Education And Debate

Hypertension treatment and control in sub-Saharan Africa: the epidemiological basis for policy

BMJ 1998; 316 doi: (Published 14 February 1998) Cite this as: BMJ 1998;316:614

This article has a correction. Please see:

  1. Richard S Cooper, chairman ([email protected])a,
  2. Charles N Rotimi, assistant professora,
  3. Jay S Kaufman, research associatea,
  4. Walinjom FT Muna, chief of cardiologyb,
  5. George A Mensah, associate professor of medicinec
  1. a Department of Preventive Medicine and Epidemiology, Loyola University Stritch School of Medicine, Maywood, IL 60153, USA
  2. b University of Health Sciences, Yaounde, Cameroon
  3. c Medical College of Georgia, Augusta, GA, USA
  1. Correspondence to: Dr Cooper
  • Accepted 22 October 1997

Although enormous challenges persist in the control of infection in sub-Saharan Africa, non-communicable diseases are also important threats to the health of adult Africans. 1 2 Controversy exists, however, over the priority these conditions deserve in the competition for scarce resources. It has recently been argued that hypertension treatment, for example, should not be attempted in sub-Saharan Africa given the high costs.3 Unfortunately, these discussions take place in an information vacuum, since it is impossible to define the burden of chronic conditions in societies where health statistics are unavailable.4 Cohort studies may serve as a proxy for vital statistics and give approximate answers to questions on the usefulness of treatment for chronic disease.5 Hypertension is particularly suited to this model because it is easily diagnosed, highly prevalent, and information on outcomes is plentiful.

Although the relative risk of a cardiovascular event in people with high and normal blood pressure is similar in Africa and the United States, the absolute risk is up to 13 times greater in Africans

Summary points

In sub-Saharan Africa it is difficult to formulate and justify policy on treating chronic conditions such as hypertension as there are no health statistics from which to judge likely costs and benefits

Cohort studies on hypertension in Nigeria and Zimbabwe and epidemiological information show that between 10 and 20 million people in sub-Saharan Africa may have hypertension and that treatment could prevent around 250 000 deaths each year

Taking account of both relative risk and absolute risk of a cardiovascular event or death, a systolic pressure of 160 mm Hg is recommended as a threshold for treatment in Africa

The reduction in population attributable risk associated with treatment could be 2% in Africa compared with 0.15% in the Unites States—some 13 times higher

“Number needed to treat” analysis shows …

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