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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 6, November/December 2020
AFRICA
285
The authors of the PASCAR commentary (page 325) on the
recently published International Society of Hypertension (ISH)
global guidelines are to be congratulated on an important,
pragmatic and clinically useful commentary that should be read
by all who measure and treat the blood pressure of persons in
sub-Saharan Africa (SSA). They draw on their extensive clinical
experience and personal knowledge of the healthcare situation
in SSA to put the ISH guidelines in context for the continent.
They start with a brief but informative discussion for the
rationale and usefulness of guidelines and then go on to point
out where the guidelines need to be modified or altered by the
availability of testing devices and laboratory services. Importantly,
they point out that some of the medicines recommended for the
treatment of hypertension are not available in much of SSA
and those that are, such as intravenous nitrates, may require
scarce intensive-care facilities. In each instance the PASCAR
commentary offers clinically helpful comments and alternatives.
This commentary should be copied and made available to all
healthcare practitioners in SSA.
The value of a commentary such as that of PASCAR becomes
immediately apparent on reading the contribution of Hu and
colleagues (page 298) who measured uric acid (UA) levels in a
large cohort of hypertensive patients in China. They concluded
that high UA level could significantly increase stroke risk in
female hypertensive patients and that these patients may benefit
from managing UA at normal levels. The PASCAR commentary
offers explicit advice to the contrary. ‘The recommendation
for treating asymptomatic hyperuricaemia is considered very
controversial.’
The importance of establishing norms and values for
determination and description of disease states and metabolic
disturbance in populations in SSA is further illustrated by the
contribution of Tladi and colleagues (page 314). They studied
Batswana adults and determined demographic and anthropometric
measurements and other risk factors for the metabolic syndrome
in 384 men and 416 women in Gaborone and surrounding villages.
They concluded that there is a difference between the cut-off values
for Europeans and those determined for the Batswana in terms of
the definition of abdominal obesity in adults, and inconsistencies in
cut-off values used have the potential for undesirable consequences
for cardiovascular risk stratification.
From Abidjan, Yao and collaborators (page 319) report that
the prevalence of admission hyperglycaemia was 40.6% in a large
number of black Africans presenting with an acute coronary
syndrome (ACS). This study, carried out in a SSA population,
shows that in the acute phase of ACS, admission blood glucose
has a powerful prognostic value on mortality rate, in accordance
with studies conducted in the West.
The CVJA is privileged to be able to continue publishing these
and other articles, documenting and commenting on patterns of
cardiovascular disease in Africa.
Pat Commerford
Editor-in-Chief
From the Editor’s Desk
The management and staff of Clinics Cardive Publishing
(publishers of the
Cardiovascular Journal of Africa
and the
South African
Journal of Diabetes & Vascular Disease
) thank all our authors, reviewers and
clients for your continued support and collaboration.
We wish you a happy holiday season and a peaceful and prosperous new year.
Please note that our office will close on Tuesday 15 December
and open on Thursday 14 January 2021.
We look forward to being of service to you in the new year.