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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 2, March/April 2015
82
AFRICA
Development of the roadmap and guidelines for the prevention
and management of high blood pressure in Africa:
Proceedings of the PASCAR Hypertension Task Force meeting: Nairobi, Kenya, 27 October 2014
Abstract
Africa has one of the fastest growing economies in the world.
The economic changes are associated with a health transi-
tion characterised by a rise in cardiovascular risk factors and
complications, which tend to affect the African population at
their age of maximum productivity.
Recent data from Africa have highlighted the increas-
ing importance of high blood pressure in this region of the
world. This condition is largely underdiagnosed and poorly
treated, and therefore leads to stroke, renal and heart failure,
and death. Henceforth, African countries are taking steps
to develop relevant policies and programmes to address the
issue of blood pressure and other cardiovascular risk factors
in response to a call by the World Health Organisation
(WHO) to reduce premature deaths from non-communicable
diseases (NCDs) by 25% by the year 2025 (25
×
25).
The World Heart Federation (WHF) has developed a
roadmap for global implementation of the prevention and
management of raised blood pressure using a health system
approach to help realise the 25
×
25 goal set by the WHO.
As the leading continental organisation of cardiovascu-
lar professionals, the Pan-African Society of Cardiology
(PASCAR) aims to contextualise the roadmap framework
of the WHF to the African continent through the PASCAR
Taskforce on Hypertension.
The Taskforce held a workshop in Kenya on 27 October
2014 to discuss a process by which effective prevention and
control of hypertension in Africa may be achieved. It was
agreed that a set of clinical guidelines for the management
of hypertension are needed in Africa. The ultimate goal of
this work is to develop a roadmap for implementation of the
prevention and management of hypertension in Africa under
the auspices of the WHF.
Keywords:
hypertension, roadmap, guidelines, implementation,
monitoring, Africa
High blood pressure (BP) is the most common single risk factor
for cardiovascular-related events and deaths worldwide. Over the
past decade, Africa has been characterised as the world’s fastest-
growing economy,
1
but is also in a precipitous health transition.
Indeed, the estimated number of hypertensive people in Africa
in 2008 was nearly four times higher than the 2005 estimate
of the World Health Organisation regional office for Africa
(WHO-AFRO), and it is projected to be 125.5 million by 2025.
2
This increasingly high prevalence of hypertension is coupled
with very poor awareness, and low treatment and control rates
across Africa.
3-6
Hypertension therefore stands in this region
of the world as the most common cause of stroke, congestive
heart failure (HF) and chronic kidney disease, and poses
additional challenges on the longstanding burden associated with
communicable diseases and the ongoing HIV/AIDS pandemic.
Since the United Nations high-level meeting to raise
international awareness on the fact that premature deaths from
non-communicable diseases (NCDs) reduce productivity, curtail
economic growth, and pose a significant social challenge in most
countries,
7
African governments are opening political windows
that need to be used as an opportunity to develop and implement
policies for the prevention and control of hypertension and other
NCDs.
As the leading continental organisation, the Pan-African
Society of Cardiology (PASCAR) has made a real evaluation
of the condition and prioritised hypertension as the highest
area of priority action to reduce heart disease and stroke on
the continent.
8
The PASCAR roadmap on hypertension aims
to develop simple and practical hypertension management
guidelines, and improve health systems and policies within
the World Heart Federation (WHF) hypertension roadmap
framework. This implies that African needs are not just for
further consensus statements reviewing the evidence, but practical
guidance on how to implement strategies that translate existing
knowledge into effective action and improve blood pressure
control and cardiovascular (CV) health in general, as suggested
by the WHF primary goal of a 25% reduction of CV mortality
by the year 2025.
It is in this vein that the PASCAR Hypertension Task Force
meeting was held in Nairobi, Kenya, on 27 October 2014.
This event brought together hypertension specialists, guideline
methodologists and clinicians, who reviewed existing guidelines
and mapped the next steps in the development of a roadmap for
the control and management of hypertension in Africa.
Welcome address and review of existing
guidelines
Prof Bongani Mayosi, president of the PASCAR, welcomed
the attendees and thanked them for the time and effort required
to attend this inaugural meeting, and for their willingness to
contribute to this most important programme in Africa. He
said that in 2013, PASCAR identified priority interventions to
ministries of health for the prevention of heart disease, diabetes
and stroke in the African region, called the 10 ‘best buys’, and
hypertension was identified as number one priority.
8
Prof Mayosi’s address was followed by a short speech by Dr
Anastase Dzudie, chair of the Task Force, who set the scene
Conference Proceedings