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VOLUME 15 NUMBER 2 • NOVEMBER 2018
PASCAR ROADMAP
SA JOURNAL OF DIABETES & VASCULAR DISEASE
specific national settings. In the latter case, we recommend that
national roadmaps be developed, using a multi-sectoral approach
in collaboration with inter-governmental organisations, heart health
advocacy foundations, cardiovascular scientific organisations,
healthcare leaders, providers from primary and specialised care,
private-sector stakeholders and people affected by CVD.
Effective advocacy towards policy-makers and politicians in
national governments is mandatory for success. Screening among
politicians might be an effective way to increase awareness and
encourage governments to act.
The PASCAR task force recommended the following steps:
• Step 1: where applicable, national cardiac societies (otherwise
national hypertension societies or cardiovascular specialists)
should take the leadership to develop and convene a
multisectoral coalition against hypertension. At this step,
persuading the government and all other stakeholders to
collaborate is essential.
• Step 2: this coalition will then assess the epidemiological profile
of hypertension and review and synthesise existing official
data and published and unpublished literature. This step also
includes a map of all existing policies.
• Step 3: the coalition conducts policy dialogues withmultiple local
stakeholders. Local problems, specific barriers to hypertension
control and potential solutions should be discussed and
appropriate strategies selected according to context. At this
step, it is important to understand existing policies and their
current effect. Within the same nation, appropriate strategies
may also need adaptation. Some stakeholders who will be
invited to the policy dialogue include the ministry of health,
various health sector staff (physicians and non-physicians),
health workers, key opinion leaders such as politicians and
religious people, and also alternative medicine specialists and
traditional healers, who may have a significant influence on
people with hypertension in some settings.
• Step 4: the coalition develops a clear national strategy and time-
bound plan for detecting, treating and controlling hypertension.
The PASCAR coalition against hypertension takes responsibility for
fostering the development of national roadmaps and supporting
national cardiac and hypertension societies at all levels.
Conclusions
Although there is significant scientific evidence that costeffective
lifestyle and medical interventions could control hypertension and
prevent health-threatening complications, such as heart disease and
stroke, the African region still bears a very high disease prevalence,
coupled with poor rates of detection, treatment and control. This
context is a barrier to the achievement of the universal global action
plan and gives reasons for urgent action.
The PASCAR task force on hypertension roadmap was conceived
by a variety of leaders and stakeholders in the field to provide the
most appropriate strategy to have 25% control of hypertension by
2025. The roadmap identifies major barriers to disease control and
priority areas of intervention, and 10 actions to improve the control
of hypertension by 2025 are proposed. The most important steps
to put forth in this continental roadmap include:
1. Advocate for government leadership and policy.
2. Allocate funding and resources.
3. Design simple and practical guidelines.
4. Promote large-scale screening.
5. Integrate hypertension detection, treatment and control in all
existing programmes.
6. Promote task sharing and expand the scope of practice.
7. Promote the use of inexpensive, good-quality BP machines and
generic medications.
8. Promote universal coverage for hypertension diagnosis and
management.
9. Support high-quality research to produce the best evidence for
interventions.
10. Invest in population preventive measures.
This is a unique moment in history for the African CVD community
to have worked with global leaders in the field in defining a
clear agenda to address the hypertension crisis. Support for this
programme from the African Union and all stakeholders will
help achieve the WHO global action plan of 2013–2020 for NCD
reduction, specifically focusing on heart attack, stroke and other
CVDs. The WHO and other UN organisations will support national
efforts with upstream policy advice and sophisticated technical
assistance, ranging from assisting governments to setting national
targets in implementing relatively simple steps, which can make a
huge difference.
Our sincere thanks go to all fraternal organisations, including
the WHF, the International Forum for Hypertension Control and
Cardiovascular Disease Prevention in Africa, the Africa Heart
Network, and all national cardiac societies for supporting this
initiative. We are grateful to the Clinical Research Education,
Networking and Consultancy for co-drafting the manuscript
and providing first versions of some figures and tables, and all
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