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VOLUME 15 NUMBER 2 • NOVEMBER 2018
81
SA JOURNAL OF DIABETES & VASCULAR DISEASE
PASCAR ROADMAP
and the draft.
15
Comments were received and the draft was
amended.
The task force reviewed the final draft of the roadmap in Mexico
in June 2016, which was then submitted for external peer-review by
three independent experts in hypertension and policy development.
The subsequent review was done by a group of experts in
cardiology, nephrology, primary care and research (including clinical
trials). Comments were reviewed and discussed by the panel and
incorporated into a revised and final document.
PASCAR searches and surveys on the status of hypertension
policy programmes and clinical practice guidelines
From May to July 2015, an internal PASCAR survey was conducted,
aiming to determine which African countries ran hypertension
control programmes focusing on policy. Using the Survey Monkey
software tool,
16
national hypertension experts from 40 countries
were asked whether a hypertension policy programme was
operating in their country and could be judged as being ‘dormant’,
‘not much active’, ‘active’, or ‘very much active’.
Among the responders (
n
= 127) representing 27 SSA countries,
we noticed that up to 63.7% did not have a hypertension policy
programme or that it was dormant or not very active. This
regrettable situation highlights the importance of a continental
initiative to develop a hypertension policy to address BP control
from a population-wide and high-risk approach.
Evidence has shown that explicit clinical practice guidelines
(CPGs) do improve the care gap by providing practitioners and
health-service users with synthesised quality evidence regarding
decision-making.
17
In another PASCAR study, we assessed the
existence, development and use of national guidelines for the
detection and management of hypertension in the African region,
regardless of quality.
Between May and July 2015, CPGs for hypertension were
searched, using a scientifically developed search strategy. Searches
were done using Google and PubMed. Search terms included
(country name) AND (hypertension OR HTN OR high blood pressure)
AND (clinical practice guidelines OR treatment guide). French,
Portuguese and Spanish translations were included in the search
strategy.
Websites of ministries of health, national medical associations
and the WHO were hand-searched, authors were e-mailed, and
requests were sent on Afronets to obtain copies of CPGs for
hypertension. To be included in the search, the CPGs had to be
available and provided in full-text versions for assessment by the
review team, comprising three independent authors. CPGs from
Europe or South America or those that could not be obtained were
considered non-existent. Two national hypertension experts were
contacted for confirmation on countries for which we could not find
CPGs on hypertension. CPGs published in peerreviewed journals
needed to be readily accessed by end-users. E-mail messages were
used for further clarification.
In Fig. 4, the 2015 map is presented of countries with clear
evidence of the existence of national guidelines for detection
and management of BP across Africa. Only 16 (25.8%) out of 62
countries had CPGs complying with our search criteria. No evidence
of CPGs on hypertension management could be found for the other
46 (74.2%) countries. Given that the only existing multinational
expert recommendations for the management of hypertension
in Africa dates back to 2003 and has not been updated since,
18
we concluded that there is a legitimate, pressing need to support
African ministries of health with a clear hypertension roadmap.
PASCAR roadmap to decrease the burden of hypertension
in Africa
To reduce the incidence of CVD through treating hypertension
in the African region, it will be necessary to increase the rates of
detection, treatment and control of the disease. The 10 actions that
need to be undertaken by African ministries of health to achieve a
25% control of hypertension in Africa by 2025 (Fig. 4) are listed
below and we include an explanation as to why (bullets) and how
(dashes) this needs to be done.
1. All NCD national programmes should additionally contain a
plan for the detection of hypertension.
• The hypertension crisis has yet to receive an appropriate
response in SSA.
19
• Incidence of hypertension increased by 67% since 1990 and
was estimated to cause more than 500 000 deaths and 10
million years of life lost in 2010 in SSA.
20,21
• Hypertension is the main cause of stroke, heart failure and
renal disease in SSA.
• Stroke, which is a major complication of uncontrolled hyper-
tension, has increased to 46% since 1990 and essentially
affects breadwinners.
20
• Failure to control hypertension and its economic repercussions
through revising health policies and services endangers the
economic prosperity of all African nations.
22
– All SSA countries should have adopted and should follow
the WHO global agenda of reducing NCDs by 2020.
– When reporting to the Ministry of Health and the WHO,
stakeholders should report specifically on hypertension.
– National cardiac and hypertension societies should
monitor the prevalence, awareness and control rates of
hypertension and report to PASCAR.
– Government, private sector, academia and community
Fig. 4.
2015 map of African countries with evidence of existing clinical
practice guidelines for hypertension management and 10 actions to reduce the
hypertension burden in Africa