The abridged South African hypertension guideline 2011

Abstract

Extensive data from randomised controlled trials have shown the benefit of treating hypertension. The target blood pressure (BP) for antihypertensive management is < 140/90 mmHg, and < 130/80 mmHg in patients with end-organ damage, coexisting risk factors, and co-morbidity. Benefits of management include reduced risk of death, stroke, cardiac failure, chronic kidney disease, and coronary heart disease. The correct BP measurement procedure is described, and evaluation of cardiovascular risk factors and recommendations for antihypertensive therapy, are stipulated. Lifestyle modification and patient education are cornerstones in the management of every patient. Major indications, precautions, and contraindications to each recommended antihypertensive drug are listed. Combination therapy should be considered ab initio if the BP is ≥ 20/10 mmHg above goal. First-line drug therapy for uncomplicated essential hypertension includes low-dose thiazidelike diuretics, calcium-channel blockers, angiotensin-converting enzyme inhibitors, or angiotensin-receptor blockers. The guideline was developed by the Southern African Hypertension Society. © MedpharmReprinted with permission from S Afr Fam Pract 2012;54(2)(Suppl 1):S4-S8

Drug therapy, lifestyle modification and blood pressure control in a primary care facility, south of Johannesburg, South Africa: an audit of hypertension management

“…CV risk associated with hypertension is amplified by diabetes, 38 and early initiation of an ACE inhibitor and control of BP to less than 130/80 mmHg slow down the onset and progression of microvascular complications. [39][40][41][42][43] Thiazide diuretic was the most frequently used antihypertensive in line with recommendations that it be used as first-line drug treatment among black patients 6,10 in whom hypertension has been linked to sodium metabolism abnormalities. 8,32 However, the Baragwanath Hypertension Ambulatory Monitoring Study showed that a CCB in the form of nifedipine was superior to thiazide diuretics as monotherapy among black South Africans.…”

“…Such individualised management includes determining the BP threshold at which treatment is commenced, selecting the appropriate antihypertensive drug(s) for a particular patient and providing adjunct treatments that may be necessary for CV risk reduction in that patient. 6,10 Active screening for complications and comorbidities should be the norm in PHC, as early interventions reverse or slow down the progression of complications. 35 The absence of symptoms should not deter clinicians from screening for comorbidities because comorbidities are usually silent, as shown in a Cape Town study according to which 25% of men and 6% of women had silent renal disease.…”

“…The prevalence of hypertension rises with age, and as many as 25% of South African adults were hypertensive in 2003. 4,5 The current South African hypertension guideline 6 is closely aligned to international hypertension guidelines and was developed to ensure, among other things, that BP is optimally controlled, appropriate lifestyle changes are reinforced and antihypertensive drugs are appropriately selected for the management of hypertension. Despite the effectiveness of antihypertensive drugs and lifestyle changes 7 (weight loss, salt restriction, increased physical activity, limited alcohol intake and healthy diet) in lowering BP, these objectives are not being achieved, 8,9 as shown by, e.g.…”

Psychological Intervention to Address Hypertension in South Africa’s Peri-Urban Settlements

“…Hypertension is particularly problematic in South Africa's black, peri-urban 1 communities (Seedat & Rayner, 2012;Steyn et al, 1996;2001). Migration and urbanization has resulted in distinct dietary practices that are characterized by high levels of fat consumption and low levels of carbohydrate and fibre intake (Bourne, Lambert, & Steyn, 2002).…”

Liking, salt taste perception and use of table salt when consuming reduced-salt chicken stews in light of South Africa's new salt regulations

“…In South Africa (SA), the SA Hypertension Guidelines recommend a salt intake of less than 6 g/day (Na 2400mg/day), based on the upper boundary of the recommended WHO level of 5-6 g/day (Seedat & Rayner, 2012). The average salt intake of South African adults, as measured by 24-hour urine sodium excretion, is between nearly 6 and 10 g/day (Barlow, Connell, & Levendig, 1982;Charlton et al, 2005;Hoosen, Seedat, & Bhigjee, 1990;Norton & Woodiwiss, 2011).…”