CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 5, November/December 2023 308 AFRICA Both European and USA guidelines contain specific recommendations for the treatment of black hypertensive adults,6,8 since it is well established that blacks living in the Northern Hemisphere respond differently to antihypertensive agents compared to white hypertensive adults due to a variety of phenotypic differences.9 However, studies in African-Americans or African-Caribbeans are not necessarily generalisable to SSA populations due to both contrasting environmental settings and genetic diversity.10 There have been a few comprehensive syntheses of pharmacotherapy used to manage hypertension in SSA.5 We aimed to systematically review antihypertensive strategies implemented in SSA to achieve BP control in real clinical practice. Methods This systematic review was registered in the PROSPERO database (CR42019146769) and was reported according to the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) guidelines.11 We included original studies describing how antihypertensive medications were prescribed in SSA countries and assessing the influence of the different strategies on BP control. We considered only observational studies in patients over 18 years with primary hypertension and living in SAA. We excluded randomised, control trials. Studies where the principal inclusion criterion was not hypertension (such as eclampsia, stroke, HIV, cancer, infections, asthma, diabetes mellitus, neurovascular disease or pulmonary hypertension) were excluded. We searched MEDLINE via PUBMED, COCHRANE and EMBASE using a strategy relying on algorithms adapted to each database, including specific key words (MeSH terms for MEDLINE and Emtree terms for EMBASE) and free text words (Table 1). The electronic research was run on 25 April 2020 without language restrictions. We restricted our search to begin in 2003 because it was the year of publication of guidelines on the management of hypertension by ethnicity in major worldwide savant society. After removing duplicates, one investigator (PC) screened the titles and abstracts. Then, two investigators (PC, CL) screened full texts independently to identify eligible articles. Disagreements were resolved by discussion with the help of a third investigator (MAN) whenever necessary, to reach consensus. Data extraction was independently performed using a standardised form by two authors (PC, CL). The list of data items collected for each included study was as follows: • General information: first author, affiliation of the first and the last author, year of publication, journal, country, study design, study duration, whether the study was single or multicentre, whether it was prospective or retrospective, inclusion and exclusion criteria, and sample size. • Baseline population characteristics: number of patients, mean age, gender ratio, co-morbidities, cardiovascular risk factors, individual wealth index, and patient location (urban or rural). • Hypertension and treatment: duration of hypertension, mean office systolic and diastolic BP value before and after treatment, prescribed antihypertensive medication classes, proportion of adherent patients, proportion of patients with controlled hypertension, and severity of hypertension • Guideline use to define hypertension control and severity, and treatment. Each country’s income was obtained from the World Bank database,12 (accessed 2 February 2020) and categorised into low-income, lower middle-income and upper middle-income countries. We used the National Institute of Health (NIH) quality assessment tools for risk of bias assessment.13 This tool was preferred because it is more comprehensive and therefore enables an exhaustive assessment of quality of included studies. The overall quality of included studies was rated as good, fair and poor. Table 1. Search algorithms in three databases # Search Results Search algorithms and results in MEDLINE #1 ((((((Therapeutics[Title/Abstract]) OR Therapy[Title/Abstract]) OR Treatment[Title/Abstract]) OR Drug Therapy[Title/Abstract]) OR Medicines[Title/ Abstract]) OR Antihypertensive agents[MeSH Terms]) #2 ((Hypertension[Title/Abstract]) OR High blood pressure[MeSH Terms]) #3 (((((((Sub-saharan Africa[MeSH Terms]) OR Black people[Title/Abstract]) OR middle income countries[Title/Abstract]) OR low income countries[Title/ Abstract]) OR poor countries[Title/Abstract]) OR developing countries[Title/Abstract])OR Africa south of the sahara[Title/Abstract]) #4 #1 AND #2 AND #3 1817 Search algorithms and results in EMBASE #1 ‘africa south of the sahara’/exp OR ‘sub-saharan africa’:ab,ti OR ‘black people’:ab,ti OR ‘black person’:ab,ti OR ‘middle income countries’:ab,ti OR ‘low income countries’:ab,ti OR ‘poor countries’:ab,ti OR ‘developing country’:ab,ti #2 therapeutics:ab,ti OR therapy:ab,ti OR treatment:ab,ti OR ‘drug therapy’:ab,ti OR medicines:ab,ti OR ‘antihypertensive agents’/exp #3 ‘hypertension’/exp OR ‘high blood pressure’:ab,ti #4 #1 AND #2 AND #3 2352 Search algorithms and results in Cochrane Central Register of Controlled Trials #1 MeSH descriptor: [Antihypertensive agent] explode all trees #2 MeSH descriptor: [Hypertension] explode all trees #3 (MeSH descriptor: [Africa South of the Sahara] explode all trees #4 (antihypertensive agents):ti,ab,kw OR (drug therapy):ti,ab,kw OR (therapeutics):ti,ab,kw OR (medecines):ti,ab,kw OR (treatments):ti,ab,kw #5 (hypertension): ti,ab,kw OR (high blood pressure): ti,ab,kw #6 (sub-Saharan Africa): ti,ab,kw OR (low income countries): ti,ab,kw OR (middle income countries): ti,ab,kw OR (black people): ti,ab,kw OR (developing countries):ti,ab,kw #7 (#1 OR #4) AND (#2 OR #5) AND (#3 OR #6) 444 exp: explosion, ti: title, ab: abstract
RkJQdWJsaXNoZXIy NDIzNzc=