What is killing young men in Nigeria?

Over the last nine months to one year, the deaths among young men have seemed to several of my colleagues to represent a new wave of premature deaths, significant enough for us to discuss it as a group.

Cardiovascular disease, especially complications of undiagnosed or poorly controlled hypertension, appears to be the dominant documented cause of sudden, unexpected natural deaths among adult men in Nigeria, including those under the age of 50.

Autopsy series and cardiologists consistently identify this pattern, amplified by lifestyle choices, economic stress, limited preventive care and men’s reduced tendency to seek medical help. In one study in a suburban Nigerian series, cardiovascular causes accounted for more than a quarter of all cases, with a two-to-one male-to-female ratio.

Hypertensive heart disease made up the majority of those cardiovascular deaths, at nearly two-thirds of all cases. Another autopsy review over a 12-year period in southeastern Nigeria found cardiovascular disease to be the top category, accounting for more than a quarter of all incidents. Hypertensive heart disease was the single most common specific cause. Cases peaked in the mid-to-late 30s, but older groups were also seen.

Infectious causes were more common in that review among those under the age of 40. These were mainly respiratory cases, at about 22 per cent; central nervous system disorders, at about 17 per cent; and other conditions. Hypertension and its sequelae predominantly affected between 40 and 70 per cent of all cases.

The leading specific causes overall included hypertensive heart disease, intracerebral haemorrhage, pneumonia and diabetic complications. Cardiologists and recent reports link most “slumping and dying” cases to heart attacks, cardiac arrest, stroke and heart failure from uncontrolled high blood pressure, cardiac arrhythmias or, less often in this age group, undiagnosed cardiomyopathies or other structural issues.

Hypertension prevalence among Nigerian adults is high, with estimates commonly ranging between 30 and 40 per cent. Now, because males are less likely to visit the hospital even for routine check-ups, they remain asymptomatic until a major event occurs, and this is increasingly seen in younger adults. Other contributors to sudden natural death include pulmonary embolism or other acute events, such as a ruptured aortic aneurysm.

Many men only learn they have high blood pressure, diabetes or high cholesterol after a crisis. Economic stress, high salt usage and the tendency to eat processed diets, obesity, physical inactivity or sudden intense exercise without screening, smoking, alcohol and substance use raise the risk.

Urban work pressures, long working hours, traffic, as in Lagos, Port Harcourt, Ibadan and lately Benin City, financial strain and cultural expectations on men as providers contribute. In addition, men are less likely than women to attend routine check-ups or act on early symptoms like chest pain, breathlessness, severe headaches and persistent abdominal pain, often due to notions of toughness, cost or access barriers.

Many deaths occur outside hospitals as a result of the conditions itemised above. Broader premature mortality among men under 50 also includes road traffic injuries. Nigeria’s roads are often riddled with axle-bursting potholes, and many drivers speed.

In this particular scenario, young men are over-represented. Then, the spectre of interpersonal violence, HIV/AIDS and tuberculosis, due mainly to delayed diagnosis and treatment, is also more commonly seen in men.

Furthermore, infections can cause rapid death but are distinct from the classic “sudden natural” cardiac-style events emphasised in the first paragraph above. Limited routine screening, expensive healthcare, self-medication or the use of herbal remedies, and uneven emergency response worsen outcomes.

Sudden deaths are not unique to Nigeria, but the combination of high hypertension rates at relatively younger ages, lifestyle transitions and barriers to healthcare makes them particularly visible and concerning among working-age men.

Apparent physical fitness seen in athletes or active people does not rule out underlying risks, while genetic or structural heart conditions can also play a role in some younger cases. Stress and overwork play a significant contributing role in sudden deaths among men under 50 in Nigeria, without a doubt.

They act mainly to amplify the dominant underlying problem, which is undetected or poorly controlled hypertension and other cardiovascular risks, rather than being the sole direct cause in most cases.

Stress and overwork affect the body in various ways. Chronic stress raises levels of stress hormones, mainly catecholamines such as adrenaline and cortisol. This elevates blood pressure, increases heart rate, promotes inflammation, disrupts heart rhythm and causes arrhythmias, and, over time, contributes to hypertension, arterial damage and a higher risk of heart attack, stroke or cardiac arrest.

Cardiologists in Nigeria have repeatedly identified long-term anxiety or emotional stress as a risk factor for sudden cardiac death. For someone already living with chronic stress, effects can include chest pain, irregular heartbeats, shortness of breath and an elevated risk of acute cardiovascular events.

Prolonged stress also weakens immunity and affects both mental and physical health. Accordingly, acute spikes in stress, such as financial shocks, extreme work pressure, strong emotional excitement during sports matches or grief, can trigger events in people with underlying medical conditions.

Experts frequently link rising reports of sudden deaths to Nigeria’s economic conditions. Financial stress, inflation, currency depreciation, job insecurity and the pressure to provide for families are described as significant drivers of elevated blood pressure.

One cardiologist noted that the current economic situation is exacerbating stress levels, which in turn drives high blood pressure through increased catecholamine secretion. Added to that is the new ‘hustle culture,’ which promotes multiple income streams, long working hours, overtime and limited recovery time. These are commonly cited among younger and middle-aged men. They usually combine with:

• Poor sleep
• Sedentary or irregular physical activity
• Reliance on quick, less healthy meals
• Neglect of routine health checks

Occupational studies illustrate the pattern. Among bank workers in one Nigerian study, longer job tenure and overtime were associated with higher hypertension rates, especially in men. Similar concerns appear among high-pressure roles such as healthcare workers, journalists, security personnel and business owners, where long hours, deadlines and inadequate rest are common.

In several discussions held over the years with bank workers, several individuals shared how, at break time or lunchtime, fruits or desserts were often replaced with medications.

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Cultural expectations around masculinity reinforce the cycle: many men suppress symptoms, avoid medical care and continue pushing through fatigue or warning signs while carrying provider responsibilities.

Overwork specifically promotes extended work hours and insufficient rest, compounding the risks by limiting recovery, disrupting sleep and reducing time for exercise or healthy eating.

Cases reported in the media and clinical commentary sometimes involve men who collapsed after periods of intense overtime or sustained high pressure. Extreme physical exertion, as seen in intense exercise without prior screening, on top of chronic stress, can also precipitate events in those with undiagnosed heart issues.

QUESTIONS AND ANSWERS

Sunday Doctor, good day. My mum is 85 years old and recently had a stroke. She is weak on the right side. She is currently doing physiotherapy. Can she have another stroke? We are very scared. 0802*******

That is a valid question. As long as she is faithfully taking her medications, she should be reasonably safe, but there is no guarantee that another stroke will not happen. People have been known to have multiple mini-strokes over a period of time or one major one after seemingly recovering well from another. So, proper monitoring of her blood pressure is as important as her physiotherapy.

Sunday Doctor. Everybody in my house is just coughing and sneezing. How can we prevent this from happening again? Thank you. 0902*******

Strictly speaking, because these disturbances are commonly caused by the common cold virus, which is transmitted by airborne droplets, they tend to be seasonal and cause limited disease conditions. Prevention is not possible, but the severity of the illness they can cause can be managed by various means.

Sunday Doctor, is it true that sometimes abortion is recommended and done to save the lives of mothers? Do you know, please? 0806*******

Some abortions are medically induced because continuing with the pregnancy puts the mother’s life at grave risk, such as in cases of uncontrolled hypertension associated with kidney failure or cancer co-existing with a pregnancy. The pregnancy could be terminated in order to treat the mother, as continuing with it while delaying treatment could endanger both the baby and the mother.

Sunday Doctor, good day. Thank you very much for the essay on how the eyes work. Please, I am 43 years old. I see quite well, but when driving at night, I see potholes clearly but not speed-breakers. I spoke with a doctor about it, and he said maybe something is wrong with my rods. How can I treat this? 0803*******

During night driving, your eyes rely more on rods than cones, but because speed bumps are usually the same colour as the road surface, they may not be that easy to detect. So, speed bumps in many countries rely on white or yellow paint to make them more obvious or reflective strips to highlight them. When driving at night, if you don’t have strong overhead lighting, unmarked speed bumps will not have a background shadow, and they can be hard to see. Your car’s headlight angle ought to be forwards and slightly down, but if it is a gentle bump in the road, the reflection will not be significant. So, the solution is to drive slowly on an unfamiliar road at night. Therefore, this is not a problem with your vision.

Sunday Doctor, good morning. My husband has recently been diagnosed with high blood pressure and put on certain drugs. But he is not taking the medication according to the prescription. He said that they are affecting his erection and that erection is more important than what he is treating. What is your advice, please? 0803*******

Libido cannot be more important than his overall health. Based on what we discussed previously on this page earlier this year, when we discussed the relationship between the health of the penis and a man’s cardiovascular health, your husband needs to understand that his blood vessels have almost certainly not been damaged by his hypertension. However, that pleasure could disappear if he ignores his current treatment. Finally, he can always have an honest conversation with the doctors who prescribed the current medicines for him so that alternatives can be prescribed for him.

Sunday Doctor, good day. Please, does the penis shrink? My husband no longer gives me pleasure in the bedroom because I am not able to feel him. His penis was never on the big side, but it was good enough for me. Now, although I know he is trying to make me have fun when we are together, I don’t feel as if anything is going on. Is this normal? I don’t know how to address the issue so as not to hurt his ego, but I am really unhappy about this. I need your help, please. 0816*******

Well, the penis can shrink with age, but the degree of shrinkage depends on a number of factors. A physically vigorous man will not experience much shrinkage in comparison with another man who does no exercise. Although you did not disclose his age, it is generally a positive thing if you can get him to see a doctor for a proper examination and advice.

Sunday Doctor, please, my uncle has just done a number of tests due to his ill health, and the conclusion is suggesting that he has cancer of the bile ducts. I want to share the results with you so that you can help us talk to him. We don’t know how to inform him. Thank you. 0805*******

Thank you for having so much confidence in this page, but what you are asking is beyond our brief. The doctors who requested these investigations should also tell your uncle their findings and what the reports mean. Based on what is evident in the reports, the cancer has spread widely.