Hypertension treatment in sub-Saharan Africa: a systematic review

Abstract

Sub-Saharan Africa (SSA) faces the highest rate of hypertension worldwide. Blood pressure (BP) control rests on the association of lifestyle modification and antihypertensive medicines. We aimed to systematically review antihypertensive strategies implemented in SSA to achieve BP control. A systematic search beginning in 2003 was performed in MEDLINE, COCHRANE and EMBASE. We included only original and observational studies in SSA countries. Thirty studies were included from 11 countries. No study was multinational. The number of patients varied from 111 to 897 (median: 294; IQR: 192-478). Overall, 21% of patients received monotherapy, 42.6% two-drug and 26.6% three-drug combinations. Out of all the strategies, renin-angiotensin system (RAS) blockers were mostly prescribed, followed by diuretics and calcium channel blockers. In monotherapy, RAS blockers were the first to be prescribed. Only 10 articles described antihypertensive strategies beyond triple combinations. BP control was highly variable (range: 16.4 to 61.2%). Multicentre studies performed in several SSA countries are needed to ensure international guidelines actually do improve outcomes in SSA.

Keywords: antihypertensive medications; developing countries; hypertension; sub‐Saharan Africa.

Fig. 1

PRISMA flow diagram summarising the identification and selection process for inclusions in the systematic review.

Fig. 2

Income level of countries in the studies included in the review.

Fig. 3

Numbers of studies included by countries in the review.

Fig. 4

Proportion of prescription by medication strategies (A) and by antihypertensive drug classes (B): median and interquartile range (IQR). Blue squares represented median, lines the interquartile range between the 25th (IQR1) and the 75th (IQR 3) percentile. CCB: calcium channel blockers, ACEI: angiotensin converting enzyme inhibitors, ARB: angiotensin receptor blockers, RAS blockers: renin–angiotensin system blockers, β-blockers: beta-blockers.

Fig. 5

Extrapolation of the antihypertensive drug classes prescribed most often by medication strategies. Diuretics were cited 29 times in the composition of three-drug strategies across the studies.

Fig. 6

Assessment of quality of reporting according to the STROBE statement.