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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 4, July/August 2017
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AFRICA
–– Therefore, advocate for a healthy public policy and
large national programme for hypertension prevention
and control.
–– Use national multi-sectoral policies and plans that
specifically address physical activity and nutrition,
including dietary salt, in preventing hypertension and
NCDs.
–– Wider implementation of successful governmental
actions including smoke-free policies, marketing of
unhealthy foods and alcohol, sin taxes (e.g. sugar
taxes), and regulation of sodium content in processed
foods.
How to adapt the PASCAR 10 actions at country
level
This roadmap can be implemented as is or adapted to overcome
local barriers and develop solutions that are more relevant
to specific national settings. In the latter case, we recommend
that national roadmaps be developed, using a multi-sectoral
approach in collaboration with inter-governmental organisations,
heart health advocacy foundations, cardiovascular scientific
organisations, healthcare leaders, providers from primary and
specialised care, private-sector stakeholders and people affected
by CVD.
Effective advocacy towards policy-makers and politicians in
national governments is mandatory for success. Screening among
politicians might be an effective way to increase awareness and
encourage governments to act.
The PASCAR task force recommended the following steps:
•
Step 1: where applicable, national cardiac societies (otherwise
national hypertension societies or cardiovascular specialists)
should take the leadership to develop and convene a multi-
sectoral coalition against hypertension. At this step, persuad-
ing the government and all other stakeholders to collaborate
is essential.
•
Step 2: this coalition will then assess the epidemiological
profile of hypertension and review and synthesise existing
official data and published and unpublished literature. This
step also includes a map of all existing policies.
•
Step 3: the coalition conducts policy dialogues with multiple
local stakeholders. Local problems, specific barriers to hyper-
tension control and potential solutions should be discussed
and appropriate strategies selected according to context. At
this step, it is important to understand existing policies and
their current effect. Within the same nation, appropriate
strategies may also need adaptation. Some stakeholders who
will be invited to the policy dialogue include the ministry of
health, various health sector staff (physicians and non-physi-
cians), health workers, key opinion leaders such as politicians
and religious people, and also alternative medicine specialists
and traditional healers, who may have a significant influence
on people with hypertension in some settings.
•
Step 4: the coalition develops a clear national strategy and
time-bound plan for detecting, treating and controlling hyper-
tension.
The PASCAR coalition against hypertension takes responsibility
for fostering the development of national roadmaps and
supporting national cardiac and hypertension societies at all
levels.
Conclusions
Although there is significant scientific evidence that cost-
effective lifestyle and medical interventions could control
hypertension and prevent health-threatening complications,
such as heart disease and stroke, the African region still bears
a very high disease prevalence, coupled with poor rates of
detection, treatment and control. This context is a barrier to
the achievement of the universal global action plan and gives
reasons for urgent action.
The PASCAR task force on hypertension roadmap was
conceived by a variety of leaders and stakeholders in the field
to provide the most appropriate strategy to have 25% control of
hypertension by 2025. The roadmap identifies major barriers to
disease control and priority areas of intervention, and 10 actions
to improve the control of hypertension by 2025 are proposed.
The most important steps to put forth in this continental
roadmap include:
1. Advocate for government leadership and policy.
2. Allocate funding and resources.
3. Design simple and practical guidelines.
4. Promote large-scale screening.
5. Integrate hypertension detection, treatment and control in all
existing programmes.
6. Promote task sharing and expand the scope of practice.
7. Promote the use of inexpensive, good-quality BP machines
and generic medications.
8. Promote universal coverage for hypertension diagnosis and
management.
9. Support high-quality research to produce the best evidence
for interventions.
10. Invest in population preventive measures.
This is a unique moment in history for the African CVD
community to have worked with global leaders in the field
in defining a clear agenda to address the hypertension crisis.
Support for this programme from the African Union and
all stakeholders will help achieve the WHO global action
plan of 2013–2020 for NCD reduction, specifically focusing
on heart attack, stroke and other CVDs. The WHO and
other UN organisations will support national efforts with
upstream policy advice and sophisticated technical assistance,
ranging from assisting governments to setting national targets
in implementing relatively simple steps, which can make a huge
difference.
Our sincere thanks go to all fraternal organisations, including the WHF, the
International Forum for Hypertension Control and Cardiovascular Disease
Prevention in Africa, the Africa Heart Network, and all national cardiac societies
for supporting this initiative. We are grateful to the Clinical Research Education,
Networking and Consultancy for co-drafting the manuscript and providing first
versions of some figures and tables, and all the reviewers for providing useful
feedback. We also thank all members of the PASCAR task force on hyperten-
sion who worked on this project and provided feedback throughout the roadmap
development, and all other partners who provided support.
Dr Poulter’s institution has received grant support for research in hyper-
tension from Pfizer and Servier and he has received speaker honoraria from
AstraZeneca, Lri Therapharma, Napi and Servier. All other authors report
no relationships that could be construed as a conflict of interest.
The project was fully funded by PASCAR. The Pan-African Society
of Cardiology received unrestricted educational grants from Servier and
AstraZeneca.