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-Sa- haran Africa for many years, and rapid urbanization is causing an upsurge of ischaemic heart disease and meta- bolic 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 medica- tions. The economic impact for loss of productive years of life and the need to divert scarce resources to tertiary care are substantial. implementation of effective preventive and therapeutic strategies remain scanty. The Global Burden of Disease, Injuries and Risk Factor Study is the first systematic and comprehensive attempt to map and quantify risk factors and diseases to identify emerging threats to population health and opportunities for prevention [2–5]. Of particular interest, the analyses of the burden of death and disability attributable to modifiable risk factors have identified emerging threats in risk factors traditionally seen in developed countries, like tobacco smoking, obesity and high salt intake [2–7]. They explain the surge in the burden of cardiovascular disease (CVD) in sub-Saharan Africa, namely hypertension, renal disease, and heart failure. This upsurge of the CVD epidemic poses an additional burden on the already over-burdened health-care systems in these settings creating critical challenges to both national health systems and policy development that can impede the development of a strategic plan to address the CVD epidemic.