Blood pressure represents the force exerted by circulating blood against the walls of the body's arteries. It is recorded using two numbers: systolic pressure, which measures the pressure when the heart beats, and diastolic pressure, which measures the pressure when the heart rests between beats. Normal adult blood pressure generally sits below 120/80 mmHg. Hypertension is diagnosed when a patient's blood pressure persistently reads at or above 140/90 mmHg during multiple clinical readings.
In Nigerian clinical practice, midwives frequently encounter pregnant women developing gestational hypertension or chronic hypertension complicating pregnancy, making accurate blood pressure measurement a vital daily skill. Digital and mercury sphygmomanometers are both used across primary health centers and tertiary hospitals, though proper cuff size and patient positioning remain critical for obtaining valid readings.
Hypertension is generally categorized into two types based on its origin. Primary (essential) hypertension has no identifiable single cause, though it is strongly linked to genetics, aging, and environmental factors. Secondary hypertension results from an underlying medical condition, such as chronic kidney disease or endocrine disorders.
Several modifiable and non-modifiable risk factors drive the high prevalence of high blood pressure in West Africa:
Hypertension is widely known as the "silent killer" because many individuals experience no noticeable symptoms for years. When symptoms do appear—often during sudden blood pressure spikes—they can include occipital headaches (typically worse in the morning), dizziness, blurred vision, fatigue, and palpitations.
Midwives conducting routine antenatal or general outpatient assessments must look beyond a single blood pressure reading. A thorough assessment includes taking a detailed medical history, checking for end-organ damage signs such as peripheral edema or abnormal urine protein tests, and assessing lifestyle habits. Routine screening ensures early detection before catastrophic complications occur.
When blood pressure remains elevated over an extended period, it places excessive mechanical stress on the arterial walls and vital organs. Over time, this damage leads to severe, life-threatening complications that disproportionately burden healthcare facilities across Nigeria.
Managing hypertension requires a combination of pharmacological therapy and diligent nursing care. Commonly prescribed antihypertensive drug classes include thiazide diuretics, ACE inhibitors, calcium channel blockers, and beta-blockers. In Nigerian hospitals, drug selection often depends on cost, availability, and any co-existing conditions like diabetes or pregnancy.
Nursing responsibilities center around patient safety and monitoring. Midwives must regularly monitor vital signs, assess for orthostatic hypotension after medication administration, and watch for adverse drug reactions like persistent dry coughs from ACE inhibitors. Ensuring adherence to the prescribed drug regimen is vital, as abrupt discontinuation can cause a dangerous rebound hypertensive crisis.
Lifestyle changes form the foundation of both preventing and managing high blood pressure. Midwives play a key role in empowering patients with practical, culturally appropriate advice regarding their daily habits.
Key lifestyle modifications include: