High Blood Pressure in Sub‐Saharan Africa: Why Prevention, Detection, and Control are Urgent and Important

In 2010, hypertension in Sub-Saharan Africa was the leading risk for death, increasing by 67% since 1990. Hypertension was estimated to cause more than 500,000 deaths and 10 million years of life lost in 2010 in Sub-Saharan Africa. It was also the sixth leading risk for disability (contributing to more than 11 million disability-adjusted life years).3 In Sub-Saharan Africa, stroke, the major clinical outcome of uncontrolled hypertension, has increased 46% since 1990 to become the fifth leading risk for death. There are several critical gaps in the prevention and control of hypertension. In Sub-Saharan Africa, only South Africa has a national program to reduce dietary salt and most of the countries do not have reliable data on salt consumption levels. Globally, the processed food industry has an important role in adversely affecting cardiovascular risk through widespread social marketing and distribution of foods high in saturated and trans fats, simple sugars, and salt and low in fiber, complex carbohydrates, potassium, and calcium. It has been estimated that about 80% of hypertension cases are directly related to added salt, low ratio of polyunsaturated fats to saturated fats, and low potassium or through obesity. Excess alcohol is the fifth leading risk for death in Sub-Saharan Africa and is another important cause of hypertension. By essence, multinational food companies aim at maximizing profits and the expansion of markets of processed foods rich in salt, fat, and sugar in Africa, which has the potential to accelerate the epidemic of noncommunicable diseases (NCDs). Comprehensive policies to limit the impact of deliberate and intentional marketing of unhealthy foods, alcohol, and tobacco are therefore a priority to help prevent NCDs. In much of Africa, there is limited capacity of the health care system to screen, diagnose, treat, and control NCDs and their risk factors. Investment needs to be made to ensure that communities and health care facilities have adequate equipment (eg, automated BP devices) and screening programs, including the capacity to treat the detected hypertension cases over the long-term. Persons diagnosed with hypertension need to have their total cardiovascular risk assessed and those at high risk need to receive effective, ideally evidence-based, and affordable drug treatment. If resources allow, patients at intermediate risk should be managed in the same way. Most importantly, a main barrier to the use of health care in Sub-Saharan Africa is the fact that most patients have to pay for medical care and medication out-of-pocket. Systems requiring direct payment at the point of care prevent millions of people from accessing health care services and this is an important barrier to adherence to long-term treatment (eg, for hypertension). It is therefore essential that inexpensive antihypertensive medications are used and that there are effective channels for procurement of low-cost generic medicines. More generally, universal health coverage will be a main step forward in ensuring that persons with hypertension and/or high cardiovascular risk have access to effective, affordable, and accessible care. We are grateful for the assistance from Anastase Dzudie, MD, FESC; Dike Ojji, MB, BS, PhD, FWACP, FESC; Brian Rayner, MBChB, SA, MMed, PhD; and Mark L Niebylski, PhD, MBA, MS.