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Dismal management of hypertension at primary level: does it reflect a failure of patients, a failure of the system or a failure of doctors?

Authors
Journal
CardioVascular Journal of Africa
1995-1892
Publisher
Clinics Cardive Publishing
Publication Date
Keywords
  • Editorial
Disciplines
  • Economics
  • Medicine

Abstract

CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 4, July/August 2011172 AFRICA Editorial dismal management of hypertension at primary level: does it reflect a failure of patients, a failure of the system or a failure of doctors? NBA NTuSI ‘My great concern is not whether you have failed, but whether you are content with your failure.’ Abraham Lincoln Hypertension is a major but modifiable risk factor for cardio- vascular disease (CVD). About 25% of adults in the world have hypertension and this is expected to increase in the coming years.1 In sub-Saharan Africa (SSA), the number of hypertensive adults is projected to rise from 80 million in 2000 to 150 million by 2025.2 In SSA, not only is hypertension common, but it is frequent- ly misdiagnosed. This is of great economic relevance as it commonly affects the young, and causes serious complica- tions.3,4 Persistently elevated blood pressure is associated with poor outcomes, including left ventricular hypertrophy, heart failure, stroke, premature coronary artery disease, chronic kidney disease, intra-cerebral haemorrhage, retinopathy, vascular dementia and acute life-threatening emergencies. Moreover, the management of hypertension remains sub-optimal worldwide. Data from the National Health and Nutrition Examination Survey (NHANES) and the United States Census Bureau from 1999 to 2000 revealed that only 29 to 31% of adult hyperten- sives were controlled, with the prevalence of poor control being higher in older people and blacks.5 Multiple patient-, system- and physician-related factors contribute to the poor management of hypertension, despite the publication of best-practice guidelines for management of high blood pressure by different professional societies. In this issue of the journal, Parker and colleagues report on a study conducted in Cape Town, South Africa, showing that these doctors’ knowledge on the management of hypertension and of the South African hypertension guidelines was poor, with 62.5

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