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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 4, July/August 2017
AFRICA
263
Abstract
Background and aim:
The Pan-African Society of Cardiology
(PASCAR) has identified hypertension as the highest area
of priority for action to reduce heart disease and stroke
on the continent. The aim of this PASCAR roadmap on
hypertension was to develop practical guidance on how to
implement strategies that translate existing knowledge into
effective action and improve detection, treatment and control
of hypertension and cardiovascular health in sub-Saharan
Africa (SSA) by the year 2025.
Methods:
Development of this roadmap started with the
creation of a consortium of experts with leadership skills in
hypertension. In 2014, experts in different fields, including
physicians and non-physicians, were invited to join. Via face-
to-face meetings and teleconferences, the consortium made a
situation analysis, set a goal, identified roadblocks and solu-
tions to the management of hypertension and customised the
World Heart Federation roadmap to Africa.
Results:
Hypertension is a major crisis on the continent but
very few randomised, controlled trials have been conducted
on its management. Also, only 25.8% of the countries have
developed or adopted guidelines for the management of
hypertension. Other major roadblocks are either govern-
ment and health-system related or healthcare professional or
patient related. The PASCAR hypertension task force identi-
fied a 10-point action plan to be implemented by African
ministries of health to achieve 25% control of hypertension
in Africa by 2025.
Conclusions:
Hypertension affects millions of people in SSA
and if left untreated, is a major cause of heart disease and
stroke. Very few SSA countries have a clear hypertension
policy. This PASCAR roadmap identifies practical and effec-
tive solutions that would improve detection, treatment and
control of hypertension on the continent and could be imple-
mented as is or adapted to specific national settings.
Keywords:
hypertension, roadmap, Africa, prevalence, control,
blood pressure, action
Submitted 26/5/17, accepted 12/8/17
Cardiovasc J Afr
2017;
28
: 261–272
www.cvja.co.zaCo-published in
Global Heart
DOI: 10.5830/CVJA-2017-040
Executive summary
The Word Health Organisation (WHO) estimated that the number
of people affected by hypertension is highest in Africa, at about
46% of adults aged 25 years and older, compared to 35 to 40%
elsewhere in the world. Many hypertensive Africans are unaware
of their status, and are rarely treated or poorly controlled, making
them at highest risk for stroke, and heart and renal disease.
African Union member states at the 2004 Addis Ababa
meeting described hypertension as one of the continent’s greatest
health challenges after HIV/AIDS. An urgency was recognised to
develop and share best practices, including affordable and effective
community-based programmes to screen and treat hypertension.
The WHO’s 2013–2020 global action plan calls upon the
United Nations (UN) member states to take immediate action in
preventing and controlling non-communicable diseases (NCDs).
Target six of the action plan aims to achieve a 25% relative
reduction in the prevalence of raised blood pressure or to
contain this by 2020, according to national circumstances.
State and government heads in the UN Political Declaration
are committed to preventing and controlling NCDs through
the establishment and strengthening of multi-sectoral national
policies and plans.
The Pan-African Society of Cardiology (PASCAR) met
several times to identify key actions for a hypertension roadmap
on the continent. The PASCAR coalition identified several
roadblocks hampering the control of hypertension on the
continent, which exist at government/health-system, physician
and patient levels and include the following.
Government- and health system-related roadblocks
•
lack of established policies for controlling hypertension
•
poor political willingness to implement policies on NCDs
•
poor universal health insurance coverage, leading to out-of-
pocket payment by most patients, which leads to poor access
and adherence to treatment
•
lack of policies on antihypertensive medication procurement
and distribution, resulting in stock shortages
•
lack of
ad hoc
screening and proper referral systems for
patients identified at routine screening
•
inability of governments to effectively work with the private
sector, non-governmental organisations (NGOs) and academ-
ia in a coordinated plan to tackle the burden of hypertension.
Healthcare professional-related roadblocks
•
lack of appropriate evidence-based guidelines for healthcare
professionals in individual countries
•
hypertension treatment guidelines are poorly implemented
because of a lack of continuing medical education
•
a dearth of healthcare professionals (physicians, nurses and
trained health workers) at primary care level with very low
physician/patient ratio
•
lack of quality and affordable antihypertension medications.
Patient-related roadblocks
•
poor awareness about hypertension and its consequences
•
poor adherence to drug therapy because of limited access to
medication
•
difficulty in changing lifestyles, and false health beliefs that
hypertension is curable, due to poor patient education.
PASCAR 10-point action plan
The PASCAR hypertension task force identified a 10-point
action plan, to be implemented by African ministries of health to
achieve 25% control of hypertension in Africa by 2025.
1. All NCD national programmes should additionally contain
a plan for the detection of hypertension.
2. Allocate appropriate funding and resources for the early
detection, efficient treatment and control of hypertension.
3. Create or adopt simple and practical clinical evidence-based
hypertension management guidelines.