PASCAR commentary on the International Society of Hypertension global guidelines 2020: relevance to sub-Saharan Africa

Jones, Erika; Damasceno, Albertino; Ogola, Elijah; Ojji, Dike; Dzudie, Anastase; Rayner, B

doi:10.5830/cvja-2020-055

Cited by 7 publications

(5 citation statements)

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“…The authors declare that all supporting data are available within the article and its online supplementary files. We systematically reviewed all literature cited in the International Society of Hypertension (2020), 8 Latin American Society of Hypertension (2017), 9 European Society of Cardiology/European Society of Hypertension (2018), 10 Pan‐African Society of Cardiology (2020), 11 American College of Cardiology/American Heart Association (2017) , 12 and Hypertension Canada (2020) 13 guidelines (Table S1 ). The terms sex and gender are not synonymous.…”

Section: Methodsmentioning

confidence: 99%

Sex‐ and Gender‐Based Reporting in Antihypertensive Medication Literature Informing Hypertension Guidelines

Gulamhusein,

Turino Miranda,

Dumanski

et al. 2024

JAHA

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Background Hypertension is the leading modifiable cardiovascular risk factor with recognized sex‐ and gender‐based differences. We assessed the incorporation of sex and gender reporting in the antihypertensive medication literature informing hypertension guidelines. Methods and Results Literature cited in the International Society of Hypertension (2020), European Society of Cardiology/European Society of Hypertension (2018), American College of Cardiology/American Heart Association (2017), Latin American Society of Hypertension (2017), Pan‐African Society of Cardiology (2020), and Hypertension Canada (2020) guidelines was systematically reviewed. Observational studies, randomized controlled trials, and systematic reviews involving antihypertensive medications were included. Studies with participants of a single sex, guidelines, and commentaries were excluded. Data on study participation‐to‐prevalence ratio by sex, analysis of baseline demographics and study outcomes by sex, and stratification of adverse events by sex were extracted. Of 1659 unique citations, 331 studies met inclusion criteria. Of those, 81% reported the sex of participants, and 22% reported a male‐to‐female participation‐to‐prevalence ratio of 0.8 to 1.2. Three percent of studies stratified baseline characteristics by sex, and 20% considered sex during analysis through statistical adjustment or stratification. Although 32% of studies reported adverse events, only 0.6% stratified adverse events by sex. Most (58%) studies reporting sex/gender used sex and gender terms interchangeably. Conclusions Incorporation of sex‐ and gender‐based considerations in study population, analysis, or reporting of results and adverse events is not common in the antihypertensive medication literature informing international hypertension guidelines. Greater attention to sex‐ and gender‐based factors in research is required to optimally inform management of hypertension.

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Section: Methodsmentioning

confidence: 99%

Sex‐ and Gender‐Based Reporting in Antihypertensive Medication Literature Informing Hypertension Guidelines

Gulamhusein,

Turino Miranda,

Dumanski

et al. 2024

JAHA

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“…The Pan-African Society of Cardiology (PASCAR) also mentions that the use of ACE inhibitors in African patients is associated with the risk of adverse events and recommends alternatives such as angiotensin receptor blockers (ARBs). However, the cost-effectiveness of ACE inhibitors over ARBs makes them widely used in African countries especially in hypertensive patients not experiencing ACE -induced adverse events [ 32 ].…”

Section: Literature Reviewmentioning

confidence: 99%

“…The Pan-African Society of Cardiology (PASCAR) and the International Society of Hypertension (ISH) recommend an initial combination of an ACEI/ARB with a CCB or a combination of CCBs with thiazide or thiazide-like diuretics in African patients. Combination therapy has been shown to improve antihypertensive efficacy and results in a 5-fold reduction in BP compared to doubling doses of single agents [ 30 , 31 ], where BP remains uncontrolled despite the use of 3 or more different classes of drugs including a diuretic, a mineralocorticoid receptor antagonist (MRA) should be added [ 32 , 33 ], and such situations then reflect resistant hypertension.…”

Section: Introductionmentioning

confidence: 99%

Pharmacogenomics of Hypertension in Africa: Paving the Way for a Pharmacogenetic-Based Approach for the Treatment of Hypertension in Africans

Katsukunya,

Soko,

Naidoo

et al. 2023

International Journal of Hypertension

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In Africa, the burden of hypertension has been rising at an alarming rate for the last two decades and is a major cause for cardiovascular disease (CVD) mortality and morbidity. Hypertension is characterised by elevated blood pressure (BP) ≥ 140/90 mmHg. Current hypertension guidelines recommend the use of antihypertensives belonging to the following classes: calcium channel blockers (CCB), angiotensin converting inhibitors (ACEI), angiotensin receptor blockers (ARB), diuretics, β-blockers, and mineralocorticoid receptor antagonists (MRAs), to manage hypertension. Still, a considerable number of hypertensives in Africa have their BP uncontrolled due to poor drug response and remain at the risk of CVD events. Genetic factors are a major contributing factor, accounting for 20% to 80% of individual variability in therapy and poor response. Poor response to antihypertensive drug therapy is characterised by elevated BPs and occurrence of adverse drug reactions (ADRs). As a result, there have been numerous studies which have examined the role of genetic variation and its influence on antihypertensive drug response. These studies are predominantly carried out in non-African populations, including Europeans and Asians, with few or no Africans participating. It is important to note that the greatest genetic diversity is observed in African populations as well as the highest prevalence of hypertension. As a result, this warrants a need to focus on how genetic variation affects response to therapeutic interventions used to manage hypertension in African populations. In this paper, we discuss the implications of genetic diversity in CYP11B2, GRK4, NEDD4L, NPPA, SCNN1B, UMOD, CYP411, WNK, CYP3A4/5, ACE, ADBR1/2, GNB3, NOS3, B2, BEST3, SLC25A31, LRRC15 genes, and chromosome 12q loci on hypertension susceptibility and response to antihypertensive therapy. We show that African populations are poorly explored genetically, and for the few characterised genes, they exhibit qualitative and quantitative differences in the profile of pharmacogene variants when compared to other ethnic groups. We conclude by proposing prioritization of pharmacogenetics research in Africa and possible adoption of pharmacogenetic-guided therapies for hypertension in African patients. Finally, we outline the implications, challenges, and opportunities these studies present for populations of non-European descent.

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“…Home Blood Pressure Measurement (HBPM) or 24-hour ambulatory blood pressure monitoring (24-hr ABPM) are also deemed to have a role (Table 1). However, these international recommendations might not be accurate, feasible or cost-effective in SSA and require further investigation 24,25 .…”

Section: Introductionmentioning

confidence: 99%

Determining the optimal diagnostic and risk stratification approaches for people with hypertension in two rural populations in Kenya and The Gambia: a study protocol for IHCoR-Africa Work Package 2

Perkins,

Awori,

Jobe

et al. 2024

NIHR Open Res

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Background Sub-Saharan Africa (SSA) has one of the highest prevalences of hypertension worldwide. The impact of hypertension is of particular concern in rural SSA, where access to clinics and hospitals is limited. Improvements in the management of people with hypertension in rural SSA could be achieved by sharing diagnosis and care tasks between the clinic and the community. To develop such a community-centred programme we need optimal approaches to identify and risk stratify patients with elevated blood pressure. The aim of the study is to improve the evidence base for diagnosis and risk estimation for a community-centred hypertension programme in two rural settings in SSA. Methods We will conduct a cross-sectional study of 1250 adult participants in Kilifi, Kenya and Kiang West, The Gambia. The study has five objectives which will determine the: (1) accuracy of three blood pressure (BP) measurement methods performed by community health workers in identifying people with hypertension in rural SSA, compared to the reference standard method; (2) relationship between systolic BP and cardiovascular risk factors; (3) prevalence of hypertension-mediated organ damage (HMOD); (4) accuracy of innovative point-of-care (POC) technologies to identify patients with HMOD; and (5) cost-effectiveness of different combinations of BP and HMOD measurements for directing hypertension treatment initiation. Expected findings This study will determine the accuracy of three methods for community BP measurement and POC technologies for HMOD assessment. Using the optimal methods in this setting it will estimate the prevalence of hypertension and provide the best estimate to date of HMOD prevalence in SSA populations. The cost-effectiveness of decision-making approaches for initiating treatment of hypertension will be modelled. These results will inform the development of a community-centred programme to improve care for hypertensive patients living in rural SSA. Existing community engagement networks will be used to disseminated within the research setting.

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PASCAR commentary on the International Society of Hypertension global guidelines 2020: relevance to sub-Saharan Africa

Cited by 7 publications

References 0 publications

Sex‐ and Gender‐Based Reporting in Antihypertensive Medication Literature Informing Hypertension Guidelines

Sex‐ and Gender‐Based Reporting in Antihypertensive Medication Literature Informing Hypertension Guidelines

Pharmacogenomics of Hypertension in Africa: Paving the Way for a Pharmacogenetic-Based Approach for the Treatment of Hypertension in Africans

Determining the optimal diagnostic and risk stratification approaches for people with hypertension in two rural populations in Kenya and The Gambia: a study protocol for IHCoR-Africa Work Package 2

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