The State of Hypertension in Sub-Saharan Africa: Review and Commentary

Ischemic heart disease is the leading cause of death globally, accounting for almost 9 million deaths annually as of 2015.¹ According to World Health Organization (WHO) data, the number of deaths as a result of ischemic heart disease has increased by almost 2 million per year since 2000.¹ In developing regions around the world, as defined by World Bank groupings, cardiovascular disease is now the number one killer in all regions with the exception of sub-Saharan Africa, where it ranks second. However, with sub-Saharan Africans above the age of 30, cardiovascular disease again rises to the top as the leading cause of death.² The WHO identifies hypertension as the leading risk factor for cardiovascular disease.³ The incidence of hypertension globally was around 1 billion people in 2008, an increase from 600 million in 1980.⁴ Across all WHO regions, including the Americas, Africa has the highest prevalence of hypertension where 46% of the entire population over 25 years of age is estimated to be hypertensive. In the INTERHEART Africa study, we learned that the age at which sub-Saharan Africans present with first myocardial infarction is significantly younger than any other global region using comparison data from the global INTERHEART study. Further, 5 modifiable risk factors, with hypertension as the most profound, is attributed to 89.2% of acute myocardial infarctions in sub-Saharan Africans.^5,6 This problem is projected to continue to worsen and without intervention could become epidemic.⁵ Given all of this, the WHO has put forth a Global Action Plan including the following goals by 2020: (i) a 25% relative reduction in the prevalence of raised blood pressure or contain the prevalence of raised blood pressure, according to national circumstances; (ii) a 30% relative reduction in mean population intake of salt/sodium; at least 50% of eligible people receive drug therapy and counseling to prevent heart attacks and strokes; (iii) an 80% availability of the affordable basic technologies and essential medicines, including generics, required to treat major noncommunicable diseases.⁷

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