As many as 40% of adults in Nigeria are hypertensive, and majority are not even aware. Of those who are aware only about 20% have their blood pressure adequately controlled. The goal for treating blood pressure is to get the levels to 130/80mmHg or lower. (130 systolic, 80 diastolic). We are concerned about poorly controlled blood pressure because of the possible side effects/complications that can arise if the blood pressure is not adequately controlled i.e Stroke, heart and kidney failure, cardiac arrest and so on.

Many people with elevated blood pressure are not able to attain this goal, and it can be frustrating for both the patient and the doctor when this persists. Before you conclude that your drugs are not effective or your doctor is a quack. Let’s run through some reasons why you may not have achieved blood pressure control:

1. Not using the medication: there is no way your blood pressure will be under control if you are not taking the medicine or you are taking it in a haphazard way. Classical example, taking drugs only when you fell “somehow”, taking medication once a week or every other day. Hypertension drugs are only effective if they are used at the correct dosage.
2. Not following the lifestyle changes: cutting down salt intake, eating a good quantity of raw vegetables and fruits as well as daily exercise ALL contribute to reducing your blood pressure. Avoiding alcohol and cigarettes are also important lifestyle changes. You must adhere to these lifestyle changes to get effective blood pressure control, even when you are on medication.
3. Inappropriate medication: hypertension management is not a “one size fit all” affair. Drugs are prescribed according to the individual’s characteristics and health needs. So you cannot achieve good blood pressure control by “borrowing or sharing“ another person’s medication.
4. Not going to hospital for follow up; So you have been given a set of BP medication, they have reduced the blood pressure, so no need to go back to see your doctor right? WRONG! When you don’t go back to the clinic for periodic follow up, the doctor will not know when other conditions develop and change your medication appropriately
5. Your blood pressure is not under the management of a specialist: you won’t take your car to a carpenter to maintain would you? So why would you decide that the most important thing to you – your health, can be managed by anyone who has a science degree?  The only people trained to manage blood pressure are doctors (primary care physicians and internists). If you are receiving care from any other category of health practitioner, you may not be getting the best treatment for you.
6. Lack of trust in the healthcare personnel: generally if you don’t trust your doctor, how can you follow their advice? Or if they are not allowing you ask questions or you don’t even understand why you are taking so many drugs in the first place. There is no harm in seeking a second opinion or looking for a doctor that you can trust well enough to follow their instructions.
7. The use of supplements: Not all supplements are good for hypertensive people. There are some pills that contain stimulants, which can raise the blood pressure and can be dangerous.
8. Excessive stress: Stress and lack of sleep both elevate hormones cortisol and adrenaline, which contribute to raise your blood pressure. Are you getting 6 hours of sleep every night? Do you get angry or worry over every little thing? This may be why your blood pressure has not been adequately controlled.

If your blood pressure is not controlled, I am sure you have found a few reasons why and you will make moves to correct them.