52 / 68
CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 3, May/June 2019
180
AFRICA
56. GaoX,WuX, Yan J, Zhang J, ZhaoW, DeMarcoD,
et al
. Transcriptional
regulation of stress kinase JNK2 in pro-arrhythmic CaMKII
δ
expres-
sion in the aged atrium.
Cardiovasc Res
2018;
114
(5): 737–746. doi:
10.1093/cvr/cvy011.
57. Yan J, Thomson JK, Zhao W, Gao X, Huang F, Chen B,
et al.
Role of
stress kinase JNK in binge alcohol-evoked atrial arrhythmia.
J Am Coll
Cardiol
2018;
71
(13): 1459–1470. doi: 10.1016/j.jacc.2018.01.060.
58. Cheng SM, Lin WH, Lin CS, Ho LJ, Tsai TN, Wu CH,
et al
. Modulation
of both activator protein-1 and nuclear factor-kappa B signal transduc-
tion of human T cells by amiodarone.
Exp Biol Med
2015;
240
(1):
99–108. doi: 10.1177/1535370214544263.
59. Capucci A, Villani GQ, Aschieri D, Rosi A, Piepoli MF. Oral amiodar-
one increases the efficacy of direct-current cardioversion in restoration
of sinus rhythm in patients with chronic atrial fibrillation.
Eur Heart J
2000;
21
(1): 66–73. doi: 10.1053/euhj.1999.1734.
60. Boos C, Ritzema J, More RS. A short course of oral amiodarone
improves sinus rhythm maintenance post-cardioversion for atrial fibril-
lation.
Heart
2004;
90
(9): 1063–1064. doi: 10.1136/hrt.2003.022665.
61. Galperin J, Elizari MV, Bonato R, Ledesma R, Vazquez Blanco M,
Lago M,
et al
. Short-term amiodarone therapy after reversion of persis-
tent atrial fibrillation reduces recurrences at 18 months.
Cardiol J
2014;
21
(4): 397–404. doi: 10.5603/CJ.a2013.0152.
62. Perez-Silva A, Merino JL. Treatment with amiodarone: How to avoid
complications with amiodarone.
e-Journal ESC Council Cardiol Pract
2011; 10.
How to deal with the mass killer, hypertension
High blood pressure is the single biggest contributor to the
global burden of disease, with hypertension leading to 10.7
million deaths every year.
1
Most worrying is a recent global
study showing that on average, more than half of those
affected don’t know they have it.
2
Because cardiovascular
disease affects a third of adults in the world, it is the largest
epidemic ever known to mankind.
3
With mortalities increasing year on year, awareness, and
therefore treatment and control rates, have been shown to
worsen as the economic status of populations drop.
2
Prof Neil
Poulter, immediate past president of the International Society
of Hypertension (ISH), says that between the highest-income
countries and the lowest, there was an 8.2% drop in awareness,
a 15% drop in treatment rates and a 6.3% drop in control. This
prompted the ISH to mount an unprecedented global blood
pressure (BP) awareness campaign during May last year.
4
Speaking at the 34th World Congress of Internal Medicine
(WCIM) that was held in Cape Town in October, Prof
Poulter said an earlier studyshowed that just 46.5% of 57 840
hypertensive people canvassed knew they had hypertension,
followed by a dramatic drop off between those treated
(40.6%) and those controlled (13.2%). In the subsequent
global ISH screening and awareness initiative, dubbed ‘May
Measurement Month’ (MMM, 2017), volunteers screened
over 1.2 million people in 80 countries. They uncovered over
150 000 people with untreated raised BP (17.3% of those
untreated) and over 100 000 with treated but uncontrolled
BP (46.3% of those treated). The ISH went one better this
year, screening over 1.5 million people in 89 countries and
detecting over 220 000 with untreated raised BP (18.4%
of those untreated) and over 110 000 with treated but
uncontrolled BP (just 40.4% of those treated).
He described the MMM campaigns as a major success
and a ‘heart-warming, fantastic volunteer effort.’
Take-home lessons
‘So, we need to put screening in place and provide
suitable drugs – most people are not getting enough drug
combinations. You need two or more drugs to manage
hypertension properly,’ said Prof Poulter.
Drug guidelines are confusing, differing in the European
Union, America andBritain, withdifferent drug combinations
recommended for different race groups. Prof Poulter favours
the British combination-drug guidelines.
‘Our problem is that world-wide we don’t know what
the best combinations are. We know that patients need at
least two drugs, sometimes three, ideally in a single pill, for
the best outcomes. A single (combination-drug) pill gives
more effective and rapid BP control than monotherapy
and two ‘free’ drugs. You get reduced side effects, enhanced
adherence, improved cardiovascular protection and they’re
more cost-effective,’ said Prof Poulter.
Prof Poulter has just completed a major trial of three
different two-drug combinations for lowering BP in black
Africans in six sub-Saharan countries (the CREOLE study),
with definitive but yet-to-be-released results. He said he
hopes to present them ‘somewhere prestigious’ early next
year.
‘We now know what works for black Africans. Our
primary end-point was to lower ambulatory systolic BP after
six months,’ he revealed, while keeping tight-lipped about the
much-anticipated findings.
continued on page 187…