Hypertension Related Co-Morbidities and Complications in Women of Sub-Saharan Africa: A Brief Review

Abstract

Hypertension is the leading cause of cardiovascular disease in women, and sub-Saharan African (SSA) countries have some of the highest rates of hypertension in the world. Expanding knowledge of causes, management, and awareness of hypertension and its co-morbidities worldwide is an effective strategy to mitigate its harms, decrease morbidities and mortality, and improve individual quality of life. Hypertensive disorders of pregnancy (HDPs) are a particularly important subset of hypertension, as pregnancy is a major stress test of the cardiovascular system and can be the first instance in which cardiovascular disease is clinically apparent. In SSA, women experience a higher incidence of HDP compared with other African regions. However, the region has yet to adopt treatment and preventative strategies for HDP. This delay stems from insufficient awareness, lack of clinical screening for hypertension, and lack of prevention programs. In this brief literature review, we will address the long-term consequences of hypertension and HDP in women. We evaluate the effects of uncontrolled hypertension in SSA by including research on heart disease, stroke, kidney disease, peripheral arterial disease, and HDP. Limitations exist in the number of studies from SSA; therefore, we will use data from countries across the globe, comparing and contrasting approaches in similar and dissimilar populations. Our review highlights an urgent need to prioritize public health, clinical, and bench research to discover cost-effective preventative and treatment strategies that will improve the lives of women living with hypertension in SSA.

Keywords: cardiovascular diseases; health inequities; kidney diseases; pre-eclampsia; pregnancy.

Figure 1:. Hypertension’s associated consequence in women and pregnancy in SSA.

Cardiovascular complications related to hypertension in women. Abbreviations: CVD, cardiovascular disease; HF, heart failure; CKD, chronic kidney disease; LVH, left ventricular hypertrophy; PAD, peripheral arterial disease; LBW, low birth weight; IUGR, intrauterine growth restriction; HIV, human immunodeficiency virus; TB, tuberculosis; IHC, intracerebral hemorrhage. Image created with BioRender.com.

Figure 2:. The underdiagnosis of hypertension in SSA reveals various barriers.

The interplay among barriers casts a shadow on the landscape of hypertension awareness in SSA. Image created with BioRender.com.

Figure 3:. Diagnosis of clinical HDP and related syndromes in the Clinic via ACOG.

^, DBP; diastolic blood pressure; SBP, systolic blood pressure; hr(s), hour(s). Image created with BioRender.com.