Study unravels how hypertension is treated in communities

No few than 29 percent of Nigerias rely on CAM in the management of hypertension, a Nigerian study has found.
A new study to determine the frequency
and factors associated with use of CAM
among hypertensive subjects found that 29
per cent used CAM in the management of
their hypertension and the most common
forms used were herbs (63%) and garlic
(21%).
Hypertension is one of the most common
non-communicable diseases worldwide
affecting up to 800 million of the world’s
adult population. It is estimated to cause 4.5
per cent of the current global disease
burden and is often as prevalent in many
developing countries as in developed
countries.
While reliable data from large scale,
population based studies in sub-Saharan
Africa are few, the evidence suggests that
overall hypertension prevalence is between
10 and 15 per cent, with specific settings
(for example, some urban centres) often
having twice these prevalence rates.
Traditional health practitioners often play a
major role in health care in many countries,
inclusive of hypertension. For example,
some researchers reported that as many as
63.9 per cent of their hypertensive subjects
in a clinic in India took herbal medicines,
while in Morocco 80 per cent of patients
with hypertension and diabetes used
medicinal plants to treat their ailments.
The study which was carried out in Idikan
community, a community in Ibadan,
involved 440 hypertensive subjects and .it
took into consideration such factors as their
gender, belief on causes of hypertension,
age, educational level and occupation. It also
included an in-depth interview with CAM
practitioners (called indigenous healers or
traditional healers) in the community to
obtain their perspectives on their
management of hypertension.
In addition, a large proportion (63.4 per
cent) of the respondents reported that they
sought care for their condition from the
hospital (the nearby University College
Hospital (UCH), community health centre and
private hospital); while 5 per cent said they
went to the chemist or Patent Medicine
Vendor (PMV). It was interesting to note that
a significant proportion of respondents
used a combination of these facilities.
Despite the fact that none of the
respondents reported using traditional
healer exclusively, 9.5 per cent of the
respondents who visited the hospital still
made use of traditional medicine, while 7.3
per cent used the chemist and traditional
medicine.
Nearly one-third (29.1 per cent) of
respondents reported using CAM. About 13
per cent of the overall sample used CAM and
sought care with a CAM practitioner while
16.1 per cent used CAM but did not seek
care from a CAM practitioner. Among those
reporting use of CAM, the main forms used
were: herbs only (63 per cent), garlic (21
per cent), and herbs and prayer (8 per cent).
The researchers found out that four
variables were independent predictors of
CAM use. They were being male, belief in
supernatural causes of hypertension, lack of
belief that hypertension is preventable and
having a family history of hypertension.
The interviews with the study participants
revealed that their beliefs was that
hypertension was caused by evil forces (21
per cent), stress or “too much blood in the
body”. They also thought they could cure
hypertension but that reduced costs
(compared to hospitals) was one of the
reasons most of their clients consult them.
The 2010 study published in BMC
Complementary and Alternative Medicine
2010 was entitled “Complementary and
alternative medicine in the management of
hypertension in an urban Nigerian
community.”
It was carried out by Pauline E. Osamor
from the Department of Sociology, Bowen
University, Iwo, Osun State in collaboration
with Bernard E. Owumi from the
Department of Sociology, University of
Ibadan, Ibadan.
In addition, the study found that men were
more than twice as likely to use CAM and
belief in supernatural causes of
hypertension was the most notable belief
predicting CAM use.
The reason why patients choose to use CAM
have been much discussed, but not fully
understood. But according to this study, it
was suggested that the common
determinants of CAM use include the socio-
demographic characteristics of patients.
They wrote: “There are other complex
psycho-social and cultural factors. Patients
may choose to use CAM because they are
dissatisfied with conventional treatments
that are perceived to be ineffective or have
unpleasant side effects. Patients may also
find CAM attractive because it is consonant
with their personal values, religious and
health philosophies.”
Meanwhile, the CAM practitioners’ views
about causes, severity and prevalence of
hypertension were interesting. They related
the cause of hypertension to being a
spiritual problem, caused by evil forces and
too much blood in the body. Hypertension
was also seen as a poor man’s sickness.
The interviews with the CAM practitioners
were quite revealing regarding the
curability of hypertension.
Two of them believed that hypertension
was curable and they themselves can
actually cure hypertension with the herbs
and concoctions they give to their clients.
One of CAM practitioner interviewed, who
was not sure if the disease was curable,
said he had seen a lot of people over the
years that had been using a combination of
orthodox medicine and traditional medicine,
and yet remained hypertensive.
Nonetheless, the researchers stated that
more research was needed on
understanding people’s perspective on the
spiritual causes of hypertension because
people’s behaviour is not independent of
their beliefs. According to them, evidence
for how these are related in CAM use would
clearly be beneficial for hypertension
control programmes.
In Nigeria, two hospital-based studies
previously found that herbal medicine
among hypertension patients was 39 per
cent and 24 per cent, respectively. For
instance, a study carried out at a secondary
health care facility in Maiduguri, Nigeria,
between April and June 2007 which
involved 500 ambulatory hypertensive
patients attending the hypertension clinic
found 120 of them to be using herbal
medicines.
The 2009 study published in the
International Journal of Pharmacy Practice
indicated the co-administration of herbal
medicines with antihypertensive agents
was done by 47.5 per cent respondents, out
of which herbs with antihypertensive
activity were used by 33.33 per cent. The
majority of respondents, 71.15 per cent,
were using herbal medicines unbeknownst
to their physicians.
Other studies have assessed patients’
perception of the therapeutic efficacy of
alternative medicines and in some of these
studies, more than half of these alternative
medicine users perceived that CAM was
responsible for some noticeable
improvement in physical or psychological
well being.
However, more research is needed in the
areas of both subjective and objective
measures of improvement achieved with
using CAM, especially because most of the
current claims for the efficacy (usually
touted in advertisements) are not backed
by any empirical data.
Several other medicinal plants have been
listed to be useful in the treatment of
hypertension. A review of such plants by
E.U Etuk from the Department of
Pharmacology, College of health Sciences,
Usmanu Danfodiyo University, Sokoto
which was published by the 2006 edition of
the Journal of Medical Science included dry
calyx of Hibiscus Sabdarifa (sobo); stem
bark of soaked in locally distilled gin; garlic
( five to 10 minced raw garlic cloves per
day); latex or leave extract of Musanga
cecropioides (Aga or Agbawoin in Yoruba,
Onru in Igbo and Uno in Efik); Cassia
occidentalis (negro coffee), Vitex dodiana
(black plum), Phyllanthus amarus and
mistletoe.