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(Circulation. 2005;112:3562-3568.)
© 2005 American Heart Association, Inc.

Heart Disease in Africa

Hypertension in Sub-Saharan African Populations

Lionel H. Opie, MD, DSc; Yackoob K. Seedat, MD, PhD

From the Hatter Institute for Cardiology Research (L.H.O.), University of Cape Town, Cape Town, South Africa, and the Faculty of Health Sciences (Y.K.S.), Nelson R. Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa.

Correspondence to Dr Lionel H. Opie, Hatter Institute, Department of Medicine, Chris Barnard Bldg, Faculty of Health Sciences, University of Cape Town, Observatory 7925, Cape Town, South Africa. E-mail Opie{at}capeheart.uct.ac.za

Received January 29, 2005; revision received June 5, 2005; accepted July 18, 2005.

Background— Hypertension in sub-Saharan Africa is a widespread problem of immense economic importance because of its high prevalence in urban areas, its frequent underdiagnosis, and the severity of its complications.

Methods and Results— We searched PubMed and relevant journals for words in the title of this article. Among the major problems in making headway toward better detection and treatment are the limited resources of many African countries. Relatively recent environmental changes seem to be adverse. Mass migration from rural to periurban and urban areas probably accounts, at least in part, for the high incidence of hypertension in urban black Africans. In the remaining semirural areas, inroads in lifestyle changes associated with "civilization" may explain the apparently rising prevalence of hypertension. Overall, significant segments of the African population are still afflicted by severe poverty, famine, and civil strife, making the overall prevalence of hypertension difficult to determine. Black South Africans have a stroke rate twice as high as that of whites. Two lifestyle changes that are feasible and should help to stem the epidemic of hypertension in Africa are a decreased salt intake and decreased obesity, especially in women.

Conclusions— Overall, differences from whites in etiology and therapeutic responses in sub-Saharan African populations are graded and overlapping rather than absolute. Further studies are needed on black Africans, who may (or may not) be genetically and environmentally different from black Americans and from each other in different parts of this vast continent.

Key Words: hypertension • epidemiology • blood pressure

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