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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 3, May/June 2018
AFRICA
199
PASCAR News
Report from Nairobi: towards a 25% reduction in
uncontrolled hypertension in Africa
‘The first step in an ambitious, long-term, intercontinental
project to save millions of lives in Africa by reducing the
unacceptably high stroke morbidity and mortality rates and
other devastating but preventable consequences of undiagnosed
and uncontrolled hypertension in Africa. Indeed an important
step towards the ultimate goal: a 25% reduction in cases of
uncontrolled hypertension on this continent by 2025, as set out
in the PASCAR Roadmap on Hypertension.’
1
This is how the outcome can be described of the first
continental meeting in Nairobi, where a delegation of more
than 30 key opinion leaders in hypertension and cardiology
from Britain, Ireland, India and Africa deliberated for two
days to review and Africanise the successful and relevant
Indian Certificate Course in the Management of Hypertension
(ICCMH*). This emerged during a media conference held at the
meeting.
Representatives of the Public Health Foundation of India
(PHFI) in New Delhi, the International Society of Hypertension
(ISH), the British and Irish Hypertension Society (BIHS), the
Centre for Chronic Disease Control (CCDC) in New Delhi and
the Pan-African Society of Cardiology (PASCAR) gathered
in Nairobi to discuss the expansion and customisation of the
ICCMH to the African region.
The main objective of the course is to train doctors, nurses and
community healthcare workers on the continent to diagnose and
manage hypertension as effectively as possible at the primary care
level, by early diagnosis and better hypertension control, based
on guidelines adapted for the African continent and different
ethnic groups. This will free the few hypertension specialists on
the continent to manage complicated hypertension cases at a
tertiary level. The following key aspects were highlighted at the
media conference.
Undiagnosed and uncontrolled hypertension is the
number one killer in the world
In excess of 10 million people around the world die each year
of hypertension-related diseases, mainly cardiovascular diseases,
including stroke. It kills more people in the world than any
other communicable disease, said Prof Francesco P Cappuccio,
president of the BIHS.
The World Health Organisation has declared
Africa the region of the world with the highest
incidence of hypertension
The African Union considers hypertension the most important
challenge on the continent after HIV/AIDS, but up to now,
experts have not succeeded in translating these political decisions
into important actions that could change cardiovascular health
on the continent, explained Prof Saad Subahi, cardiologist
and president of PASCAR’s National Council. This is where
PASCAR entered four years ago and initiated the PASCAR
Roadmap on Hypertension
.
A recent situation analysis revealed that hypertension affects
one-third (150 million) of the adult population in Africa, but
only one-tenth (about 15 million) of these people are aware of
the disease, and when they are aware, only one in five people
(about three million) is treated. When they are treated, only one
in 14 (about 215 000) is treated to such an extent that their risk for
renal disease, heart disease or stroke, or dying from hypertension
are reduced. This is a dire situation, Prof Subahi said.
Increased awareness among health professionals
and society was identified as the highest priority
towards a 25% reduction in uncontrolled
hypertension by 2025
In the first attempt to increase awareness, more than 20 African
countries took part in a huge global initiative in 2017 to
screen people for hypertension. This will now be followed
by the Africanisation, translation and roll out of the Indian
hypertension-education programme in Africa over the next two
years, said Prof Neil Poulter, president of the ISH.
International hypertension experts from the ISH,
BHIS and India are keen and commited to assist
Africa in its fight against hypertension
‘It is our duty to fill a gap. A 25% reduction in undiagnosed,
uncontrolled hypertension will mean saving the lives of millions
of people every year. It will also reduce morbidity by millions,’
Cappucino reiterated.
The next steps
Following the meeting in Nairobi, the priority actions, as
identified in the PASCAR Roadmap on Hypertension, will be
implemented to overcome the identified roadblocks. These key
elements were highlighted at the media conference:
•
Training and education to increase awareness: PASCAR will
roll out the adapted training programme to train the trainers
across the African region in the coming months; to ultimately
train 250 000 community health workers, 50 000 nurses and
25 000 certified general physicians.
•
Create and customise easy-to-use treatment protocols for
different ethnic groups within a proper referral linkage
pattern. Poulter shed more light on the possible treatment
protocols: ‘The CREOLE trial
2
in six sub-Saharan African
countries, to indicate which antihypertensive drugs and