Hypertension in Africa: An Escalating Public Health Crisis
As the world marks World Hypertension Day on 17 May and observes May Measurement Month, the South African Medical Research Council (SAMRC) is calling on healthcare providers to make blood pressure checks a routine part of every patient visit. The SAMRC is also urging the government to integrate regular screenings into school health programmes, laying the foundation for a healthy generation and reducing the growing burden of hypertension in communities across the country.
Hypertension, commonly known as high blood pressure, remains one of the leading risk factors for cardiovascular disease (CVD) and global CVD-related deaths. It causes a series of cardiovascular disorders, including ischemic heart disease, heart failure and stroke with 50–60% of strokes being attributable to elevated blood pressure. Clinically defined as a systolic/diastolic blood pressure ≥140/90 mmHg, hypertension affects an estimated 1.4 billion adults aged 30–79 worldwide, with more men likely to have hypertension than women before the age of 55.
Over the past two decades, the burden of hypertension has shifted markedly from high-income countries (HIC) to low-and middle-income countries (LMICs) with nearly two-thirds of affected individuals residing in LMICs. Regions such as South Asia, parts of Latin America and sub-Saharan Africa (SSA) have seen particularly steep increases. In South Africa (SA), hypertension affects 48% of women and 34% of men, according to 2019 data. More worryingly, there is a rising prevalence of childhood hypertension, often linked to early life exposure as well as increased rates of overweight and obesity. This suggests a looming public health crisis, especially given the long-term cardiovascular risk associated with early-onset hypertension.
Despite multiple calls to action strategic roadmaps from regional and international bodies, awareness, treatment, and control of hypertension remains suboptimal, both globally and in SA . A recent study by Dr. Lebo Gafene-Matemane reports that fewer than 10% of hypertensive men and only 13% of women in SA are aware of their condition. Among those diagnosed and treated, just 14–21% achieve adequate blood pressure control. Regarding childhood hypertension, there is a lack of African-specific blood pressure nomograms for children, and no adequate data exists to evaluate the long-term effectiveness of pharmacological treatment for high BP in children and adolescents.
This is particularly concerning given the evidence that individuals of African descent often experience more severe hypertension phenotypes, requiring more aggressive treatment regimens. Yet regional variability is high, and factors such as rapid urbanisation, lifestyle transitions in rural communities, limited access to health education, and the obesity epidemic continue to fuel the disease burden, especially in SA. South Africa, already grappling with the quadruple burden of disease, infectious illnesses, non-communicable diseases (NCDs), maternal and child health issues, and trauma, faces a growing hypertension epidemic that threatens to overwhelm an already stretched healthcare system. The socio-economic consequences are substantial, including lost productivity and escalating healthcare costs.
In response to this global crisis, initiatives like May Measure Month, a public health campaign spearheaded by the International Society of Hypertension (ISH), aim to raise awareness and increase screening. This effort underscores the importance of 'knowing your numbers,' as hypertension is often asymptomatic yet profoundly increases the risk of heart disease, stroke, kidney failure, and premature death.
Once identified, lifestyle modification remains a cornerstone of management. Some evidence-based recommendations include:
Physical activity: At least 150 minutes of moderate-intensity aerobic activity per week (e.g., 30 minutes of brisk walking five days a week).
Sleep: Prioritising 7–8 hours of quality sleep nightly.
Stress reduction: Incorporating deep breathing, mindfulness, or social connection strategies.
Dietary changes: Limiting salt and sugar intake, increasing hydration, replacing alcohol with herbal teas or sparkling water, and swapping sugary beverages for fruit-infused water.
These accessible interventions can improve both blood pressure control and overall well-being.
The 2024 European Society of Hypertension (ESH) guidelines present significant advancements in pharmacological management aimed at simplifying treatment regimens and adherence. In addition, according to the new guidelines, an aggressive blood pressure target of <130/80 mmHg is now advocated for most patients, to reduce CV events.
Nevertheless, despite these interventions, a significant portion of hypertensive individuals struggle with uncontrolled blood pressure due to inadequate drug response, rendering them vulnerable to CVD events. As such, 'therapeutic trial and error' becomes a challenge as medications are based on a 'one drug fits all approach', but adjustments are needed as the individuals' comorbidities, diet, body mass index, and genetic makeup affect how one respond to antihypertensive medications. African populations, though genetically diverse, have historically been underrepresented in genetic studies, resulting in significant gaps in understanding the genetic basis of diseases within these communities. This lack of empirical data limits insights into how African individuals respond to various antihypertensive medications, leading to the widespread use of a 'one drug fits all approach'. Prof Rabia Johnson said that 'while standard hypertension therapies may be effective for the majority, a more personalised approach is critical for individuals with distinct hypertension subtypes that do not respond as expected. Addressing this gap through pharmacogenetic research can optimise treatment strategies, improve patient outcomes, and advance precision medicine for African populations. Although promising strides are being made, we remain a long way from achieving truly personalised medicine, making sustained research efforts in this area more important than ever.'
We call on healthcare providers across South Africa to make blood pressure measurement a routine part of every patient visit. A simple check could save a life. Early detection and management are key to preventing long-term damage. We urge the South African government and Department of Health to integrate regular blood pressure screenings into school health programs. Early screening and education can build a generation of heart-healthy citizens and reduce the burden of hypertension in our communities. And to every South African, take charge of your health, get your blood pressure measured. Whether at a clinic, pharmacy, or community health event, knowing your numbers is the first step to controlling them. Together, we can beat hypertension, one blood pressure check at a time.
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