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VOLUME 15 NUMBER 2 • NOVEMBER 2018
75
SA JOURNAL OF DIABETES & VASCULAR DISEASE
PASCAR ROADMAP
Abstract
Background and aim:
The Pan-African Society of Cardiology
(PASCAR) has identified hypertension as the highest area of
priority for action to reduce heart disease and stroke on the
continent. The aim of this PASCAR roadmap on hypertension
was to develop practical guidance on how to implement
strategies that translate existing knowledge into effective
action and improve detection, treatment and control of
hypertension and cardiovascular health in sub-Saharan
Africa (SSA) by the year 2025.
Methods:
Development of this roadmap started with the
creation of a consortium of experts with leadership skills in
hypertension. In 2014, experts in different fields, including
physicians and non-physicians, were invited to join. Via
face-to-face meetings and teleconferences, the consortium
made a situation analysis, set a goal, identified roadblocks
and solutions to the management of hypertension and
customised the World Heart Federation roadmap to Africa.
Results:
Hypertension is a major crisis on the continent but
very few randomised, controlled trials have been conducted
on its management. Also, only 25.8% of the countries have
developed or adopted guidelines for the management of
hypertension. Other major roadblocks are either government
and health-system related or healthcare professional
or patient related. The PASCAR hypertension task force
identified a 10-point action plan to be implemented byAfrican
ministries of health to achieve 25% control of hypertension
in Africa by 2025.
Conclusions:
Hypertension affects millions of people in SSA
and if left untreated, is a major cause of heart disease and
stroke. Very few SSA countries have a clear hypertension
policy. This PASCAR roadmap identifies practical and
effective solutions that would improve detection, treatment
and control of hypertension on the continent and could be
implemented as is or adapted to specific national settings.
Keywords:
hypertension, roadmap, Africa, prevalence, control,
blood pressure, action
Executive summary
The Word Health Organisation (WHO) estimated that the number
of people affected by hypertension is highest in Africa, at about
46% of adults aged 25 years and older, compared to 35 to 40%
elsewhere in the world. Many hypertensive Africans are unaware
of their status, and are rarely treated or poorly controlled, making
them at highest risk for stroke, and heart and renal disease.
African Union member states at the 2004 Addis Ababa meeting
described hypertension as one of the continent’s greatest health
challenges after HIV/AIDS. An urgency was recognised to develop
and share best practices, including affordable and effective
community-based programmes to screen and treat hypertension.
The WHO’s 2013–2020 global action plan calls upon the United
Nations (UN) member states to take immediate action in preventing
and controlling non-communicable diseases (NCDs). Target six of
the action plan aims to achieve a 25% relative reduction in the
prevalence of raised blood pressure or to contain this by 2020,
according to national circumstances. State and government heads
in the UN Political Declaration are committed to preventing and
controlling NCDs through the establishment and strengthening of
multi-sectoral national policies and plans.
The Pan-African Society of Cardiology (PASCAR) met several
times to identify key actions for a hypertension roadmap on the
continent. The PASCAR coalition identified several roadblocks
hampering the control of hypertension on the continent, which
exist at government/health-system, physician and patient levels and
include the following.
Government- and health system-related roadblocks
• lack of established policies for controlling hypertension
• poor political willingness to implement policies on NCDs
• poor universal health insurance coverage, leading to out-of-
pocket payment by most patients, which leads to poor access
and adherence to treatment
• lack of policies on antihypertensive medication procurement
and distribution, resulting in stock shortages
• lack of
ad hoc
screening and proper referral systems for patients
identified at routine screening
• inability of governments to effectively work with the private
sector, non-governmental organisations (NGOs) and academia
in a coordinated plan to tackle the burden of hypertension.
Healthcare professional-related roadblocks
• lack of appropriate evidence-based guidelines for healthcare
professionals in individual countries
• hypertension treatment guidelines are poorly implemented
because of a lack of continuing medical education
• a dearth of healthcare professionals (physicians, nurses and
trained health workers) at primary care level with very low
physician/patient ratio
• lack of quality and affordable antihypertension medications.
Patient-related roadblocks
• poor awareness about hypertension and its consequences
• poor adherence to drug therapy because of limited access to
medication
• difficulty in changing lifestyles, and false health beliefs that
hypertension is curable, due to poor patient education.
PASCAR 10-point action plan
The PASCAR hypertension task force identified a 10-point action
plan, to be implemented by African ministries of health to achieve
25% control of hypertension in Africa by 2025.
1. All NCD national programmes should additionally contain a
plan for the detection of hypertension.
2. Allocate appropriate funding and resources for the early
detection, efficient treatment and control of hypertension.
3. Create or adopt simple and practical clinical evidence-based
hypertension management guidelines.
4. Annually monitor and report the detection, treatment and
control rates of hypertension, with a clear target of improvement
by 2025, using the WHO STEPwise surveillance in all countries.
5. Integrate hypertension detection, treatment and control within
existing health services, such as vertical programmes (e.g. HIV,
TB).
6. Promote a task-sharing approach with adequately trained
community health workers (shift-paradigm).
7. Ensure the availability of essential equipment and medicines for
managing hypertension at all levels of care.
8. Provide universal access and coverage for detecting, treating
and controlling hypertension.