CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 5, June 2013
194
AFRICA
Conference Report
4th All-African conference on heart disease, diabetes and stroke
11th Pan-African Society of Cardiology (PASCAR) conference
Cardiovascular disease is on the rise in
Africa. Evidence indicates an increased
prevalence of ischaemic heart disease,
diabetes, stroke, cardiomyopathies,
congenital heart disease, rheumatic
heart disease and disease of the
pericardium (HIV/AIDS). Highlights
from the PASCAR meeting hosted in
Dakar, Senegal, 16–20 May 2013, are
reported below. The full set of abstracts
can be viewed at
/
onlinejournal/vol24/pascar_2013.
Hypertension
Hypertension is a silent killer, remaining
undiagnosed in 30–90% of people in
varying socio-economic circumstances.
Hypertension is the most widespread
cardiovascular disease, affecting over one
billion people worldwide. In sub-Saharan
Africa, hypertension is the third highest
risk factor for myocardial infarction,
after diabetes mellitus and smoking.
Furthermore, 50% of stroke deaths are
linked to hypertension.
1
Guidelines for the diagnosis of
hypertension in Africa should include
repeated blood pressure measurements in
the office, self-measurement (12 hourly
over three days) and ambulatory blood
pressure monitoring.
1,2
A comprehensive
family and clinical history should be
investigated and a physical examination
performed.
Routine
laboratory
investigations and instrumental tests
should include:
•
fasting plasma glucose
•
serum total cholesterol, LDL choles-
terol, HDL cholesterol
•
fasting serum triglycerides
•
serum potassium
•
serum uric acid
•
serum creatinine
•
estimated creatinine clearance
•
haemoglobin and haematocrit
•
urinalysis
•
electrocardiogram.
Lifestyle choices can assist in preventing
the development of hypertension or help
manage blood pressure levels. Systolic
blood pressure reductions are associated
with the cessation of smoking; a reduction
of weight (5–10 mmHg/10 kg), salt intake
(2–8 mmHg), saturated and total fat
intake, as well as excessive alcohol intake
(2–4 mmHg); and increased physical
activity (4–9 mmHg) and intake of fruit
and vegetables.
Pharmaceutical intervention is
required should lifestyle alterations not
deliver sufficient benefits in maintaining
blood pressure targets. Monotherapy is
effective in a limited number of patients
only (those with mild blood pressure
elevation and low-to-moderate total
cardiovascular risk), and more than one
drug is usually required to achieve blood
pressure targets. A significant decrease
in the incidence of stroke has been noted
when comparing the use of combination
therapy to monotherapy.
Of the drug combinations tested or
widely used, a beta-blocker/diuretic
combination favours the development
of diabetes. Treatment needs to be
individualised to the patient to ensure
tolerance. If hypertension is not controlled
at six months, pill-taking behaviour
should be checked. If adherence is
sound, a third hypertensive agent can be
added. Ideally, fixed drug combinations
are required to simplify treatment and
improve compliance.
2
1.
Moustapha Sarr. Epidemiology and diagno-
sis of hypertension in 2013.
2.
Daniel Lemogoum. Guidelines for the
management of hypertension in Africa: is
an update needed?
Diabetes and obesity
The extent of diabetes mellitus in Africa
is not yet appreciated by communities
and decision makers.
1
Sub-Saharan Africa
currently has a diabetes disease burden of
15 million, and is expected to double over
the next 20 years. Of this disease burden,
it is estimated that 81% of individuals
with diabetes remain undiagnosed; not
surprisingly, this region has the highest
global diabetes mortality rate.
2
Many barriers hinder effective
prevention and management of diabetes.
HIV is associated with diabetes and
the metabolic syndrome, as is rapid
urbanisation. Stigma issues surrounding
obesity are problematic, with female
obesity still considered attractive in some
communities. On the African continent
obesity is more common in females
than in males; however obesity is an
independent risk factor for diabetes in
both genders.
1,2
The paradox of malnutrition and
obesity, historically urban, is increasingly
described in rural communities as money
from the cities moves into rural areas for
development.
1,2
Maternal under-nutrition
influences risk of cardiometabolic
disease, with evidence of foetal under-
nutrition conferring a higher risk of
hypertension in later life. Hypothalamic
control of appetite is modulated by early-
life nutrition.
3
Poverty, lack of access to clinics and
a dearth of specialists on the African
continent further contribute to the burden
of disease. Often, inAfrica, cardiovascular
complications are already present
at the time of diagnosis of diabetes.
These complications could be avoided
with earlier diagnosis and management
of diabetes.
1
Biochemical screening tests
recommended for diagnosing diabetes in
‘The growing epidemic of non-commu-
nicable disease is a crisis of our own
creation, … through poor choices of
lifestyle and urbanisation.’
Walinjom Muna, Cameroon
‘Seven of the 10 top determinants of
mortality in the world relate to how we
eat, drink and move.’
Elijah Ogola, Kenya
‘It is staggering to consider the grave
consequences of lack of action now.’
Samuel Omokhodion, Nigeria
