Hypertension is contributing to a rising epidemic of cardiovascular disease, particularly amongst our majority black ethnic group.1
Extensive data from randomized, controlled trials have shown the benefit of treating hypertension. The Southern African Hypertensive Society (SAHS) recommends that target blood pressure (BP) for antihypertensive management is systolic <140 mmHg and diastolic <90 mmHg, with minimal or no drug side effects.2
Recommendations from SAHS2
- BP ≥140-159 (systolic)/90-99 (diastolic) mmHg: Lifestyle modification for three to six months unless the patient is stratified as high risk by the following criteria: three or more major risk factors, diabetes, target-organ damage or complications of hypertension.
- BP ≥160/100 mmHg: Commence drug therapy and lifestyle modification.
- Before choosing an antihypertensive agent, practitioners should consider cost, patient-related factors, conditions favouring use and contraindications, complications and target-organ damage.
Despite global evidence supporting equal efficacy between original and generic medications for controlling hypertension in over 39,000 hypertensive patients,3 cost of medication has been shown to be a barrier to compliance in taking blood pressure medication in a South African cohort.4
The Pan-African Society of Cardiology has identified hypertension as the #1 area for priority for action to reduce heart disease and stroke on the continent. In 2017 they developed a roadmap to improve detection, treatment and control of hypertension and cardiovascular health in sub-Saharan Africa by 2025. Their roadmap supports the use of generic antihypertensive medications in order to reduce cost of care, but with a caveat that the generic medications need to be of high quality.5
Rayner, B. Hypertension: Detection and Management in South Africa. Nephron Clinical Practice. 2010; 116(4), c269–c273. doi:10.1159/000318788
Seedat YK, Rayner BL, Veriava Y. South African Hypertension Practice Guideline 2014. CVJA. 2014;25(6):288-294. doi:10.5830/CVJA-2014-0623
Cooper-DeHoff RM, Elliott WJ. Generic Drugs for Hypertension: Are They Really Equivalent? Curr Hypertens Rep. 2013;15(4):340-345. doi:10.1007/s11906-013-0353-4
Peltzer K. Health Beliefs and Prescription Medication Compliance Among Diagnosed Hypertension Clinic Attenders in a Rural South African Hospital. Curationis. 2004;27(3):15-23. doi:10.4102/curationis.v27i3.994
Dzudie A, Rayner B, Ojji D, et al. Roadmap to Achieve 25% Hypertension Control in Africa by 2025. CVJA. 2017;28(4):261-272. doi:10.5830/CVJA-2017-040