anyone.

I came to a rude awakening. Nearly 8 out of 10 people had moderate to severe hypertension, far surpassing the 8% prevalence reported in literature (1). Some individuals were in their thirties. Many were undiagnosed and untreated, putting them at risk of developing serious complications from the disease.

In the face of this multifaceted health crisis, Uganda urgently needs a strategic approach that integrates cost-effective preventive measures into its healthcare system. The silent killer at work in Uganda must be mitigated.

According to the World Health Organization (WHO), normal adult blood pressure is defined as a systolic blood pressure of 120 mm Hg (the top number representing active heart contraction) and a diastolic blood pressure of 80 mm Hg (the bottom number representing heart relaxation). When the systolic blood pressure is equal to or above 140 mm Hg and/or the diastolic blood pressure is equal to or above 90 mm Hg, the blood pressure is deemed to be high (2). Some medical authorities have more stringent parameters than the WHO’s standard.

High blood pressure, often referred to as “the silent killer” can damage the body without obvious symptoms in the beginning. While some individuals with hypertension may experience symptoms like headaches, shortness of breath, dizziness, chest pain, heart palpitations, or nosebleeds, others may remain asymptomatic.

Left uncontrolled, hypertension can lead to a heart attack, an enlargement of the heart, and eventually heart failure. Blood vessels may develop bulges (aneurysms) and weak spots that make them more likely to clog and burst. The pressure in the blood vessels can cause blood to burst out into the brain and cause a stroke. Hypertension can also lead to kidney failure, blindness, and cognitive impairment.

The costs of healthcare associated with the treatment of hypertension and its comorbidities are exorbitant. Hypertension, along with its complications, can escalate treatment costs, resulting in reduced productivity. Given the high prevalence of hypertension and the limited resources available for managing this disease and its sequelae, Uganda must integrate cost-effective preventive measures into its healthcare system to mitigate this silent killer.

Preventing a disease, naturally, is better and cheaper than trying to manage it afterwards. Preventative measures are, therefore, cost-effective. But they require commitment on the part of the patient.

Uganda can work on implementing the following objectives in a strategic health plan:

• Healthy diet

• Education and Promotion: Uganda should educate the public through clinics and hospitals about the importance of a healthy diet. Specifically:
  • Encourage the consumption of 5 servings of fruits and vegetables daily.
  • Limit saturated fatty foods: Educate about the risks associated with high saturated fat intake, which can contribute to heart disease and hypertension.
  • Restrict salt consumption: Emphasize that less than a teaspoon of salt per day is recommended to maintain healthy blood pressure.

• Healthy weight:
  • Obesity reduction: Public education efforts should highlight the impact of weight on blood pressure. Key points include:
    • Curbing obesity: Explain that maintaining a healthy weight can significantly reduce systolic blood pressure.
    • Weight loss benefits: For every 5 kg (11 lbs) of weight lost, systolic blood pressure can drop by 2-10 points.

• Physical activity vs. sedentary Lifestyle:

• • Encourage regular physical activity:
    1. Recommend at least 3 days a week of 20-30 minutes of walking to help normalize blood pressure.

• • Public awareness campaigns:
    1. Smoking: emphasize that smoking increases the risk of hypertension.
    2. Alcohol: Limit alcohol intake to one or fewer drinks per day to prevent blood pressure escalation.

To some people, adhering to the above lifestyle modifications alone may not suffice, and they may require prescription medication to manage their blood pressure. In such cases, adults can actively support their treatment by seeing their doctor, adhering to prescribed medications, maintaining lifestyle changes, and monitoring their overall health.

In Uganda, a silent killer is going undetected, with innumerable sufferers remaining undiagnosed and untreated, teetering on the precipice of serious complications. Uganda urgently needs a strategic approach to combat this silent killer. A four-pronged preventative approach that encompasses a healthy diet, a healthy weight, physical activity, and smoking/alcohol cessation is imperative to turn the tide.

1. Majumdar et al., “Hypertension screening, prevalence, treatment, and control at a large private hospital in Kampala, Uganda: A retrospective analysis,” 2022.

2. WHO news release, “First WHO report details devastating impact of hypertension and ways to stop it.” 2023.

About the writer
Dr. Ivan Edwards is a Ugandan American who was born and raised in Uganda, and later immigrated to the US, where he currently resides. He is a medical doctor, a USAF flight surgeon, at the rank of Lieutenant Colonel, a humanitarian, an entrepreneur and an international motivational speaker.