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Management of hypertension at the community level in Sub-Saharan Africa (SSA): towards a rational use of available resources

Marc Twagirumukiza (UGent) and Lucas Van Bortel (UGent)
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Abstract
Hypertension is emerging in many developing nations as a leading cause of cardiovascular mortality, morbidity and disability in adults. In sub-Saharan African (SSA) countries it has specificities such as occurring in young and active adults, resulting in severe complications dominated by heart failure and taking place in limited-resource settings in which an individual's access to treatment (affordability) is very limited. Within this context of restrained economic conditions, the greatest gains for SSA in controlling the hypertension epidemic lie in its prevention. Attempts should be made to detect hypertensive patients early before irreversible organ damage becomes apparent, and to provide them with the best possible and affordable non-pharmacological and pharmacological treatment. Therefore, efforts should be made for detection and early management at the community level. In this context, a standardized algorithm of management can help in the rational use of available resources. Although many international and regional guidelines have been published, they cannot apply to SSA settings because the economy of the countries and affordability of the patients do not allow access to advocated treatment. In addition, none of them suggest a clear algorithm of management for limited-resource settings at the community level. In line with available data and analysing existing guidelines, a practical algorithm for management of hypertension at the community level, including treatment affordability, has been suggested in the present work.
Keywords
prevalence, cost of illness, sub-Saharan Africa, African continental ancestry groups, MIDDLE-INCOME COUNTRIES, LEFT-VENTRICULAR HYPERTROPHY, CARDIOVASCULAR RISK-FACTORS, WORLD-HEALTH-ORGANIZATION, TARGET ORGAN DAMAGE, STAGE RENAL-FAILURE, HIGH BLOOD-PRESSURE, SOUTH-AFRICA, NONPHARMACOLOGICAL TREATMENT, INTERNATIONAL-SOCIETY

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Citation

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Chicago
Twagirumukiza, Marc, and Lucas Van Bortel. 2011. “Management of Hypertension at the Community Level in Sub-Saharan Africa (SSA): Towards a Rational Use of Available Resources.” Journal of Human Hypertension 25 (1): 47–56.
APA
Twagirumukiza, Marc, & Van Bortel, L. (2011). Management of hypertension at the community level in Sub-Saharan Africa (SSA): towards a rational use of available resources. JOURNAL OF HUMAN HYPERTENSION, 25(1), 47–56.
Vancouver
1.
Twagirumukiza M, Van Bortel L. Management of hypertension at the community level in Sub-Saharan Africa (SSA): towards a rational use of available resources. JOURNAL OF HUMAN HYPERTENSION. 2011;25(1):47–56.
MLA
Twagirumukiza, Marc, and Lucas Van Bortel. “Management of Hypertension at the Community Level in Sub-Saharan Africa (SSA): Towards a Rational Use of Available Resources.” JOURNAL OF HUMAN HYPERTENSION 25.1 (2011): 47–56. Print.
@article{2034680,
  abstract     = {Hypertension is emerging in many developing nations as a leading cause of cardiovascular mortality, morbidity and disability in adults. In sub-Saharan African (SSA) countries it has specificities such as occurring in young and active adults, resulting in severe complications dominated by heart failure and taking place in limited-resource settings in which an individual's access to treatment (affordability) is very limited. Within this context of restrained economic conditions, the greatest gains for SSA in controlling the hypertension epidemic lie in its prevention. Attempts should be made to detect hypertensive patients early before irreversible organ damage becomes apparent, and to provide them with the best possible and affordable non-pharmacological and pharmacological treatment. Therefore, efforts should be made for detection and early management at the community level. In this context, a standardized algorithm of management can help in the rational use of available resources. Although many international and regional guidelines have been published, they cannot apply to SSA settings because the economy of the countries and affordability of the patients do not allow access to advocated treatment. In addition, none of them suggest a clear algorithm of management for limited-resource settings at the community level. In line with available data and analysing existing guidelines, a practical algorithm for management of hypertension at the community level, including treatment affordability, has been suggested in the present work.},
  author       = {Twagirumukiza, Marc and Van Bortel, Lucas},
  issn         = {0950-9240},
  journal      = {JOURNAL OF HUMAN HYPERTENSION},
  keyword      = {prevalence,cost of illness,sub-Saharan Africa,African continental ancestry groups,MIDDLE-INCOME COUNTRIES,LEFT-VENTRICULAR HYPERTROPHY,CARDIOVASCULAR RISK-FACTORS,WORLD-HEALTH-ORGANIZATION,TARGET ORGAN DAMAGE,STAGE RENAL-FAILURE,HIGH BLOOD-PRESSURE,SOUTH-AFRICA,NONPHARMACOLOGICAL TREATMENT,INTERNATIONAL-SOCIETY},
  language     = {eng},
  number       = {1},
  pages        = {47--56},
  title        = {Management of hypertension at the community level in Sub-Saharan Africa (SSA): towards a rational use of available resources},
  url          = {http://dx.doi.org/10.1038/jhh.2010.32},
  volume       = {25},
  year         = {2011},
}

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