Guidelines published this week on the management of hypertension and cardiovascular risk factors in sub-Saharan Africa aim to deal with the growing epidemic of cardiovascular disease in the area with the limited resources available.
Hypertension was placed second only to AIDS in the health challenges facing countries in Africa at a meeting of the African Union in 2001. This resulted in the Durban Decision being adopted by African heads of state and governments, which emphasised the need to tackle hypertension and cardiovascular risk factors in the face of the emerging epidemic of cardiovascular disease in African countries.
Figures from the World Health Organization predict that cardiovascular disease will be the commonest cause of death in developing countries by the year 2020. As a result, the European Commission has provided funding and resources to develop guidelines for the management of cardiovascular risk factors.
The new guidelines, published in the Journal of Hypertension ( 2003;21:1993-2000)[Medline], argue that particular consideration has to be given to cost effectiveness and affordability because many countries in sub-Saharan Africa have severe resource constraints.
In some countries, the health budget per person is less than $10 a year. As a result, the panel that developed the guidelines—including clinicians from several African countries—followed the main recommendations made in previous relevant guidelines (including the 2003 statement of management of hypertension by WHO and the International Society of Hypertension) but adapted them to make them more appropriate to the resources available in many sub-Saharan African countries.The guidelines recommend that low dose thiazide diuretics (for example, hydrochlorothiazide 12.5 mg daily) should generally be used as first line drug treatment for hypertension, with the target blood pressure being <140 mm Hg systolic and <90 mm Hg diastolic in patients with uncomplicated hypertension.
A lower target of <130 mm Hg and <80 mm Hg should be the aim in patients with established cardiovascular disease, diabetes, or chronic renal disease. Other drugs should only be used when there are compelling reasons, such as the use of angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor antagonists in patients who also have diabetes. Generic drugs should be used whenever possible. (Source: Susan Mayor BMJ 2003;327:1305, 6 December)
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