Hypertension

Overview

High blood pressure (BP) is the most common single risk factor for cardiovascular-related events and deaths worldwide. Over the past decade, Africa has been characterised as the world's fastest growing economy, but is also in a precipitous health transition. Indeed, the estimated number of hypertensive people in Africa in 2008 was nearly four times higher than the

2005 estimate of the World Health Organisation regional office for Africa (WHO-AFRO), and it is projected to be 125.5 million by 2025.

This increasingly high prevalence of hypertension is coupled with very poor awareness, and low treatment and control rates across Africa.3-6 Hypertension therefore stands in this region of the world as the most common cause of stroke, congestive heart failure (HF) and chronic kidney disease, and poses additional challenges on the longstanding burden associated with communicable diseases and the ongoing HIV/AIDS pandemic.

Since the United Nations high-level meeting to raise international awareness on the fact that premature deaths from non-communicable diseases (NCDs) reduce productivity, curtail economic growth, and pose a significant social challenge in most countries, African governments are opening political windows that need to be used as an opportunity to develop and implement policies for the prevention and control of hypertension and other NCDs.

As the leading continental organisation, the Pan-African Society of Cardiology (PASCAR) has made a real evaluation of the condition and prioritised hypertension as the highest area of priority action to reduce heart disease and stroke on the continent. The PASCAR roadmap on hypertension aims to develop simple and practical hypertension management guidelines, and improve health systems and policies within the World Heart Federation hypertension roadmap framework (appended). This implies that African needs are not just for further consensus statements, reviewing the evidence, but practical guidance on how to implement strategies that translate existing knowledge into effective action and improve blood pressure control and cardiovascular (CV) health in general, as suggested by the WHF primary goal of a 25% reduction of CV mortality by the year 2025.

It is in this vein that the PASCAR Hypertension Task Force meeting was held in Nairobi, Kenya, on 27 October 2014. This event brought together hypertension specialists, guideline methodologists, and clinicians, who reviewed existing guidelines and mapped the next steps in the development of a roadmap for the control and management of hypertension in Africa.

 

Conference Proceedings: Development of the roadmap and guidelines for the prevention and management of high blood pressure in Africa: proceedings of the PASCAR Hypertension Task Force meeting: Nairobi, Kenya, 27 October 2014. Cardiovascular Journal of Africa, March/April 2015 (click here to download)

Meeting Report: Anastase Dzudie, Abdoul Kan, et al. Development of the roadmap for reducing cardiovascular morbidity and mortality through the detection, treatment and control of hypertension in Africa: report of a working group of the PASCAR Hypertension Task Force. Cardiovascular Journal of Africa, May/June 2016 (click here to download)

Hypertension Publications (African and International)

GUIDELINES

Burundi 2012 (click here to download pdf)

Egypt 2003 (click here to download pdf)

Ethiopia: 2014 General Hospital (click here to download pdf)

Ethiopia: 2014 Primary Hospital (click here to download pdf)

Ghana 2012 (click here to download pdf)

Kenya 2009 (click here to download pdf)

Lesotho 2005 (click here to download pdf)

Malawi 2009 (click here to download pdf)

Mauritius (click here to download pdf)

Nigeria 2008 (click here to download pdf)

Rwanda (click here to download pdf)

South Africa 2006 (click here to download pdf)

Sudan 2012 (click here to download pdf)

Tanzania 2013 (click here to download pdf)

Uganda 2012 (click here to download pdf)

Zambia 2008 (click here to download pdf)

Clinical Practice Guidelines for detection and management of Hypertension in Africa (click here to download pdf)

STUDIES

Table 1: List of Hypertention RCTs (click here to download pdf)

Hypertension Knowledge Development in Africa: Clinical Trials for Africa 2016 - Pan African Society of Cardiology With the technical support of Guidelines International Network African Community (click here to download pdf)

Erik J. A. J. Beune, Eric P. Moll van Charante, et al. Culturally adapted hypertension education (CAHE) to improve blood pressure control and treatment adherence in patients of African origin with uncontrolled hypertension: cluster-randomized trial. Open Access. March 2014 (click here to download pdf)

Anastase Dzudie, Andre Pascal Kengne, et al. Prevalence, awareness, treatment and control of hypertension in a selfselected sub-Saharan African urban population: a cross-sectional study. BMJ Open, May 2014 (click here to download)

Vedanthan R1, Kamano JH, et al. Optimizing linkage and retention to hypertension care in rural Kenya (LARK hypertension study): study protocol for a randomized controlled trial. Pubmed, April 2014 (click here to read abstract)

Lepièce B, Reynaert C, et al. General practice and ethnicity: an experimental study of doctoring. Pubmed, May 2014 (click here to read abstract)

Pengpid S, Peltzer K, et al. Efficacy of a church-based lifestyle intervention programme to control high normal blood pressure and/or high normal blood glucose in church members: a randomized controlled trial in Pretoria, South Africa. Pubmed June 2014 (click here to read abstract)

Chukwunomso E. Osakwe, Lotte Jacobs, et al . Newer Versus Older Antihypertensive Agents in African Hypertensive Patients Trial (NOAAH) Investigators. Heart rate variability on antihypertensive drugs in black patients living in sub-Saharan Africa. Pubmed, June 2014 (click here to download pdf)

Gbenga Ogedegbe, Jacob Plange-Rhule, et al. A cluster-randomized trial of task shifting and blood pressure control in Ghana: study protocol. Biomed, July 2014 (click here to download pdf)

Adebowale Adeyemo, Bamidele O Tayo, et al. The Nigerian antihypertensive adherence trial: a community-based randomized trial. NIH Public Access. January 2013 (click here to download pdf)

L Sikiru and GC Okoye. Effect of interval training programme on pulse pressure in the management of hypertension: a randomized controlled trial. Pubmed, September 2013 (click here to download pdf)

Abdul MA, Nasir UI,et al. Low-dose magnesium sulphate in the control of eclamptic fits: a randomized controlled trial. Pubmed January 2013 (click here to read abstract)

Iyalomhe GB, Omogbai EK, et al. Efficacy of initiating therapy with amlodipine and hydrochlorothiazide or their combination in hypertensive Nigerians. Pubmed 2013 (click here to read abstract)

J R M'Buyamba-Kabangu, B C Anisiuba, et al. Efficacy of newer versus older antihypertensive drugs in black patients living in sub-Saharan Africa. Pubmed, December 2013 (click here to download pdf)

Odili AN, Ezeala-Adikaibe B, et al. Progress report on the first sub-Saharan Africa trial of newer versus older antihypertensive drugs in native black patients. Pubmed, May 2012 (click here to read abstract)

Bobrie G, et al. I-COMBINE Study Investigators.I-COMBINE study: assessment of efficacy and safety profile of irbesartan/amlodipine fixed-dose combination therapy compared with amlodipine monotherapy in hypertensive patients uncontrolled with amlodipine 5 mg monotherapy: a multicenter, phase III, prospective, randomized, open-label with blinded-end point evaluation study. Pubmed. Augustus 2012 (click here to read abstract)

Lamina, S. Comparative effect of interval and continuous training programs on serum uric acid in management of hypertension: a randomized controlled trial. Pubmed, March 2011 (click here to read abstract)

Van der Merwe JL, Hall DR, et al. Does a patient information sheet lead to better understanding of pre-eclampsia? A randomised controlled trial. Pubmed, July-October 2011 (click here to read abstract)

Lamina S, Okoye CG. Uricaemia as a cardiovascular events risk factor in hypertension: the role of interval training programme in its downregulation. Pubmed. January 2011 (click here to read abstract) 

Mendis S, Johnston SC, et al. Cardiovascular risk management and its impact on hypertension control in primary care in low-resource settings: a cluster-randomized trial. Pubmed, June 2010 (click here to read the abstract)

Nigel S. Beckett, Ruth Peters, et al. [Antihypertensive treatment in patients older than 80 years of age]. N Engl J Med, May 2008 (click here to read article)

Charlton KE, Steyn K, et al. A food-based dietary strategy lowers blood pressure in a low socio-economic setting: a randomised study in South Africa. Pubmed, August 2008 (click here to read abstract)

Dietz R, Dechend R, et al. Effects of the direct renin inhibitor aliskiren and atenolol alone or in combination in patients with hypertension. Pubmed, September 2008 (click here to read abstract)

Alaa A. El Guindy, Ashraf F. Nabhan. A randomized trial of tight vs. less tight control of mild essential and gestational hypertension in pregnancy. De Gruyter, September 2008 (click here to read abstract)

Cappuccio FP, Kerry SM, et al. A community programme to reduce salt intake and blood pressure in Ghana. Pubmed. January 2006 (click here to read abstract)

Swift PA, Markandu ND, et al. Modest salt reduction reduces blood pressure and urine protein excretion in black hypertensives: a randomized control trial. Pubmed, June 2005 (click here to read abstract)

Libhaber EN, Libhaber CD, et al. Effect of slow-release indapamide and perindopril compared with amlodipine on 24-hour blood pressure and left ventricular mass in hypertensive patients of African ancestry. Pubmed, May 2004 (click here to read abstract)

Ajayi AA, Sofowora GG, et al. Adjunctive sympathoplegic therapy to ACE inhibition in Blacks with congestive heart failure: a comparison of alpha-1 with beta-1 blockade on exercise tolerance and cardiac sympathovagal reflex activity. Pubmed 2003 (click here to read abstract)

Radevski IV, Valtchanova ZP, et al. Comparison of indapamide and low-dose hydrochlorothiazide monotherapy in black patients with mild to moderate hypertension. Pubmed July 2002 (click here to read abstract)

Csaba Farsang, K. Kawecka-Jaszcz, et al. Antihypertensive effects and tolerability of candesartan cilexetil alone and in combination with amlodipine. Springer Link, January 2001 (click here to read abtract)

Sareli P, Radevski IV, et al. Efficacy of different drug classes used to initiate antihypertensive treatment in black subjects: results of a randomized trial in Johannesburg, South Africa. Pubmed, April 2001 (click here to read abstract)

Breeze E, Rake EC, et al. Comparison of quality of life and cough on eprosartan and enalapril in people with moderate hypertension. Pubmed, December 2001 (click here to read abstract)

Okeahialam BN, Thacher TD, et al. Lacidipine in the treatment of hypertension in black African people: antihypertensive, biochemical and haematological effects. Pubmed 2000 (click here to read abstract)

Radevski I, Skudicky D, et al. Antihypertensive monotherapy with nisoldipine CC is superior to enalapril in black patients with severe hypertension. Pubmed February 1999 (click here to read abstract)

Salako BL, Kadiri S, et al. Evaluation of lacidipine (a calcium blocker) in the treatment of hypertension in black African people: a double-blind comparison with hydrochlorothiazide. Pubmed March - June 1998 (click here to read abstract)

Manyemba J. A randomised crossover comparison of reserpine and sustained-release nifedipine in hypertension. Europe PMC, December 1997 (click here to read abstract)

A. A. Ajayi, A. O. Akintomide. The efficacy and tolerability of amlodipine and hydrochlorothiazide in Nigerians with essential hypertension. Pubmed July 1995 (click here to download pdf)

Ramaiya C, Mgaya HN. Low dose aspirin in prevention of pregnancy-induced hypertension in primigravidae at the Muhimbili Medical Center, Dar es Salaam. Pubmed, November 1995 (click here to read abstract)

Ogola EN, Yonga GO. Comparative study of the efficacy and tolerability of hydroflumethiazide versus propranolol in Africans with mild to moderate hypertension. Pubmed, May 1993 (click here to read abstract)

Habte B. The efficacy of hydrochlorothiazide, timolol and enalapril in Ethiopians with essential hypertension. Pubmed, July 1992 (click here to read abstract)

C.M. Stein, P. Neill, et al. Antihypertensive effects of low doses of hydrochlorothiazide in hypertensive black Zimbabweans. Elsevier, November 1992 (click here to read abstract)

L. Duncan Saunders, Leslie M. Irwig, et al. A randomized controlled trial of compliance improving strategies in Soweto hypertensives. JSTOR, July 1991 (click here to read abstract)

Venter CP, Venter HL, et al. [The effect of enalapril and prazosin on mild to moderate hypertension in black South Africans]. Article in Afrikaans. Pubmed, October 1991. (click here to read abstract)

Leary WP, Maharaj B. Comparison of felodipine and hydrochlorothiazide for the treatment of mild to moderate hypertension in black Africans. Pubmed, 1990 (click here to read abstract)

Ajayi AA, Oyewo EA, et al. Ladipo Enalapril and hydrochlorothiazide in hypertensive Africans. Clinical Pharmacology, 1989 (click here to download pdf)

Seedat YK, Parag KB. A comparison of lisinopril and atenolol in black and Indian patients with mild-to-moderate essential hypertension. Pubmed, February 1987 (click here to read abstract)

Goodman C, Rosendorff C. Comparison of the antihypertensive effect of enalapril and propranolol in black South Africans. Europe PMC, 1985 (click here to read abstract)

Abengowe CU. A double-blind comparison of acebutolol (Sectral) and propranolol (Inderal) in the treatment of hypertension in black Nigerian patients. Pubmed 1985 (click here to read abstract)

Obel AO. A comparison of timolol plus hydrochlorothiazide plus amiloride and methyldopa in essential hypertension in Black Africans. Pubmed 1983 (click here to read abstract)

Abson CP, Levy LM, et al. Once-daily atenolol in hypertensive Zimbabwean blacks. A double-blind trial using two different doses. Pubmed July 1981 (click here to read abstract)

Salako LA, Falase AO, et al. Comparative beta-adrenoreceptor-blocking effects and pharmacokinetics or propranolol and pindolol in hypertensive Africans. Europe PMC, December 1979 (click here to read abstract)

Salako LA, Falase AO, et al. Placebo-controlled, double-blind clinical trial of alprenolol in African hypertensive patients. Taylor & Francis Online, 1979 (click here to read abstract)

Dean G, Louw S, et al. A double-blind trial in hypertension comparing Baycaron (FBA 1500), hydrochlorothiazide and placebo. Pubmed, March 1971 (click here to read abstract) 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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