High Blood Pressure in Sub‐Saharan Africa: The Urgent Imperative for Prevention and Control

Abstract

Higher-than-optimal blood pressure (BP), along with tobacco use and dyslipidemia, is one of the three most important modifiable risk factors for CVD. For more than 2 decades, studies have indicated an escalating pattern of hypertension in SSA. 1,2 Estimates indicate unacceptably high rates of undiagnosed and poorly controlled disease in SSA, in spite of substantially enhanced knowledge on pharmacologic and lifestyle interventions for controlling BP. The reasons for the escalating burden of hypertension in SSA are yet fully elucidated; however, important drivers include rapid urbanization, adoption of unhealthy eating habits, and sedentary lifestyles. Addressing hypertension in SSA requires multipronged interventions to achieve better prevention, detection, and control of the condition.In this article, we discuss the urgency of prevention as a priority for hypertension control, as well as possible strategies to be employed to initiate health service and community-based actions toward the prevention of hypertension in SSA. THE DEVASTATING HUMAN AND ECONOMIC BURDEN OF HYPERTENSION IN SSAHigh BP is one of the leading causes of death and disability globally, 1,2 and significantly affects countries within SSA. Between 1990 and 2010, the prevalence of hypertension in SSA increased by 67%, and hypertension was responsible for more than 500,000 deaths and 10 million years of life lost in 2010 in the region.2 This is at variance with many other countries worldwide where absolute BP levels and prevalence of hypertension may be decreasing. 2 The prevalence of hypertension in some SSA countries are among the world's highest. A recent review showed that hypertension prevalence varies between 15% and 70%, with an average of 30%, among SSA countries.3 Furthermore, between 44% and 93% of people with hypertension in SSA are unaware of their hypertensive status.3 The extent of the adverse effects of hypertension on the health and lives of populations within SSA remains largely unexplored. Extrapolations from studies among African descents in the diaspora suggest that the outcomes of hypertension among populations in SSA are likely devastating.Indeed, the few studies conducted among SSA populations indicate that up to 42% of cases of ischemic heart disease (IHD) are related to hypertension, 4 that hypertension increases the risk of stroke by at least five-fold, 5 and that a third of heart failure cases in SSA are caused by hypertension. 6 Other potential consequences of elevated BP in SSA that are becoming increasingly common are chronic kidney disease, 7 adverse pregnancy outcomes, 8 and vascular dementia. 9 The likelihood of these poor outcomes is heightened by the low uptake of treatments for hypertension in SSA. Only about 18% of individuals with hypertension in SSA receive any treatment for hypertension, with only about 7% achieving target BP control levels. 3Treating hypertension is expensive, imposing a huge economic burden on individuals and national healthcare systems in SSA, mainly because of the costs associated with con...

Population awareness of cardiovascular disease and its risk factors in Buea, Cameroon

“…This is less than the >50% reported by Awad et al [25]. Almost half of our study participants were physically inactive, a finding which is alarming and higher than the 16.9% reported in West Cameroon [17], and almost twice as high as previous estimates for SSA [5]. Over one in five participants reported alcohol use.…”

Prevalence and predictors of hypertension in Namibia: A national-level cross-sectional study

“…This changing circumstance is of great concern in SSA, given the dual burden of communicable and non-communicable diseases (NCDs) with which many resource-constrained countries in the region must now contend [ 2 , 4 – 7 ]. The situation is aggravated by the increased risk of adverse outcomes, primarily due to lower levels of hypertension awareness and control, a younger age of onset of the disease, and a potentially more aggressive disease course observed in persons of black African ancestry [ 1 , 2 , 8 – 11 ].…”

“…Accordingly, currently available literature consistently underlines the need for more nationally representative surveys to better elucidate the country-level burden of hypertension and the problem it presents for the SSA region [ 3 , 4 , 8 – 10 , 12 ]. This need for national-level data on hypertension burden appears particularly relevant given reports that the prevalence of hypertension in some SSA countries is among the world’s highest [ 8 , 11 , 13 ]. Indeed, a 2012 cross-sectional study of hypertension across four rural and urban communities in SSA reported age-standardized prevalence estimates of 19.3% (95%CI:17.3–21.3), 21.4% (19.8–23.0), 23.7% (21.3–26.2) and 38.0% (35.9–40.1) in rural Nigeria, rural Kenya, urban Tanzania and urban Namibia, respectively [ 15 ], supporting theories of the magnitude of the hypertension burden in SSA and providing shocking evidence of a remarkably high burden among urban Namibian residents (crude: 32.0%; age-standardized: 38.0%) similar to that of non-Hispanic black adults in the USA (38.6%) [ 16 , 17 ].…”

Echocardiographic findings in non-hypertensive subjects in Bayelsa, Nigeria

“…[1] The prevalence of hypertension in Nigeria has been recorded to be 20% and in Bayelsa State, it has been estimated to be as high as 27.8% and several risk factors and morbidities identified. [2] Consultations, investigations, pharmacotherapy, lifestyle modification practices and in patient care are known to contribute to the cost of care of people living with hypertension.…”