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

Gaps in Hypertension Guidelines in Low- and Middle-Income Versus High-Income Countries

“…However, the South African Hypertension Guideline 26 and the 2010 Chinese guideline from LMIC were developed with strict adherence to the IOM recommendations (Table 3). The 2010 Chinese guidelines 8 described the treatment of hypertension in chronic kidney disease, stroke and coronary artery disease.…”

“…Currently guidelines from LMIC are not unique to LMIC setting as they were adopted from existing HIC guidelines without due considerations about their implementability. 26 They were not based on contextually relevant locally-derived evidence. Indeed as alluded to in the 2012 South African Hypertension guidelines 26 , the HIC guidelines have some recommendations which LMIC may not be able to implement because of the socio-economic context within the countries.…”

“…26 They were not based on contextually relevant locally-derived evidence. Indeed as alluded to in the 2012 South African Hypertension guidelines 26 , the HIC guidelines have some recommendations which LMIC may not be able to implement because of the socio-economic context within the countries. 11 …”

Recent advances in hypertension in sub-Saharan Africa

“…The recent publication of the South African hypertension guideline 201156 forms an important basis for the development of a new Pan-African hypertension guideline for SSA. The South African guideline reflects important changes in perspectives and advances in the management of hypertension compared to the International Forum for Hypertension control and prevention in Africa (IFHA) guideline published by Lemogoum et al 57.…”

Comparability of total cardiovascular disease risk estimates using laboratory and non-laboratory based assessments in urban-dwelling South Africans: The CRIBSA study

“…In South Africa (SA), the South African Heart Association and the Lipid and Atherosclerosis Society of Southern Africa, [5] as well as the Southern African Hypertension Society in conjunction with the National Department of Health (DoH), [6] have adopted a cardiovascular risk stratification approach for the management of CVD risk factors. Given the lack of prospective data in the African setting and the absence of locally validated total CVD risk assessment tools, and in view of the fact that the Framingham risk scores have been validated in white and black populations and are transportable to other culturally diverse populations, this approach has been considered appropriate for local use.…”