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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 6, November/December 2020
AFRICA
329
with gout. Antiplatelet therapy should be considered in patients
with CVD (secondary prevention only).
From the PASCAR perspective, the lipid guidelines are too
complexandrelyonweb-basedriskchartsforimplementation,and
the recommendation for treating asymptomatic hyperuricaemia
is considered very controversial. In addition, aspirin should be
used in all patients with established atherosclerotic CVD, unless
there is a contra-indication.
Other
In SSA, where there is the highest prevalence of people living
with HIV and, with around one of every four of them having
hypertension, it is important to be aware of the drug interactions
between CCB and antiretroviral therapies. Amlodipine dose
should be reduced when used in combination with protease
inhibitors due to the risk of prolonging the PR interval.
24
Other
antihypertensives that are affected by various anti-retrovirals
are detailed by van Zoest
et al
.
25
Otherwise the treatment of
hypertension remains the same as in general hypertensives.
Rationale for creating this commentary
The ISH guidelines were developed in order to create a uniform
platform that is accessible and usable to all environments, both
high and low income. In order to improve accessibility, they were
published in two major hypertension journals. The aim was to
create recommendations that can be adopted in different settings
but that are accepted international standards of care.
The guidelines provide a tool to promote the improvement
of BP control to 25% in Africa as developed by the PASCAR
task force.
11
Adopting the ISH guidelines will provide a standard
of care for African hypertension groups to lobby healthcare
providers and governments to develop basic standards of care
for the diagnosis and treatment of hypertension. However,
this commentary serves to underline that some of the
recommendations are not realisable in SSA at the current time.
There is also a need to develop a guideline to enable nurse
practitioners to treat hypertension and provide greater access to
basic care for patients.
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