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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 2, March/April 2015
AFRICA
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for the meeting. He indicated that the meeting’s purpose was
to constitute the Task Force, identify all stakeholders, define
consensus on scoping, planning and method, and agree on
time lines with milestones. He said that the outcome will be to
develop an African hypertension roadmap, one of the key steps
being the development of an African guideline for hypertension
management with a monitoring and implementation strategy,
taking into account the local barriers.
As co-chair of the World Heart Federation (WHF) Working
Group on Hypertension, Prof Neil Poulter presented the WHF
Hypertension (HT) roadmap. He reiterated that raised BP is
considered to be the biggest single risk factor contributing to
global death and global burden of disease, a situation that
is expected to worsen if urgent action is not taken. During
the WHO meeting in Geneva in May 2013, the World Health
Assembly, addressing NCDs, adopted as primary goal a 25%
reduction in NCD deaths by 2025 (25
×
25). Among targets
to achieve this goal, reduction of high BP by 25% by 2025 is a
priority aim. He further said that the priority actions to reach
this target will include opportunistic screening, prevention and
re-screening for high-normal BP, improved treatment for HT,
and education on adherence. The WHF strategy will avoid
duplication of effort in different regions of the world and seeks
to be synergistic with PASCAR’s initiative.
Prof Basden Onwubere, president elect, International Forum
for Hypertension Prevention and Control in Africa (IFHA) and
chair, International Society of Hypertension (ISH) low- and
middle-income countries committee presented the 2003 IFHA
recommendations for prevention, diagnosis and management
of hypertension and cardiovascular risk factors in sub-Saharan
Africa.
9
He indicated that these guidelines are currently under
review through a committee chaired by Prof YK Seedat (South
Africa). He concluded that PASCAR’s idea of a task force
is commendable and that it is desirable for composition and
nomenclature of the task force to reflect the partnership with
already existing hypertension groups with significant efforts on
high BP management in Africa.
Dr Ruth Cornick (South Africa) presented the ‘practical
approach to care kit’ (PACK), a clinical practice guideline for
primary adult care, including hypertension. Her presentation
addressed critical issues to consider when developing clinical
guidelines in order to ensure their implementability and
effectiveness, which included assessing user requirements,
simplicity, keeping up to date, tackling the system and choosing
an effective implementation strategy.
Pof Elijah Ogola (Kenya): Kenya has embarked on an
AstraZeneca-supported programme called Healthy Heart
Africa (HHA), which will focus initially on primary healthcare
providers. The pilot programmes, which were developed with
input from local medical experts, will start at the end of 2014.
The pilot programmes will include creating public awareness and
also using technology to track those at risk. The next step is to
formally endorse a ‘national primary care guideline’ and expand
to a more comprehensive guideline with interaction through this
PASCAR initiative.
Prof Brian Rayner (South Africa) presented a comparative
review of the NICE, the JNC 8 and the International Society
on Hypertension in Blacks (ISHIB) consensus guidelines. The
consensus points were on BP targets/goals that will be less
aggressive than before. Also, there is a much closer agreement
on optimal drug treatment (ACE or ARB, CCB, diuretic, or all
three).
Prof Abdoul Kane (Senegal) presented a comparative
review of the French and the European Society of Cardiology
(ESC)/European Society of Hypertension (ESH) guidelines on
hypertension. He put forward that ESC/ESH guidelines were
state of the art on hypertension (72 pages), while the French
guidelines (four pages) were easy to read and apply to clinical
practice.
Dr Marc Twagirumukiza (Rwanda) presented strategies
for cardiovascular risk assessment of hypertensive patients
in low-resources settings. The Framingham and other similar
studies provide the basis for the equations upon which many
of the existing cardiovascular risk (CVR)-score algorithms
have been developed, however such risk-profiling charts lack
universal applicability. Particularly in low-resource countries, the
major drawbacks to existing CVR-score algorithms include the
selection and definition of the risk factors to be included in given
specific populations,
10
but also the required laboratory tests,
which are not always accessible or available in local settings.
11
The Community Observational Study, Bukavu ObServ
Cohort Study, which will follow a population from 2012 to 2021
Group photo. Front (left to right):
Benedict Anisiuba
(PASCAR Council, Nigeria), BA Serigne (PASCAR
Council, Senegal), Ana Olga Mocumbi (PASCAR Council,
Mozambique), Bongani Mayosi (president PASCAR), Dike
Ojji (co-chair, PASCAR Hypertension Task Force), Anastase
Dzudie (chair, PASCAR Task Force on Hypertension).
Middle (left to right):
Toure Ali Ibrahim (PASCAR Council,
Niger), Abdoul Kane (Senegal), Albertino Damasceno
(Mozambique), Elijah Ogola (PASCAR Council and chair
of Hypertension programme in Kenya), Basden Onwubere
(president elect, IFHA), George Nel (PASCAR executive
officer).
Back (left to right):
Awad Mohamed (PASCAR Council,
Sudan), Brian Rainer (ex-officio president, South Africa
Hypertension Society), Aletta Schutte (South Africa), Marc
Twagirumukiza (African Society of Hypertension Initiative),
Aletta Schutte (president, Southern African Hypertension
Society), and Neil Poulter (co-chair, World Heart Federation
Working Group on the Hypertension roadmap).