CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 4, July/August 2011
174
AFRICA
use of caffeine- and fructose-rich substances and beverages
should be discouraged.
Every consultation with a hypertensive patient needs to be
seen as an opportunity for health promotion and general cardio-
vascular risk assessment. Such assessment would include look-
ing for hypertensive damage to target organs and involves a urine
dipstick, a 12-lead ECG and blood tests for plasma glucose,
electrolyte, creatinine and urea, and cholesterol levels. Education
about and screening for cardiovascular disease at primary health
centres should be increased.
Doctors working at primary healthcare level should regularly
consider the use of specialist services if blood pressure remains
elevated. Likewise, the publication of guidelines by specialists
is not sufficient. There should be multiple opportunities for
on-going education of all levels of doctors, on management of
hypertension and for engagement between primary-level doctors
and specialists. Medical outreach is one strategy for facilitating
such interaction. Opportunities exist for engagement between
healthcare professionals, academia, industry and civil society
and need to be encouraged.
19
Conclusion
Detection and management of hypertension in South Africa
remains sub-optimal. Doctors working alone have failed in their
endeavour to improve the health of hypertensive patients and the
prevention of premature mortality in this group of patients. The
management of hypertension presents both complex challenges
and opportunities. Doctors should not be content with their
failure, but rather use their power and foresight, in collaboration
with partners from various sectors, to deliver the promise of ‘a
better health for all’.
Dr Ntusi receives funding from the Medical Research Council of South
Africa, the Discovery Foundation, and the Nuffield Foundation.
NTOBEKO BA NTUSI, MB ChB,
Department of Medicine, University of Cape Town and Groote
Schuur Hospital, Cape Town, South Africa;
Department of Cardiovascular Medicine, University of Oxford
and John Radcliffe Hospital, Oxford, United Kingdom
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