Hypertension treatment and control in sub-Saharan Africa

BMJ 1998; 317 doi: http://dx.doi.org/10.1136/bmj.317.7150.76 (Published 04 July 1998) Cite this as: BMJ 1998;317:76

Figure of $1800 per life saved seems optimistic

  1. Justin Burdon, Medical officer
  1. Centre Médical Evangelique, Nyankunde, Republic of Congo (c/o PO Box 21285, Nairobi, Kenya)
  2. St Luke's Medical Centre, Brixham, Devon TQ5 8NA
  3. North Tyneside General Hospital, North Shields NE29 8AH
  4. Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne NE1 7RU
  5. Royal College of Physicians of London, London NW1 4LE
  6. Department of Preventive Medicine and Epidemiology, Loyola University Medical School, Maywood, IL 60153, USA
  7. University of the Health Sciences, Yaounde, Cameroon

    EDITOR—Cooper et al call for the inclusion of antihypertensive treatment among health priorities in sub-Saharan Africa.1 Assuming that the patient needs one drug to control his or her blood pressure and that compliance is good, they estimate that one death could be prevented at a cost of $1800 (£1130).

    Some patients need two or more drugs to control their hypertension, and compliance rates for chronic diseases in Africa are low for many reasons, including poverty, lack of access to health services, mobility of the population, and a lack of understanding of the nature of chronic disease. In the Republic of Congo patients arrive at a health centre to be cured. A doctor who can only control an illness is often seen as having failed, and the patient will then either try a new doctor or consult the local healer.

    The Centre Médical Evangelique runs an externally funded project for patients with epilepsy. The cost of the treatment is only $18-$24 (£11.70-£15.10) a year, and most patients see a considerable change in their condition. The programme is mobile to facilitate access. Despite this the average non-attendance at any consultation is about 40%. This figure is likely to be higher for a similar programme of antihypertensive treatment, because the patient often experiences no improvement in symptoms and may have side effects from the medicine prescribed.

    I think that Cooper et al's figure of $1800 per life saved is optimistic. Even if accurate it means that antihypertensive treatment cannot rank alongside the provision of clean water, vaccination, and oral rehydration in terms of lives saved …

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