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Pathophysiologically based antihypertensive pharmacotherapeutics rationality, efficacy and safety in Sub Saharan

A A L Ajayi1, O E Ajayi2

  • 1Division of Hypertension and Clinical Pharmacology, Keck Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA.

International Journal of Cardiology. Cardiovascular Risk and Prevention
|November 26, 2021
PubMed

Insights

Hypertension is a major health issue in Sub-Saharan Africa, with uncontrolled blood pressure common. This review highlights common treatments and identifies factors contributing to uncontrolled blood pressure, suggesting areas for improved hypertension management.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacotherapy
  • Public Health in Sub-Saharan Africa

Background:

  • Hypertension (HT) and uncontrolled blood pressure (UBP) exhibit the highest prevalence, morbidity, and mortality rates in Sub-Saharan Africa (SSA).
  • Understanding the pathophysiology of HT and its correlation with antihypertensive drug (AHD) therapy is crucial for potential amelioration of outcomes in SSA.

Purpose of the Study:

  • To review the unique characteristics of hypertension in SSA.
  • To identify the causes of uncontrolled blood pressure.
  • To examine diagnostic modalities, antihypertensive drug utilization, and treatment efficacy in the SSA context.

Main Methods:

  • A systematic review of 14 published therapeutic audits from four SSA nations was conducted, encompassing a total of 6,496 patients.
  • Data were sourced from Google Scholar and PubMed.
  • Analysis focused on common antihypertensive drugs, combination therapies, treatment adherence, and achievement of blood pressure targets.

Main Results:

  • Calcium Channel Blockers (CCB) like amlodipine and thiazide diuretics (TD) such as hydrochlorothiazide (HCTZ) were the most frequently used AHDs; Thiazide-Like Diuretics (TLD) were underutilized.
  • A significant proportion of patients received multiple AHDs, with 2-drug combinations (ACEI/ARB + TD; CCB + TD; ACEI + CCB) being common.
  • Blood pressure control (<140/<90 mmHg) was achieved in a median of 44% of patients. Common comorbidities included Diabetes Mellitus (DM), Chronic Kidney Disease (CKD), and Coronary Artery Disease (CAD).

Conclusions:

  • Therapeutic inertia, non-compliance, comorbidities, refractory HT, lack of awareness, and substandard AHDs contribute to uncontrolled blood pressure in SSA.
  • Further research is needed on 24-hour Ambulatory Blood Pressure Monitoring (ABPM) in relation to complications and mortality, and the impact of different AHD classes on ABPM.
  • Investigating specific AHD combinations (e.g., ACEI + alpha-1 blockers + TLD) and personalized care strategies for 24-hour ABPM are recommended.
Abstract

Keywords:
24 hour ABPMAntihypertensive drugsHypertensionNon-complianceResistant hypertensionSub Saharan AfricaTherapeutic auditsUncontrolled blood pressure

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