Hypertension in developing nations in sub-Saharan Africa

Area of Science:

• Global Health
• Cardiology
• Public Health

Background:

• The 'second wave epidemic' of cardiovascular disease (CVD) is rapidly increasing in developing countries and former socialist republics.
• Coronary heart disease and cerebrovascular disease are projected to be leading causes of global burden by 2020.
• Despite low prevalence in some areas, the absolute number of hypertensive individuals in developing nations is high, posing affordability challenges for standard treatments.

Purpose of the Study:

• To highlight the escalating burden of cardiovascular disease in developing countries.
• To address the economic and therapeutic challenges in managing hypertension in these regions.
• To propose an integrated cardiovascular disease control program focusing on hypertension.

Main Methods:

• Analysis of World Health Organization (WHO) data on disease burden.
• Cost-analysis of antihypertensive drug treatments for developing countries.
• Review of hypertension control rates and treatment responses in different populations, particularly black hypertensive patients.

Main Results:

• Hypertension control rates are low globally, with Africa at 5-10% achieving <140/90 mm Hg, compared to 20% in the USA.
• Black hypertensive patients show differential responses to antihypertensive drugs: good response to thiazide diuretics and calcium channel blockers, poor response to beta-blockers and ACE inhibitors unless combined with a diuretic.
• Social, economic, and cultural factors significantly impair hypertension control in developing countries.

Conclusions:

• A comprehensive cardiovascular disease program, starting with hypertension control, is essential for Africa.
• Integrated CVD control requires primary prevention through lifestyle programs and cost-effective detection/management strategies.
• Empowering communities via health education and reorienting healthcare infrastructure are crucial to address the emerging CVD challenge.