Hypertension, or high blood pressure, remains a significant public health concern in Nigeria. It is a major contributor to the growing burden of cardiovascular diseases (CVDs). Despite being a modifiable risk factor, hypertension continues to be underdiagnosed and poorly managed, particularly within the primary healthcare (PHC) system.

Recent studies consistently indicate a high prevalence of hypertension among Nigerian adults. Surveys conducted by Health Watch and other organisations report an age-standardized prevalence of 38.1%, with regional variations ranging from 20.9% in the North-Central to 52.8% in the South-East. Alarmingly, awareness, treatment, and control rates remain critically low, with only 29% of hypertensive individuals aware of their condition, an estimated 12% receiving treatment, and a mere 3% achieving adequate blood pressure control.

Combating the burden of hypertension depends heavily on how responsive and empowered the primary healthcare system becomes. The PHC system must serve as the first line of defence in managing the rising prevalence of hypertension among Nigerians. This effort starts with establishing robust awareness protocols and effective treatment procedures. Unfortunately, many PHC facilities lack the essential equipment and medications required for adequate hypertension management. A study assessing 305 PHCs found that only 1.6% had physicians, while a significant number lacked a consistent supply of antihypertensive medications and functioning blood pressure monitoring devices.

Another significant limitation in hypertension management is the shortage of trained healthcare professionals, which severely hampers the delivery of quality care. Most PHCs are staffed primarily by community health workers (CHWs), whose training in non-communicable disease management is limited. As a result, their capacity to diagnose, manage, and follow up with hypertensive patients is often inadequate.

In addition, the absence of robust health information systems further impedes the tracking, monitoring, and long-term follow-up of patients. Without efficient data systems, continuity of care is compromised, leading to suboptimal hypertension management outcomes.

Cultural beliefs also play a substantial role in shaping attitudes toward hypertension in Nigeria, as in much of the African continent. Deeply ingrained cultural perceptions, combined with low health literacy and economic constraints, contribute to poor adherence to treatment regimens and resistance to necessary lifestyle modifications. Many patients rely on traditional remedies or distrust long-term pharmaceutical treatment, further complicating management efforts.

‍

‍

What The New Order should be

If we are to rewrite the narrative of hypertension management in Nigeria, the task must be entrusted to those closest to the frontline; the PHC system must be empowered to take ownership of this challenge. It begins with targeted investments in PHC infrastructure. Providing essential equipment, ensuring a consistent supply of antihypertensive medications, and maintaining facilities capable of delivering quality services are foundational steps.

Community health workers and PHC staff must receive regular training on current hypertension management protocols to enhance care delivery. The adoption of standardized treatment protocols, such as the WHO’s HEARTS technical package, can provide clear guidance and consistency in managing hypertension effectively at the PHC level.

Developing electronic health records and launching sustained public health campaigns will also be critical. EHR systems can enable better patient tracking, data collection, and proactive follow-up, while public awareness initiatives can help foster better understanding of hypertension and encourage proactive health behaviours.

Addressing hypertension in Nigeria requires a multifaceted approach, but strengthening the PHC system as our primary line of defence is essential and non-negotiable. With strategic investments and coordinated action, the PHC system can play a pivotal role in reversing the current trends and safeguarding the cardiovascular health of Nigerians.

‍