CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 5, November/December 2023 AFRICA 307 Review Article Hypertension treatment in sub-Saharan Africa: a systematic review Pauline Cavagna, Céline Leplay, Roland N’Guetta, Kouadio Euloge Kramoh, Ibrahima Bara Diop, Dadhi M Balde, Jean Bruno Mipinda, Michel Azizi, Xavier Jouven, Marie Antignac Abstract Sub-Saharan Africa (SSA) faces the highest rate of hypertension worldwide. Blood pressure (BP) control rests on the association of lifestyle modification and antihypertensive medicines. We aimed to systematically review antihypertensive strategies implemented in SSA to achieve BP control. A systematic search beginning in 2003 was performed in MEDLINE, COCHRANE and EMBASE. We included only original and observational studies in SSA countries. Thirty studies were included from 11 countries. No study was multinational. The number of patients varied from 111 to 897 (median: 294; IQR: 192–478). Overall, 21% of patients received monotherapy, 42.6% two-drug and 26.6% three-drug combinations. Out of all the strategies, renin–angiotensin system (RAS) blockers were mostly prescribed, followed by diuretics and calcium channel blockers. In monotherapy, RAS blockers were the first to be prescribed. Only 10 articles described antihypertensive strategies beyond triple combinations. BP control was highly variable (range: 16.4 to 61.2%). Multicentre studies performed in several SSA countries are needed to ensure international guidelines actually do improve outcomes in SSA. Keywords: sub-Saharan Africa, developing countries, hypertension, antihypertensive medications Submitted 9/8/21, accepted 14/11/22 Published online 25/5/23 Cardiovasc J Afr 2023; 34: 307–317 www.cvja.co.za DOI: 10.5830/CVJA-2022-065 In low- and middle-income countries, infectious and non-communicable diseases exist contemporarily.1 In those countries, recent studies have emphasised the increasing contribution of non-communicable diseases to the global burden of disease.2 The number of adults with raised blood pressure (BP) has increased alarmingly from 0.59 to 1.13 billion between 1975 and 2015, especially in low- and middle-income countries.3 Furthermore, epidemiological trends show that the burden of hypertension in Sub-Saharan Africa (SSA) has overtaken that of many European and North American states.3 The highest prevalence of hypertension is found in SSA, with a three-fold higher mortality rate from stroke and other associated disease.4,5 The association of lifestyle measures and antihypertensive medicines are the cornerstone of hypertension control.6 Randomised clinical trials conducted in high-income countries have proven that antihypertensive medication therapy reduces BP and cardiovascular, cerebrovascular and renal morbidity and mortality rates.7 The World Health Organisation (WHO) aims to achieve a 25% relative reduction in the prevalence of raised BP in SSA in 2025.4 Department of Pharmacy, Pitié Salpêtrière Hospital, AP-HP Sorbonne University, Paris, France Pauline Cavagna, Pharm D, pauline.cavagna@aphp.fr Céline Leplay, Pharm D Marie Antignac, Pharm D, PhD Université Paris Cité, Inserm, PARCC, Paris, France Pauline Cavagna, Pharm D Xavier Jouven, MD, PhD Marie Antignac, Pharm D, PhD Institute of Cardiology of Abidjan, Abidjan, Ivory Coast Roland N’Guetta, MD Kouadio Euloge Kramoh, MD Cardiology Department, University Hospital of Fann, Dakar, Senegal Ibrahima Bara Diop, MD Department of Cardiology, University Hospital of Conakry, Guinea Dadhi M Balde, MD University Hospital of Libreville, Libreville, Gabon Jean Bruno Mipinda, MD Cardiovascular Epidemiology Department, University of Paris, Paris, France Michel Azizi, MD, PhD Xavier Jouven, MD, PhD Hypertension Unit, European Georges Pompidou Hospital, and National Institute of Health and Medical Research, Clinical Research Centre, Paris, France Michel Azizi, MD, PhD Cardiology Department, European Georges Pompidou Hospital, Paris, France Xavier Jouven, MD, PhD
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