Abstract
BackgroundInadequate diagnosis and suboptimal control of hypertension is a major driver of cardiovascular morbidity and mortality in Africa. Understanding the levels of awareness, treatment and control of hypertension and the associated factors has important implications for hypertension control efforts.MethodsThe PubMed database was searched for original articles related to awareness, treatment and control of hypertension in Africa published between 1993 and 2013. The key search terms were: Africa, awareness, treatment, control, and hypertension. Exploration of bibliographies cited in the identified articles was done to provide further studies. Full texts of the articles were obtained from various internet sources and individual authors. A data extraction sheet was used to collect this information.ResultsThirty eight studies drawn from 23 African countries from all regions of the continent met the inclusion criteria. The levels of awareness, treatment and control varied widely from country to country. Rural populations had lower levels of awareness than urban areas. North African countries had the highest levels of treatment in the continent. There was generally poor control of hypertension across the region even among subjects that were aware of their status and those that were treated. On the whole, the women had a better control status than the men.ConclusionThere are low levels of awareness and treatment of hypertension and even lower levels of control. Tailored research is required to uncover specific reasons behind these low levels of awareness and treatment, and especially control, in order to inform policy formulation for the improvement of outcomes of hypertensive patients in Africa.
Highlights
Inadequate diagnosis and suboptimal control of hypertension is a major driver of cardiovascular morbidity and mortality in Africa
We considered articles that defined hypertension as a measured blood pressure of >140 systolic and >90 diastolic; awareness as the prior knowledge of hypertensive status; treatment as any attempted pharmacological therapy for hypertension in patients who were aware of their status and control as a blood pressure of
This systematic review confirms the low levels of treatment and awareness
Summary
Inadequate diagnosis and suboptimal control of hypertension is a major driver of cardiovascular morbidity and mortality in Africa. Hypertension is the driver of the CVD epidemic in Africa where it is a major, independent risk factor for heart failure, and stroke and kidney failure [6]. The management of these complications is difficult to sustain in sub-Saharan countries where resource-intensive care is not very feasible. The improved control of hypertension has led to considerable reduction in overall morbidity and mortality over the last fifty years [8,9]. Evidence from large clinical trials has shown a 40% reduction in stroke and a reduction of at least 25% in myocardial infarction associated with treatment and control of hypertension [10,11]
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