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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 4, July/August 2017
AFRICA
271
•
Clear evidence exists that health staff without formal
professional training can be adequately trained to effec-
tively detect people with severe hypertension.
25
•
Using trained community health workers (CHW) to detect
hypertension would free health professionals in Africa to
treat and control the condition.
•
Well-trained nurses, general and family physicians can
adequately manage uncomplicated hypertension, freeing
specialists for more severe cases.
–– Design a course to train CHW in detecting hyperten-
sion, providing information and educating the commu-
nity.
–– Train 250 000 CHW to detect hypertension by 2025.
–– Design special courses reinforcing health staff capacity
to manage hypertension.
–– Use an online system to train at least 50 000 certified
nurses and 25 000 certified general physicians to take
appropriate decisions regarding detecting, treating and
controlling hypertension by 2025.
–– PASCAR and national cardiac societies will design the
course, and national recertification may be required
after training.
7. Ensure the availability of essential equipment and medicines
for managing hypertension at all levels of care.
•
Target 8 of the global action plan acknowledges the need
to improve the availability of affordable BP machines and
medicines for the poor.
26
•
Target 9 of the global action plan is an 80% availability
of affordable basic technologies and essential medicines,
including generics, required to treat major NCDs in public
and private facilities.
26
•
Access to affordable and good-quality drugs for hyperten-
sion is important for all LMICs, and especially SSA.
26
–– Governments and societies should be willing to priori-
tise hypertension control and provide low-cost BP
machines and medications.
–– PASCAR and national cardiac and hypertension socie-
ties have adopted a hypertension treatment algorithm,
suggesting the use of high-quality antihypertensive
medications (Fig. 2).
–– The ongoing randomised clinical trial, Comparing
Three Combination Therapies in Lowering Blood
Pressure in Black Africans (Creole), will provide more
evidence-based information on the most efficacious of
three ‘free’ combinations of two antihypertensive agents
on 24-hour ambulatory systolic BP.
27
–– PASCAR has defined minimum standards for BP
machines and drug availability and affordability to
control hypertension in Africa (Table 3).
–– PASCAR and national cardiac and hypertension
societies should strongly advocate making antihyper-
tensive medications available and more affordable to
patients.
–– Governments should encourage adding to and peri-
odically updating the hypertension medications on their
national essential medicine list.
–– Governments should subsidise the cost of and remove
import duties on these essential medications.
–– Governments should put in place an efficient, high-
quality monitoring process of medicines.
–– Donor organisations and pharmaceuticals should be
engaged in making these medications affordable.
–– PASCAR will regularly measure the proportion of the
population with access to affordable, essential drugs in
sentinel sites.
8. Provide universal access and coverage for detecting, treating
and controlling hypertension.
•
There are proven cost-effective lifestyle and medical inter-
ventions to prevent and manage hypertension. However, in
Africa, uptake is still unacceptably low.
3
•
Universal health coverage will be the main step forward to
ensure that persons with hypertension have access to effec-
tive, affordable and accessible care.
–– Governments must have the political will to acknowl-
edge the hypertension crisis, and the commitment to
convince their parliaments to approve budgets needed
for universal coverage.
–– Failure to implement universal coverage may result in
increased healthcare expenditure on the complications
of hypertension.
9. Support high-quality research to produce the evidence that
will guide interventions.
•
Data from randomised, controlled trials on hypertension
management are lacking in SSA.
•
Research is vital in formulating a sound healthcare policy
to evaluate the performance of interventions in hyperten-
sion control and take managerial decisions in the overall
NCD policy.
28
•
Research into hypertension in Africa should be essential,
especially where it can inform resource-allocation deci-
sions.
–– African governments should encourage all multidisci-
plinary, multidirectional and collaborative approaches
at national and international levels, and take a firm
commitment to develop research guided through prior-
ity intervention, as suggested by the WHO.
26
–– National cardiac and/or hypertension societies should
take responsibility for identifying research priorities,
building national and international research networks
and partnerships, and advocating for investment in
research to support best practices.
–– PASCAR, with its good continental research network,
will continue taking the leadership for research train-
ing and funding while ensuring to develop and sustain
research activities to guide cost-effective interventions
for hypertension control.
10. Invest in population-level interventions for preventing hyper-
tension, such as reducing salt intake and obesity levels,
increasing fruit and vegetable intake and promoting physical
activity.
•
The relationship between BP and the risk of developing
stroke or heart disease is ongoing, starting at a systolic
pressure > 115 mmHg.
1
•
Hypertension is a preventable cause of morbidity and
mortality.
•
High-quality evidence in non-acutely ill adults shows that
reduced sodium intake reduces BP.
29
•
These two previous facts highlight the importance of high-
risk and population-based strategies in BP management
and control.