CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 5, November/December 2023 AFRICA 313 did adjust for key potential confounding variables. In addition, some items of the quality assessment tools were not reported across the studies. Concerning the quality of reporting, 32% (287/884) of the STROBE items were not reported at all. Of the 30 articles, on average, 32% (282/884) of items were completely reported and 36% (315/884) were not completely reported. Of the 30 articles, three40,41,43 had more than 60% of the STROBE items completely reported. Notable items that were not completely reported or not reported at all were with regard to methods, as detailed in Fig. 6, particularly those used to examine subgroups and interactions, flow diagram and the number of participants with missing data. Discussion Our systematic review retrieved 30 observational studies reporting how antihypertensive medications were prescribed and assessing the influence of different antihypertensive medication strategies on BP control in SSA countries. Overall, 21% of patients received monotherapy, 42.6% two-drug combinations and 26.6% three-drug combinations. Among all the strategies, RAS blockers were the most commonly prescribed BP-lowering drugs, followed by diuretics and CCB. In monotherapy, RAS blockers were the first class, and diuretics and CCB usage exceeded RAS blockers only in two-drug strategies. Monotherapy and two-drug combinations were well described. However, only 10 articles described antihypertensive Monotherapy Two-drug strategies Three-drug strategies Number of citations of the most prescribed drug classes by strategies 45 40 35 30 25 20 15 10 5 0 Vasodilators Centrally active drug Beta-blockers Calcium channel blockers Renin–angiotensin system blockers Diuretics Fig. 5. Extrapolation of the antihypertensive drug classes prescribed most often by medication strategies. Diuretics were cited 29 times in the composition of three-drug strategies across the studies. 0% 20% 40% 60% 80% 100% 21 Generalisability 19 Limitations 12c Missing data 15 Outcome measures 06 Participants 10 Study size 13c Flow diagram 02 Rationale 17 Other analyses 12a Statistical methods 14b Number of participants with 04 Study design 16b Categorized variables 08 Data sources 13a Number of participants 01a Title Completely reported Not completely reported Not reported at all Not adapted Fig. 6. Assessment of quality of reporting according to the STROBE statement. Monotherapy Two-drug strategies Three-drug strategies % of antihypertensive strategies 60 50 40 30 20 10 0 Median IQR 1 IQR 3 CCB Diuretics ACEI ARB RAS blockers β- blockers Centrally active drug Vasodilators % of antihypertensive drug 80 70 60 50 40 30 20 10 0 Median IQR 1 IQR 3 Fig. 4. Proportion of prescription by medication strategies (A) and by antihypertensive drug classes (B): median and interquartile range (IQR). Blue squares represented median, lines the interquartile range between the 25th (IQR1) and the 75th (IQR 3) percentile. CCB: calcium channel blockers, ACEI: angiotensin converting enzyme inhibitors, ARB: angiotensin receptor blockers, RAS blockers: renin–angiotensin system blockers, β-blockers: beta-blockers. A B
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