Cardiovascular disease and hypertension in sub-Saharan Africa: burden, risk and interventions

Abstract

Cardiovascular disease, including stroke, heart failure and kidney disease, has been common in sub-Saharan Africa for many years, and rapid urbanization is causing an upsurge of ischaemic heart disease and metabolic disorders. At least two-thirds of cardiovascular deaths now occur in low- and middle-income countries, bringing a double burden of disease to poor and developing world economies. High blood pressure (or hypertension) is by far the commonest underlying risk factor for cardiovascular disease. Its prevention, detection, treatment and control in sub-Saharan Africa are haphazard and suboptimal. This is due to a combination of lack of resources and health-care systems, non-existent effective preventive strategies at a population level, lack of sustainable drug therapy, and barriers to complete compliance with prescribed medications. The economic impact for loss of productive years of life and the need to divert scarce resources to tertiary care are substantial.

Keywords: Cardiovascular disease; Drug therapy; Hypertension; Salt reduction; Sub-Saharan Africa.

Fig. 1

a Number and yearly rate (per 100,000) of deaths from stroke in 10-year age-bands in adult men and women in Dar-es-Salaam, Hai district, Morogoro rural district, and England and Wales (1992) (from Walker et al. [13]). b Age-specific stroke rates for people aged 45 years or over in Hai, Dar-es-Salaam, and black people in Northern Manhattan (from Walker et al. [14])

Fig. 2

Top proportion of people with hypertension, who were detected, treated, and controlled (i.e., BP 140 and 90 mmHg) by gender and age group in Ashanti, West Africa. Hypertension is defined as systolic BP 140 and/or diastolic BP 90 mmHg, or on anti-hypertensive medication. Bottom proportion of people with hypertension, as defined above, who were detected, treated, and controlled (i.e., BP 140 and 90 mmHg) in rural and semi-urban villages by age group (from Cappuccio et al. [28])

Fig. 3

Effects of a 4-week intervention aiming at reducing dietary salt consumption in 20 adult farmers in the Ashanti region of Ghana (from Cappuccio et al. [33])