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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 4, July/August 2015
152
AFRICA
Hypertension in sub-Saharan Africa: a massive and
increasing health disaster awaiting solution
Norm RC Campbell, Daniel Lemogoum
Increased blood pressure is the leading risk for death globally.
1
While this is also true in sub-Saharan Africa, there are many
hypertension issues that are unique to the region.
2
A prime
and important example is that in most countries in the region,
population blood pressure is increasing, while in most countries
in the rest of the globe, population blood pressure is decreasing.
3
Currently hypertension prevalence rates in some sub-Saharan
African countries are among the highest in the world, while a
few short decades ago, several countries in sub-Saharan Africa
had among the lowest blood pressure levels.
2
Importantly,
several sub-Saharan African countries still have hypertension
prevalence rates below the global average, providing an important
opportunity for prevention. Recently, a needs assessment of
hypertension organisations in sub-Saharan Africa also showed
important and different needs from hypertension organisations
in other regions of the world.
4,5
Dr Seedat has comprehensively outlined relevant issues in his
article ‘Why is control of hypertension in sub-Saharan Africa
poor?’ (page 193) He concludes by quoting Nelson Mandela
‘We must face the matter squarely …We know that we have it in
ourselves as Africans to change all this’.
In my opinion, defining and acknowledging the problem is
the most important step, but it is also just the first step in a long
journey to improving hypertension prevention and control. That
the solution to hypertension in sub-Saharan Africa is within
sub-Saharan Africa is another critical observation to start that
journey. What are the potential next steps?
Leadership
Without strong sub-Saharan African champions who will lead
and provide direction, little will change. At a recent Pan-African
hypertension meeting in Douala, there were several strong
hypertension champions with knowledge, vision and skill. Many
other strong champions, such as Dr Seedat, reside throughout
Africa. These leaders need to work together on the following
actions.
Partnership
There are several important and engaged organisations related to
hypertension in sub-Saharan Africa [e.g. International Forum for
Hypertension Control and Prevention in Africa, African Heart
Network (AHN), Pan-African Society of Hypertension, World
Hypertension League African regional office and Pan-Africa
Society of Cardiology (PASCAR)]. Much broader partnerships
are needed. There is an urgent need to partner with governments
and the World Health Organisation (WHO), who have the ability
to change policies for prevention and control. The recent world-
leading and strong policy to regulate a reduction in salt additives
to food in South Africa is a prime example.
6,7
Forming partnerships with primary care, with other
non-communicable disease (NCD) groups (e.g. diabetes), and
with infectious disease groups and programmes will allow a
sharing of limited resources and approaches to people at health
risk and this is likely to be more efficient and cost effective. The
WHO PENs programme provides a template that could assist in
the integration of hypertension control with NCD control.
8
Civil society organisations are better placed to advocate for
societal changes to address fundamental issues such as poverty,
corruption and other major social issues that Dr Seedat outlined.
Civil society organisations will also have a strong interest in
access to medications and basic health needs.
Public health and epidemiological organisations are critical
to assisting in advocating for improved public health policies
that might prevent hypertension. Hypertension leaders need to
develop the partnerships required to drive the necessary changes
Dr Seedat outlined.
Strategic planning
A coalition of partner organisations needs to develop and agree
to a strategic plan for hypertension prevention and control that
is either independent or integrated with NCD prevention and
control.
9
There are several models for hypertension strategies
that could be used as examples, and the Expanded Chronic
Disease model can be used as a template.
10-14
Recently, many African health organisations supported a fact
sheet and call to action on hypertension that could form the basis
Departments of Medicine, Physiology and Pharmacology,
and Community Health Sciences, O’Brien Institute for
Public Health, Libin Cardiovascular Institute, Cumming
School of Medicine, University of Calgary, Canada
Norm RC Campbell, MD,
ncampbel@ucalgary.caDouala School of Medicine and Pharmaceutical Sciences,
University of Douala, Cameroon, and Erasme Hospital,
Free Brussels University, Belgium
President of the International Forum for Hypertension
Control and Prevention in Africa (IFHA), President of
the Cameroon Heart Foundation, and Director of the
Cameroon Heart Institute
Daniel Lemogoum, MD, MPH, PhD, FESC
Editorial