Abstract
The Pan-African Society of Cardiology (PASCAR) has identified hypertension as the highest area of priority action to reduce heart disease and stroke on the continent. The aim of this PASCAR roadmap on hypertension was to develop practical guidance on how to implement strategies that translate existing knowledge into effective action and improve detection, treatment and control of hypertension and cardiovascular health in sub-Saharan Africa (SSA) by the year 2025. Development of this roadmap started with the creation of a consortium of experts with leadership skills in hypertension. In 2014, experts in different fields, including physicians and nonphysicians, were invited to join. Via face-to-face meetings and teleconferences, the consortium made a situation analysis, set a goal, identified roadblocks and solutions to the management of hypertension and customized the World Heart Federation roadmap to Africa. Hypertension is a major crisis on the continent but very few randomized controlled trials have been conducted on its management. Also, only 25.8% of the countries have developed or adopted guidelines for management of hypertension. Other major roadblocks are either government and health-system related or health care professional or patient related. The PASCAR hypertension task force identified a 10-point action plan to be implemented by African ministries of health to achieve 25% control of hypertension in Africa by 2025. Hypertension affects millions of people in SSA and if left untreated, is a major cause of heart disease and stroke. Very few SSA countries have a clear hypertension policy. This PASCAR roadmap identifies practical and effective solutions that would improve detection, treatment and control of hypertension on the continent and could be implemented as is or adapted to specific national settings.
Highlights
Background and aimThe Pan-African Society of Cardiology (PASCAR) has identified hypertension as the highest area of priority for action to reduce heart disease and stroke on the continent
The PASCAR hypertension task force identified a 10-point action plan to be implemented by African ministries of health to achieve 25% control of hypertension in Africa by 2025
We identified roadblocks to the control of hypertension in the African region and proposed solutions to these roadblocks, defining the best strategy to achieve this in sub-Saharan Africa (SSA)
Summary
The Word Health Organisation (WHO) estimated that the number of people affected by hypertension is highest in Africa, at about 46% of adults aged 25 years and older, compared to 35 to 40% elsewhere in the world. The PASCAR hypertension task force identified a 10-point action plan, to be implemented by African ministries of health to achieve 25% control of hypertension in Africa by 2025. After identifying the target population, practical steps are provided for improving hypertension management These include opportunistic screening for awareness of BP status and effective drug treatment for high BP. Guidance is provided for policy makers, healthcare professionals (nurses, general practitioners, family doctors, internists, cardiologists, nephrologists and other hypertension specialists), patients, the private sector and the public, including civil society, on controlling hypertension to reduce premature mortality from CVD. To guide the action of stakeholders, we highlight the importance of reaching minimum standards (Table 3) for the health systems of countries to achieve the 25% hypertension control target Implementation of these solutions and suggestions on customising the overall strategy at a country level are discussed. Population-based strategies for lowering BP may be cost-effective, they are not the focus of this roadmap, but we recognise these would be beneficial
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