Hypertension in developing nations in sub-Saharan Africa

• Published in: Journal of human hypertension Vol. 14; no. 10-11; pp. 739 - 747
• Main Author: Seedat, YK
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing 01.10.2000; Nature Publishing Group
• Subjects: Africa South of the Sahara - epidemiology; Angiotensin; Angiotensin-converting enzyme inhibitors; Antihypertensives; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Blood pressure; Cardiology. Vascular system; Cardiovascular disease; Cardiovascular diseases; Cerebrovascular diseases; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Coronary artery disease; Cost analysis; Delivery of Health Care - organization & administration; Developing Countries; Diuretics; Health care; Heart diseases; Humans; Hypertension; Hypertension - epidemiology; Hypertension - prevention & control; LDCs; Medical sciences; Patients; Peptidyl-dipeptidase A; Prevalence; Primary Prevention - organization & administration; Reserpine; Risk Factors; Tropical medicine; Vasodilators; Sub-Saharan Africa; Africa; Africa South of the Sahara; Human; Hypertension; Sanitary program; Costs; Prognosis; Treatment efficiency; Mortality; Developing countries; Cardiovascular disease; Epidemiology; Morbidity; Prevention; Chemotherapy; Treatment; Health economy; Antihypertensive agent; Evolution; Public health
• ISSN: 0950-9240; 1476-5527
• DOI: 10.1038/sj.jhh.1001059

There is a rapid development of the 'second wave epidemic' of cardiovascular disease that is now flowing through developing countries and the former socialist republics. It is now evident from WHO data that coronary heart disease and cerebrovascular disease are increasing so rapidly that they will rank No. 1 and No. 5 respectively as causes of global burden by the year 2020. In spite of the current low prevalence of hypertensive subjects in some countries, the total number of hypertensive subjects in the developing world is high, and a cost-analysis of possible antihypertensive drug treatment indicates that developing countries cannot afford the same treatment as developed countries. Control of hypertension in the USA is only 20% (blood pressure <140/90 mm Hg). In Africa only 5-10% have a blood pressure control of hypertension of <140/90 mm Hg. There are varying responses to antihypertensive therapy in black hypertensive patients. Black patients respond well to thiazide diuretics, calcium channel blockers vasodilators like alpha-blockers, hydralazine, reserpine and poorly to beta-blockers, angiotensin-converting enzyme inhibitors and All receptor antagonists unless they are combined with a diuretic. A comprehensive cardiovascular disease (CVD) programme in Africa is necessary. There are social, economic, cultural factors which impair control of hypertension in developing countries. Hypertension control is ideally suited to the initial component on an integrated CVD control programme which has to be implemented. Primary prevention, through a population-based lifestyle linked programme, as well as cost-effective methods of detection and management are synergistically linked. The existing health care infrastructure needs to be orientated to meet the emerging challenge of CVD, while empowering the community through health education.