Hypertension In Africa Research Articles

Integrating health services for HIV infection, diabetes and hypertension in sub-Saharan Africa: a cohort study

BackgroundHIV, diabetes and hypertension have a high disease burden in sub-Saharan Africa. Healthcare is organised in separate clinics, which may be inefficient. In a cohort study, we evaluated integrated management...

Independent relationships between renal mechanisms and systemic flow, but not resistance to flow in primary hypertension in Africa.

Whether renal mechanisms of hypertension primarily translate into increases in systemic vascular resistance (SVR) in all populations is uncertain. We determined whether renal mechanisms associate with either increases in SVR (and impedance to flow) or systemic flow in a community of African ancestry. In a South African community sampled across the full adult age range (n = 546), we assessed stroke volume (SV), peak aortic flow (Q), SVR, characteristic impedance (Zc) and total arterial compliance (TAC) from velocity and diameter measurements in the outflow tract (echocardiography) and central arterial pressures. Renal changes were determined from creatinine clearance (glomerular filtration rate, GFR) and fractional Na+ excretion (FeNa+) (derived from 24-h urine collections). Independent of confounders (including MAP and pressures generated by the product of Q and Zc), SV (and hence cardiac output) (P < 0.0001) and Q (P < 0.01), but not SVR, Zc or TAC (P = 0.09-0.20) were independently associated with decreases in both GFR (index of nephron number) and FeNa+. Through an interactive effect (P < 0.0001), the impact of GFR on SV or Q was strongly determined by FeNa+ and vice versa. The relationship between the GFR-FeNa+ interaction and either SV or Q was noted in those above or below 50 years of age, although neither GFR, FeNa+ nor the interaction were independently associated with SVR, Zc or TAC at any age. Across the full adult lifespan, in groups of African ancestry, renal mechanisms of hypertension translate into increases in systemic flow rather than into resistance or impedance to flow.

Phytoconstituent of Allanblackia floribunda Seeds

Allanblackia floribunda seed is one of the underutilized and under-exploited seeds in Nigeria, it is a flowering plant in the clusiaceae family that has been used over the years in folk medicine especially in managing hypertension in Africa. This study seeks to evaluate the phytoconstituents of Allanblackia floribunda. Qualitative phytochemical screening, proximate analysis and volatile compounds present in the seeds were evaluated using standard methods. The phytochemical screening showed the presence of alkaloids, flavonoids, tannins, triterpenoids and saponins in the seeds. The result from the proximate compositions showed that the seed had high fibre (4.21%), lipid (10.46%), protein (19.25%), and carbohydrate (61.26%) contents. The GCMS result revealed the presence of compounds with medicinal and nutritional potentials, among these compounds are caryophyllene (13.228%) and oleic acid (2.021%). This study revealed that an Allanblackia floribunda seed has phytoconstituent with nutritional and medicinal importance.

Paediatric Hypertension in Africa: A Systematic Review and Meta-Analysis

Background: The burden of cardiovascular disease (CVD) and hypertension is rapidly increasing in low- and middle-income countries, this is evident not only in adults, but also in children, but recent estimates of prevalence in children are lacking. The association between hypertension and increased body mass index is well known. With rapidly increasing childhood overweight and obesity, updated estimates are important. As such, we conducted a systematic review and meta-analysis to provide updated estimates of paediatric hypertension in Africa. Methods: We searched PubMed and EBSCO to identify articles published from January 2017 to November 2020. Studies were assessed for quality. We combined results for meta-analyses using a random effects model following the Freeman-Tukey arcsine transformation to stabilize the variance. Heterogeneity was quantified using the I2 statistic. Findings: We included 53 studies in narrative synthesis and 41 in meta-analysis reporting pooled data of 52918 participants 3-19 years from 10 countries. Publication bias was low for 23 studies, moderate for 15, with no high-risk studies. Hypertension prevalence ranged substantially across studies (0·2%-38·9%). The pooled prevalence for hypertension (systolic or diastolic blood pressure (BP) ≥95th percentile) was 7·45% (95%CI 5·30-9·92), elevated BP (systolic or diastolic BP ≥90th percentile and <95th percentile) 11·38% (95%CI 7·94-15·33) and combined hypertension/elevated BP 21·74% (95%CI 15·5-28·69). Participants categorized as overweight/obese had a significantly higher prevalence of hypertension (18·5% [95%CI 10·2-28·5]) than those categorized as underweight or normal (1·0% [95%CI 0·1-2·6], 4·8% [95%CI 2·9-7·1], p<0·001). Significant differences in hypertension prevalence were seen when comparing methodology of BP collection (number of measures and measurement occasions, and method of BP collection) and classification guidelines used. Interpretation: When compared to a previous systematic review conducted in 2017, this study suggests a continued increase in prevalence of paediatric hypertension in Africa, as well as highlighting the potential role of to increasing overweight/obesity. Funding: None. Declaration of Interests: We declare no competing interests.

PASCAR commentary on the International Society of Hypertension global guidelines 2020: relevance to sub-Saharan Africa.

Hypertension guidelines have been based on country-specific data until the publication of the International Society of Hypertension (ISH) global guidelines. The major differences between the ISH global guidelines and other international guidelines are the stratified recommendations to accommodate differences in available resources between countries and within countries. This is a key and novel proposal in the new ISH guidelines. There is the separation of optimal versus essential criteria for diagnosis and treatment according to availability of resources. This guideline includes recommendations for sub-Saharan Africa. The Pan-African Society of Cardiology (PASCAR) continues to promote awareness and recommendations on hypertension in Africa. This commentary provides a summary and discussion of the global guidelines in order to clarify the position of PASCAR.

Epidemiology of depressive disorders in people living with hypertension in Africa: a systematic review and meta-analysis

ObjectivesBetter knowledge of epidemiology of depressive disorders in people living with hypertension can help to implement pertinent strategies to address its burden. The objective was to estimate the prevalence of...

The association of malaria infection and gestational hypertension in Africa: Systematic review and meta-analysis.

BackgroundThe World Health Organisation (WHO) estimates that hypertensive disorders of pregnancy (HDP) contribute 14% to global maternal mortality. HDP encompasses several subcategories, including gestational hypertension (GH) and pre-eclampsia. These two conditions are both characterised by a rise in blood pressure, with an onset from 20 weeks of gestation. They also share some common risk factors. The current definition of pre-eclampsia includes raised blood pressure in the absence of proteinuria, thus presenting the two conditions as a spectrum. In this article, we refer to both conditions as gestational hypertension, which is our outcome of interest. The aetiology of GH is not yet clearly understood. Observational studies have suggested that malaria may be associated with GH. However, the evidence from these small studies has been inconclusive. Having a better understanding of the association between malaria and GH may help inform prevention strategies to reduce maternal and infant mortality and morbidity.MethodsIn assessing the association between malaria infection and GH we explored open access articles published in the English language on Medline, Embase, WHO GIM and Google scholar. The subject related articles were retrieved and processed according to preferred reporting items in systematic reviews and meta-analyses (PRISMA) guidelines. Search date was 9th week of 2018. Inverse variance weighting method in Revman 5 software (Cochrane Collaboration, London, United Kingdom) was used to aggregate evidence by computing the pooled odds ratio to show the nature and strength of the relationship between malaria and GH.ResultsUsing critical appraisal skills program (CASP) checklist tool we identified four good quality case-control studies. The total sample size was 1281 women out of which 518 were cases. These studies together show malaria is associated with GH with an overall odds ratio of 2.67, 95% confidence interval (CI) = 1.58-4.53. Heterogeneity of the individual studies supported fixed effect modelling assumptions (I2 = 0%). Malaria infection may have a constant effect on GH across different African populations. The funnel plot did not suggest publication bias however, the four studies involved in the meta-analysis were insufficient to rule it out.ConclusionsOur findings provide evidence of an association between malaria infection and gestational hypertension; this underscores the need to control malaria especially during pregnancy.

Pulmonary vascular disease in Africa: Lessons from registries.

The epidemiology of pulmonary vascular disease (PVD) remains unclear in Africa, where health systems do not reach the majority of the population and heath information systems are poorly developed. In this context, registries are particularly important in gathering crucial information on PVD, aiming at improving knowledge of the epidemiology and/or quality of care. While population-based registries are the main tool to identify incident cases, and be a better indicator of pulmonary vascular disease burden, hospital-based registries can give an indication of the demand for specific care services, which is useful for health policy and planning.The only registry for pulmonary hypertension in Africa – the Pan African Pulmonary Hypertension Cohort (PAPUCO) – involved four countries, and was a pragmatic study that revealed a unique pattern of environmental risks, issues related to low access to health care, and ill-equipped health facilities for diagnosis and management of pulmonary hypertension. In addition, disease specific registries for conditions such as congenital heart disease and rheumatic heart disease uncovered high occurrence of PVD that can be managed and/or prevented with improvements in community awareness, surveillance, management and prevention.It is suggested that existing networks of experts and researchers develop regional registries to determine the epidemiology of PVD in Africa, assess geographic, environmental and seasonal differentials, as well as inform policy and care provision in the continent.

Global Risk Factors of Contrast-Induced Acute Kidney Injury: Systematic Review and Meta-Analysis

Background: Administration of iodinated contrast is common but may be associated with contrast-induced acute kidney injury (CI-AKI), particularly in at-risk patients. There is no recent systematic review of potentially modifiable risk factors. Methods: We searched MEDLINE, Embase and the Cochrane Database of Systematic Reviews (to 30th June 2019) for observational studies assessing risk factors associated with CI-AKI. Twelve potentially modifiable risk factors were finally included in this thematic review and meta-analysis. Random or fixed meta-analysis was performed to derive the adjusted odds ratio (aOR), and the population attributable risk (PAR) was calculated for each risk factor globally and by region. Findings: We included 157 studies (2,297,863 participants). Most studies had a low risk of bias. The global incidence of CI-AKI was 5.4%. The potentially modifiable risk factors included high contrast volume (PAR 33%), eight cardiovascular risk factors (diuretic use, multivessel coronary artery disease, acute coronary syndrome, hypertension, hypotension, heart failure, reduced left ventricular ejection fraction and intra-aortic balloon pump use) (combined PAR 76.2%) and three noncardiovascular risk factors (renal dysfunction, diabetes mellitus and anaemia) (combined PAR 47.4%) with geographical differences. In Asia, the PAR of high contrast agent volume ranks first with limited data, while diuretic use ranks first in Europe and North America. The PAR of heart failure was higher in Europe, as was renal insufficiency in North America and hypertension in Africa and Latin America. Interpretation: Prevention and treatment strategies targeting these potentially modifiable risk factors or patients with risk factors, especially cardiovascular disorders, may reduce the incidence of CI-AKI and should be evaluated in future studies. Funding Statement: The study is supported by the Science and Technology Planning Project of Guangdong Province (grant no. 2014B070706010), the National Science Foundation of China (grant no. 81670339 and 81970311), and the Beijing Lisheng Cardiovascular Pilot Foundation (grant no. LHJJ201612127). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: (PROSPERO register number: CRD42019121534).

Tswana traditional health practitioners' perspectives on the management of diabetes and hypertension: a qualitative study using focus group discussions.

IntroductionThe literature suggests the involvement of Traditional Health Practitioners (THPs) perspectives in treating diabetes and hypertension in Africa. This study sought the perspectives of Tswana THPs in the management of both diabetes and hypertension.MethodsUsing a semi-structured interview guide, four Focus Group Discussions (FGDs) sessions were held with 40 THPs; FGD1 (12) FGD2 (6); FGD3 (13) and FGD4 (9) who were purposely selected from Bojanala and Dr. Ruth Sekgopomati Districts in the North-West Province of South Africa.ResultsTswana THPs perceived diabetes as a “sugar” disease and described hypertension as a disease associated with the abnormal flow of blood in a patient's body. In addition, some of the signs and symptoms of both diabetes and hypertension mentioned by Tswana THPs agreed with scientific literature. Tswana THPs employed the use of the following plants: borago officinalis, ziziphus mucronata, hypoxis hemerocallidea, sutherlandia frutescens, senna italica, urginea sanguinea and eucalyptus globulus in the management of diabetes and hypertension.ConclusionSome of the medicinal plants employed by THPs in the management of both diabetes and hypertension has been proven scientifically to be effective against these chronic conditions.

P1586Research network in Africa (RNA): antihypertensive drugs strategies in 12 African countries

Abstract Background High Blood Pressure is the worldwide leading global burden of disease risk factor. In Sub-Saharan Africa, the number of adults with raised blood pressure has alarmingly increased from 0.59 to 1.13 billion between 1975 and 2015. Blood pressure-lowering medicines are cornerstone of cardiovascular risk reduction. Data on management of anti-hypertensive drugs in sub-Saharan Africa are squarce. Purpose Our study aims to describe antihypertensive drugs strategies in Africa. Methods We conducted a cross-sectional survey in urban clinics during outpatient consultation specialized in hypertension cardiology departments of 29 medical centers from 17 cities across 12 African countries (Benin, Cameroon, Congo, Democratic Republic of Congo, Gabon, Guinea, Ivory Coast, Mauritania, Mozambic, Niger, Senegal, Togo). Data were collected on demographics, treatment and standardized BP measures were made among the hypertensive patients attending the clinics. Country income was retrieved from the World Bank database. All analyses were performed through scripts developed in the R software (3.4.1 (2017–06–30)). Results A total of 2198 hypertensive patients (58.4±11.8 years; 39.9% male) were included. Among whom 2123 (96.6%) had at least one antihypertensive drug. Overall, 30.8% (n=653) received monotherapy and calcium-channel blockers (49.6%) were the most common monotherapy prescribed follow by diuretics (18.7%). Two-drug strategies were prescribed for 927 patients (43.6%). Diuretics and Angiotensin-converting enzyme inhibitors was the combination most frequently prescribed (33.7%). Combination of three drugs or more was used in 25.6% (n=543) of patients. The proportion of drugs strategies differed significantly according to countries (p&lt;0.001), monotherapy ranged from 12.7% in Niger to 47.1% in Democratic Republic of the Congo (figure). Furthermore we observed a significantly difference of strategies between low and middle income countries (55.3% and 44.7% of monotherapy respectively) (p&lt;0.001). According to hypertension grades 1, 2 and 3, the proportion of three-drugs or more combination was 25%, 28% and 34% in middle-income and lower in low-income countries (18%, 19% and 25%). Furthermore, Grade 3 hypertension in low income countries was still treated with monotherapy (36%) instead of 19% in middle income countries (p&lt;0.01). Antihypertensive strategies by country Conclusion Our study described antihypertensive drugs use across 12 sub-Saharan countries, and identified disparities specific to the income context. Inequity in access to drugs combination is a serious barrier to tackle the burden of hypertension in Africa.

Healthy Heart Africa–Kenya: A 12-Month Prospective Evaluation of Program Impact on Health Care Providers' Knowledge and Treatment of Hypertension

BackgroundGiven the rising burden of hypertension in Africa, the Healthy Heart Africa program was developed to improve access to quality hypertension care in the primary care setting. The Healthy Heart Africa program provides a comprehensive, coordinated intervention directed at health care providers (HCPs) and the general public. ObjectiveThe impact of Healthy Heart Africa on HCPs’ knowledge of hypertension and facility-level services in Kenya was evaluated by a 12-month prospective study. MethodsIntervention facilities were selected by stratified random sampling and matched to similar control facilities. Intervention facilities received a hypertension treatment protocol, equipment, training and patient education materials, and improved medical supply chain, whereas control facilities did not. HCPs responsible for hypertension care were surveyed at baseline and 12 months later. Hypertension screening and treatment data were abstracted from service delivery registers. A differences-in-differences analysis estimated the impact of Healthy Heart Africa on HCPs’ knowledge, hypertension services, and the number of patients diagnosed with and seeking treatment for hypertension. ResultsSixty-six intervention and 66 control facilities were surveyed. Healthy Heart Africa improved HCPs’ knowledge of ≥5 hypertension risk factors and ≥5 methods for reducing/managing hypertension but not hypertension consequences. At end line, more intervention than control facilities measured blood pressure more than once during the same visit to diagnose hypertension, dedicated days to hypertension care, used posters to increase hypertension awareness, and provided access to hypertension medications. The number of patients diagnosed with hypertension and those seeking treatment for hypertension increased with intervention, but the change was not significant relative to control subjects. ConclusionsHCP-directed hypertension education and provision of basic resources positively influenced hypertension care in Kenya in the first 12 months of implementation.

Effects of angiotensin converting enzyme gene polymorphism on hypertension in Africa: A meta-analysis and systematic review.

BackgroundHypertension is dramatically increasing in Africa with evidence of increased severity and resistance to treatment. Although angiotensin converting enzyme gene polymorphism is associated with higher prevalence of hypertension, the evidence is inconclusive on its influence on the emerging pattern in Africa. This meta-analysis is conducted to pool the available evidence to inform future research and interventions.MethodsArticles published through May 2018 were systematically searched in PubMed, Scopus and EMBASE databases. Studies were assessed for inclusion by two independent researchers. Six models were used to assess the effect of angiotensin converting enzyme deletion-insertion gene polymorphism. Heterogeneity and publication bias were tested and sensitivity analysis was carried out. Odds ratio and 95% confidence intervals were measured for pooled effect. Both random effect and fixed effect models were used, whilst the frequency of DD, II and DI genotypes were computed and compared.ResultPatients with D allele were 1.49 times more likely to develop essential hypertension compared with patients who carry the I allele (OR:1.49; CI:1.07, 2.07). Similarly, patients who had homozygous co-dominance genotype DD (i.e., DD vs II) were at a 2.17 times higher risk of essential hypertension compared to the co-dominant genotype II (OR:2.17, CI:1.79, 3.18), dominant model (I.e., DD+ID vs II) (OR:1.48; CI:1.03, 2.12), and recessive model (OR:1.64; CI:1.03, 2.61). On subgroup analysis, participants from Sub-Saharan Africa were more genetically susceptible to hypertension compared to their North Africa counterparts. There was no publication bias found, but there was high to moderate heterogeneity.ConclusionACE I/D polymorphism is associated with essential hypertension in Africa in the allele contrast model, as well as the dominant, recessive and homozygous codominance model. On subgroup analysis, ACE I/D was associated with essential hypertension in patients from Sub-Saharan Africa but not in North Africa. A future large scale study, which includes different ethnic groups, is recommended.

Active smoking among people with diabetes mellitus or hypertension in Africa: a systematic review and meta-analysis

The objective was to summarize existing data on the prevalence of active tobacco smoking among patients with hypertension or diabetes mellitus in Africa. We searched PubMed, EMBASE, and AJOL to include studies published from January 01, 2000 to August 23, 2017 reporting on the prevalence of active smoking in individuals aged ≥15 years with hypertension or diabetes mellitus residing inside Africa. We used a random-effects meta-analysis model to pool studies. The pooled prevalence of active smoking among patients with hypertension or diabetes was 12.9% (95%CI: 10.6–15.3; 50 studies; 16,980 patients) and 12.9% (95%CI: 9.6–16.6; 42 studies; 18,564 patients), respectively. For both conditions, the prevalence of active smoking was higher in males than in females (p < 0.001), and in Northern compared to sub-Saharan Africa (p < 0.001). There was no difference between urban and rural settings, and between community-based and hospital-based studies, except for patients with diabetes for whom the prevalence was higher in hospital-based studies (p = 0.032). The prevalence of active smoking is high among patients with hypertension or diabetes mellitus in Africa, with the heaviest burden in Northern Africa. Interventions for smoking prevention or cessation should be implemented in these high risk populations, targeting particularly the males.

Hypertension in Africa.

Hypertension in Africa.

Development of the certificate course in the management of hypertension in Africa (CCMH-AFRICA)

In response to the call by the world health organization to reduce premature deaths from non-communicable diseases by 25% by the year 2025 (25×25), the pan-african society of cardiology (PASCAR) in partnership with several organizations including the world heart federation have developed the 10-point urgent action plan to improve detection, treatment and control of hypertension in Africa. Priority 6 of this action plan is to promote a task-shifting/task-sharing approach in the management of hypertension. This capacity building initiative aims to enhance the knowledge, skills and core competences of primary health care physicians in the management of hypertension and related complications. In a collaborative approach with the international society of hypertension, the British and Irish hypertension society, the public health foundation of India and the centre for chronic disease control, the PASCAR hypertension taskforce held a continental faculty meeting in Kenya on the 25th and 26th of February 2018 to review and discuss a process by which effective contextualization and implementation of the Indian hypertension management course can be done on the African continent. A tailored African course in terms of evidence based learning, up-to-date curriculum and on-the-job-training was developed with a robust monitoring and evaluation strategy. The course will be offered on a modular basis with judicious mix of case studies, group discussions and contact sessions with great flexibility to accommodate the participant's queries. Hypertension affects millions of people in Africa and if left untreated, is a major cause of heart disease and stroke. CCMH-AFRICA will train in the next 10 years 25,000 certified general physicians and 50,000 nurses capable of adequately managing uncomplicated hypertension, thereby freeing the few available specialists for focus on severe or complicated cases.

A Review of Plants Used in South African Traditional Medicine for the Management and Treatment of Hypertension

South Africa contains 9% of the world's higher plants, and despite its rich biodiversity, it has one of the highest prevalence of hypertension in Africa. This review provides information on medicinal plants embraced in South Africa for hypertension management, with the aim of reporting pharmacological information on the indigenous use of these plants as antihypertensives. This review not only focuses on the activity of antihypertensive medicinal plants but also reports some of its phytochemical constituents and other ethnopharmacological and therapeutic properties. Information obtained from scientific and or unpublished databases such as Science Direct, PubMed, SciFinder, JSTOR, Google Scholar, Web of Science, and various books revealed 117 documented antihypertensive plant species from 50 families. Interestingly, Asteraceae topped the list with 16 species, followed by Fabaceae with 8species; however, only 25% of all plant species have demonstrated antihypertensive effects originating from both in vitro and in vivo studies, lending credence to their folkloric use. Only 11 plant species reportedly possess antihypertensive properties in animal models, with very few species subjected to analytical processes to reveal the identity of their bioactive antihypertensive compounds. In this review, we hope to encourage researchers and global research institutions (universities, agricultural research councils, and medical research councils), particularly those showing an interest in natural products, for the need for concerted efforts to undertake more studies aimed at revealing the untapped potential of these plants. These studies are very important for the development of new pharmaceuticals of natural origin useful for the management of hypertension.

Development of the certificate course in the management of hypertension in Africa (CCMH-Africa): proceedings of the first continental faculty meeting, Nairobi, Kenya, 25-26 February 2018.

In response to the call by the World Health Organisation to reduce premature deaths from non-communicable diseases by 25% by the year 2025 (25×25), the Pan-African Society of Cardiology (PASCAR), in partnership with several organisations, including the World Heart Federation, have developed an urgent 10-point action plan to improve detection, treatment and control of hypertension in Africa. Priority six of this action plan is to promote a task-shifting/task-sharing approach in the management of hypertension. This capacity-building initiative aims to enhance the knowledge, skills and core competences of primary healthcare physicians in the management of hypertension and related complications. In a collaborative approach with the International Society of Hypertension, the British and Irish Hypertension Society, the Public Health Foundation of India and the Centre for Chronic Disease Control, the PASCAR hypertension taskforce held a continental faculty meeting in Kenya on 25 and 26 February 2018 to review and discuss a process of effective contextualisation and implementation of the Indian hypertension management course on the African continent. A tailored African course in terms of evidence-based learning, up-to-date curriculum and on-the-job training was developed with a robust monitoring and evaluation strategy. The course will be offered on a modular basis with a judicious mix of case studies, group discussions and contact sessions, with great flexibility to accommodate participants' queries. Hypertension affects millions of people in Africa and if left untreated is a major cause of heart disease, kidney disease and stroke. CCMH-Africa will train in the next 10 years, 25 000 certified general physicians and 50 000 nurses, capable of adequately managing uncomplicated hypertension, thereby freeing the few available specialists to focus on severe or complicated cases.

PO232 A Systematic Review and Meta-Analysis of Prevalence Studies of White Coat and Masked Hypertension In Africa

PO232 A Systematic Review and Meta-Analysis of Prevalence Studies of White Coat and Masked Hypertension In Africa

A11829 Design and development of GANEO-App

Objectives: The highest prevalence of hypertension globally is found in Africa, where awareness, treatment and control remain very low. Digital health technology may serve as a cost-effective and scalable tool to increase awareness and access to effective care. We here describe the design and development of GANEO-App, a digital tool for early detection, referral and management of people with hypertension in Africa. Methods: A 3-phase process was used to develop a comprehensive digital tool for hypertension. In phase I, multidisciplinary team of physicians, pharmacists, engineers worked together to develop and iteratively test GANEO-App. In phase II, 6 community health workers (CHWs) were recruited for usability test. In phase III, we are planning to conduct a prospective pilot study to test the effectiveness of the GANEO-App. Results: Phase I and II were successfully completed. GANEO-app is a mobile application embedded in tablets. It included two modules: one for CHWs and another for physicians. The two modules communicate via secure cloud. CHW module included: (1) evidence-based cardiovascular disease risk tool with referral recommendations (2) personalized lifestyle advices (3) monitoring of treatment adherence (4) education and support. Physician's module enables easy access to data collected by CHWs, consultation and to set personalized goals. The usability test during phase II demonstrated high rate of acceptability and usability by CHWs. Conclusion: GANEO-app has the potential to improve early management of hypertension in Africa. Future feasibility testing in a prospective study will firmly establish the effectiveness and cost-effectiveness of GANEO-App.