Nigeria has one of the highest hypertension burdens in the world. Studies conducted in urban Lagos and other major Nigerian cities consistently show adult hypertension prevalence of 30–45%. Applying the mid-range estimate of 35% to Nigeria's adult population of approximately 110 million means approximately 38 million Nigerians have hypertension — making it the most common non-communicable disease in the country.
The cascade of care for hypertension in Nigeria is broken at every step: 60% are undiagnosed, only 40% of those diagnosed are on treatment, and only 30% of those on treatment have their blood pressure adequately controlled. This means that roughly 1 in 8 hypertensive Nigerians has their blood pressure controlled — a rate that represents one of the worst control figures in the world.
Stroke is the most devastating direct consequence of uncontrolled hypertension. Nigeria has the highest age-standardised stroke mortality rate in the world according to GBD data — and hypertension is the attributable cause in the majority of cases. The typical Nigerian stroke patient is younger than their European counterpart — often in their 50s or 60s — at the peak of their productive years, frequently the breadwinner of a large family.
Hypertension also drives: chronic kidney disease (the kidneys are exquisitely sensitive to elevated pressure — nephrosclerosis from hypertension is a leading cause of dialysis need in Nigeria), heart failure (hypertensive cardiomyopathy — enlarged, stiffened heart that fails progressively), coronary artery disease (accelerated atherosclerosis), and vascular dementia.
The major modifiable risk factors prevalent in Nigeria include: high dietary salt (processed foods, stock cubes, preserved fish), rising rates of overweight and abdominal obesity particularly in urban Lagos, insufficient physical activity, heavy alcohol use in men, and psychological stress from urban living conditions. Genetic factors — Black African ethnicity has an intrinsically higher propensity for salt-sensitive hypertension — also play a role.
At primary care level, the interventions that matter are: measuring blood pressure at every clinical contact (BP is checked on every patient at Mascot Healthcare regardless of the presenting complaint); prescribing evidence-based antihypertensives rather than inappropriate combinations; monitoring organ damage annually (kidney function, ECG); and educating patients on why medication must be continued even when they feel well.
About the author: Dr. Adebayo Okonkwo is general practitioner, mascot healthcare at Mascot Healthcare, Akoka, Lagos. This article is reviewed annually and updated to reflect current guidelines and data.
Blood pressure check at every consultation at Mascot Healthcare, Akoka. Walk-in from ₦5,000.