Article by Dr Barbara Kakande, a Consultant Non-interventional Cardiologist at UMC Victoria Hospital

When *John walked into UMC Victoria Hospital last Friday, he was caught off guard by a diagnosis of stage 1 hypertension. 

He recalls only experiencing occasional irregular heartbeat, after strenuous exercise, headache, and recent weight gain, with no obvious clues pointing to raised blood pressure.

“They measured my blood pressure and discovered that it was 131/88, and I had thickening of blood vessels in the heart, which the doctor said can increase risk of heart attack,” narrates 33-year-old John. 

“This was shocking to me. I was advised to have lifestyle modification: do more physical exercise and eat a healthy diet –with enough fruits and vegetables,” he adds.

John is part of the 1 in 4 Ugandans who have elevated blood pressure, a risk factor for many complications, such as heart attack, stroke, and kidney failure, among others.

Dr Barbara Kakande, a Consultant Non-interventional Cardiologist at the facility, explains the critical role of early detection and paints, a vivid picture of why hypertension demands urgent attention.

“The normal blood pressure should be about 120/80,” she explains. “Anything above 130 over 80, and you’re hypertensive.”

While young people may naturally have lower readings, like 90 or 100, hypertension doesn’t discriminate by age. “Some come in with normal readings, like 120, but we find their kidneys are failing, their heart is swollen, or they’ve had a stroke,” she says. This is where her expertise shines, using tools like 24-hour blood pressure monitors, to uncover hidden hypertension that standard checks might miss.

Hypertension, if untreated, can wreak havoc from head to toe. “It can affect every organ,” Dr. Kakande warns. The brain risks strokes, the eyes face blindness, the heart is prone to attacks, kidneys may fail, and poor circulation in the legs can lead to amputations.

She says her approach is meticulous; “when a patient presents with high blood pressure, I investigate which organs are impacted, as treatment varies depending on the damage. Each patient is unique, which calls for tailoring therapies to address specific complications.”

What it takes to get diagnosis

Although some patients may walk straight to a cardiologist, the journey to a cardiologist often begins with a general practitioner.

Patients with symptoms like chest pain, shortness of breath, leg swelling, or extreme fatigue are flagged for heart tests. Those with risk factors—diabetes, obesity, high cholesterol, or thyroid issues—are sent for screenings, even without seeing a cardiologist first.

“Sometimes, it’s not about symptoms,” Dr. Kakande notes. “A general doctor might hear an abnormal heart sound through a stethoscope, like a murmur, and that’s enough to warrant further tests.”

Genetics and hypertension link

Dr. Kakande highlights a critical genetic predisposition among black populations, who are more likely to develop hypertension. “There’s a balance in the body between good and bad substances,” she explains.

Stress hormones like adrenaline and endophilins can constrict blood vessels, while protective substances like nitric oxide keep them relaxed.

In some individuals, genetics tip this balance unfavourably, producing too few “good” substances or an excess of harmful ones.

Additionally, those born with smaller kidneys or low birth weight face higher risks. “Race plays a big role,” she says, noting that Black individuals are particularly sensitive to salt, which increases blood volume and strains the heart.

Diet fuelling hypertension risks

Diet is another battleground in the fight against hypertension. Dr. Kakande laments the shift away from the wholesome meals of past generations. “Our mothers fed us well when we were young—with boiled foods, vegetables, fruits,” she recalls. Yet, modern diets heavy in fried foods, chips, and chicken are fuelling health crises.

Her advice is simple but profound: eat like your mother fed you as a child. “Boiled food can be delicious,” she insists, advocating for healthier oils like olive or light sunflower oil and preparation methods like steaming.

Reducing salt intake is critical, as it leads to water retention, increasing blood volume and pressure, which overworks the heart.