TRAJECTORY OF HYPERTENSION IN AFRICA FROM NEAR ABSENCE TO A SILENT EMERGING EPIDEMIC

*Prof. Jacob Mufunda, MBChB; PhD; MBA, Prof. Peter Nyarango, MBChB; MPH; MMED, Dr. Reginald Matchaba-Hove, MBChB; MSC

ABSTRACT

ALTHOUGH HYPERTENSION WAS VIRTUALLY ABSENT IN AFRICA BEFORE 1930 IT HAS NOW BECOME AN emerging epidemic essentially responsible for the double burden of disease in developing countries. This non-communicable disease (NCD) epidemic epitomized by hypertension in Africa, is largely driven by population migration, growth and ageing coupled with socio-cultural transitions. Hypertension was defined by the WHO technical report of 1958 as blood pressure >160/95 mmHg. During the earlier reports, blood pressures were and still are higher in men than in women demonstrating universal gender dichotomy in blood pressure. Blood pressure also did not increase with age beyond 60 years in some of the populations in Africa according to studies before 1930. The hypertension prevalence then gradually increased from then over the decades linked to migration and socio-cultural changes among the populations. These initial observations in blood pressure were attributed to urbanization and dietary changes especially increased salt intake. Obesity especially among the peri-urban women exacerbated the increase in the prevalence of hypertension with levels higher in some women than in men creating a reversed gender dichotomy in blood pressure. Some populations exhibited high prevalence of hypertension at very low body mass indices an observation that created another dichotomy. Prenatal determination of hypertension was reported with underweight babies developing more hypertension in adult life than normal weight babies. There have been matching global approaches of firstly quantifying the burden of hypertension and risk factors and secondly introduction of standardized global measures to prevent and control the disease. One such approach is the global burden of disease study complimented by the Non-Communicable Disease (NCD) STEPwise approach to surveillance (STEPS) approach. Other global continental frameworks as interventions have been successfully implemented under the auspices of CINDI (Countrywide Integrated Non-Communicable Diseases Intervention) and CARMEN (Conjunto de Acciones para la Reduccion Multifactorial de Enfermedades No Transmisibles) (Collaborative Action for Risk Factor Reduction and Effective Management of NCDs) to prevent and control hypertension in Europe and America. The resultant evidence based review of hypertension guidelines have continued to lower the definition of hypertension initially to 140/90 mmHg in 1999 by the WHO to the current 130/80 mmHg by the World Hypertension League. While this review is focusing on hypertension equally important are the other non-communicable diseases such as diabetes mellitus and cancers. The future of prevention and control of hypertension is buttressed by the successful realization of the third goal of the UN Sustainable Development Goals 2016-30. The WHO PEN template has now been adapted to many developing countries including in Africa. The thrust of the intervention is primary, secondary and tertiary prevention to ensure public health interventions to reduce exposure to risk factors and early recognition and treatment of hypertensive cases.

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