Blood pressure-lowering medicines implemented in 12 African countries: the cross-sectional multination EIGHT study

Objective In Africa, the number of patients with hypertension is expected to reach 216.8 million by 2030. Large-scale data on antihypertensive medications used in Sub-Saharan Africa (SSA) are scarce. Here, we describe antihypertensive drug strategies and identify treatment factors associated with blood pressure (BP) control in 12 Sub-Saharan countries. Setting Outpatient consultations for hypertension in urban tertiary cardiology centres of 29 hospitals from 17 cities across 12 SSA countries between January 2014 and November 2015. Participants Patients ≥18 years of age with hypertension were enrolled at any visit during outpatient consultations in the cardiology departments Main outcome measure We collected BP levels, demographic characteristics and antihypertensive treatment use (including traditional medicine) of patients with hypertension attending outpatient visits. BP control was defined as seated office BP <140/90 mm Hg. We used logistic regression with a random effect on countries to assess factors of BP control. Results Overall, 2198 hypertensive patients were included and a total of 96.6% (n=2123) were on antihypertensive medications. Among treated patients, 653 (30.8%) patients received a monotherapy by calcium channel blocker (n=324, 49.6%), renin–angiotensin system blocker (RAS) (n=126, 19.3%) or diuretic (n=122, 18.7%). Two-drug strategies were prescribed in 927 (43.6%) patients including mainly diuretics and RAS (n=327, 42% of two-drug strategies). Prescriptions of three-drugs or more were used in 543 (25.6%) patients. Overall, among treated patients, 1630 (76.7%) had uncontrolled BP, of whom 462 (28.3%) had BP levels ≥180/110 mm Hg, mainly in those on monotherapy. After adjustment for sociodemographic factors, the use of traditional medicine was the only factor significantly associated with uncontrolled BP (OR 1.72 (1.19 to 2.49) p<0.01). Conclusion Our study provided large-scale data on antihypertensive prescriptions in the African continent. Among patients declared adherent to drugs, poor BP control was significantly associated with the use of traditional medicine.

[1]  X. Jouven,et al.  The importance of considering cultural and environmental elements in an interventional model of care to fight hypertension in Africa , 2021, Journal of clinical hypertension.

[2]  H. Cabral,et al.  Availability and prices of medicines for non-communicable diseases at health facilities and retail drug outlets in Kenya: a cross-sectional survey in eight counties , 2020, BMJ Open.

[3]  Z. Saleem,et al.  Fixed dose drug combinations – are they pharmacoeconomically sound? Findings and implications especially for lower- and middle-income countries , 2020, Expert review of pharmacoeconomics & outcomes research.

[4]  J. Sundewall,et al.  Availability, prices and affordability of essential medicines for treatment of diabetes and hypertension in private pharmacies in Zambia , 2019, PloS one.

[5]  Andrew S. Boozary,et al.  Effect on Treatment Adherence of Distributing Essential Medicines at No Charge , 2019, JAMA internal medicine.

[6]  X. Jouven,et al.  Factors associated with poor adherence to medication among hypertensive patients in twelve low and middle income Sub-Saharan countries , 2019, PloS one.

[7]  B. Kuate Defo,et al.  Blood pressure and burden of hypertension in Cameroon, a microcosm of Africa: a systematic review and meta-analysis of population-based studies , 2019, Journal of hypertension.

[8]  Mohammad Hosein Farzaei,et al.  Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017 , 2018, Lancet.

[9]  Jon Adams,et al.  Traditional, complementary and alternative medicine use in Sub-Saharan Africa: a systematic review , 2018, BMJ Global Health.

[10]  G. Lip,et al.  2018 ESC/ESH Guidelines for the management of arterial hypertension. , 2018, European heart journal.

[11]  K. Narayanan,et al.  Socioeconomic Status and Hypertension Control in Sub-Saharan Africa: The Multination EIGHT Study (Evaluation of Hypertension in Sub-Saharan Africa) , 2018, Hypertension.

[12]  R. Brook,et al.  2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. , 2018, Journal of the American Society of Hypertension : JASH.

[13]  Jiang He,et al.  Comparative Effectiveness of Implementation Strategies for Blood Pressure Control in Hypertensive Patients , 2018, Annals of Internal Medicine.

[14]  É. Marijon,et al.  Fighting fake medicines: First quality evaluation of cardiac drugs in Africa. , 2017, International journal of cardiology.

[15]  S. Yusuf,et al.  Availability and affordability of blood pressure-lowering medicines and the effect on blood pressure control in high-income, middle-income, and low-income countries: an analysis of the PURE study data. , 2017, The Lancet. Public health.

[16]  L. Ragno,et al.  Integrating Traditional Healers into the Health Care System: Challenges and Opportunities in Rural Northern Ghana , 2017, Journal of Community Health.

[17]  A. Liwa,et al.  Herbal and Alternative Medicine Use in Tanzanian Adults Admitted with Hypertension-Related Diseases: A Mixed-Methods Study , 2017, International journal of hypertension.

[18]  É. Marijon,et al.  Letter by Antignac et al Regarding Article "Access to Medications for Cardiovascular Diseases in Low- and Middle-Income Countries". , 2016, Circulation.

[19]  Richard O Laing,et al.  Access to Medications for Cardiovascular Diseases in Low- and Middle-Income Countries. , 2016, Circulation.

[20]  Mohsen Naghavi,et al.  Estimates of Global and Regional Premature Cardiovascular Mortality in 2025 , 2015, Circulation.

[21]  X. Jouven,et al.  Early renal damage in patients with sickle cell disease in sub-Saharan Africa: a multinational, prospective, cross-sectional study. , 2014, The Lancet. Haematology.

[22]  D. Adeloye,et al.  Estimating the Prevalence and Awareness Rates of Hypertension in Africa: A Systematic Analysis , 2014, PloS one.

[23]  M. Gitonga,et al.  Level of blood pressure control among hypertensive patients on follow-up in a Regional Referral Hospital in Central Kenya , 2014, The Pan African medical journal.

[24]  Jackson T. Wright,et al.  2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). , 2014, JAMA.

[25]  G. Musinguzi,et al.  Use of alternative medicine for hypertension in Buikwe and Mukono districts of Uganda: a cross sectional study , 2013, BMC Complementary and Alternative Medicine.

[26]  Hassan Khan,et al.  Adherence to cardiovascular therapy: a meta-analysis of prevalence and clinical consequences. , 2013, European heart journal.

[27]  A. Dominiczak,et al.  2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension. , 2013, Journal of hypertension.

[28]  Martin McKee,et al.  Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. , 2013, JAMA.

[29]  R. Wanyenze,et al.  Hypertension awareness, treatment and control in Africa: a systematic review , 2013, BMC Cardiovascular Disorders.

[30]  J. Pouchot,et al.  Validation of a French Version of the 8‐Item Morisky Medication Adherence Scale in Hypertensive Adults , 2012, Journal of clinical hypertension.

[31]  A. Turner,et al.  Angiotensin-Converting Enzyme 2: The First Decade , 2011, International journal of hypertension.

[32]  A. Adoubi,et al.  Management of Hypertension in the Elderly Patient at Abidjan Cardiology Institute (Ivory Coast) , 2011, International journal of hypertension.

[33]  G. De Backer,et al.  Current and projected prevalence of arterial hypertension in sub-Saharan Africa by sex, age and habitat: an estimate from population studies , 2011, Journal of hypertension.

[34]  B. Owumi,et al.  Complementary and alternative medicine in the management of hypertension in an urban Nigerian community , 2010, BMC complementary and alternative medicine.

[35]  Mitch Blair,et al.  How parents choose to use CAM: a systematic review of theoretical models , 2009, BMC complementary and alternative medicine.

[36]  Phalla Ou,et al.  Prevalence of rheumatic heart disease detected by echocardiographic screening. , 2007, The New England journal of medicine.

[37]  B. Davis,et al.  Clinical Events in High-Risk Hypertensive Patients Randomly Assigned to Calcium Channel Blocker Versus Angiotensin-Converting Enzyme Inhibitor in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial , 2006, Hypertension.

[38]  M. Eddouks,et al.  Ethnopharmacological survey of medicinal plants used for the treatment of diabetes mellitus, hypertension and cardiac diseases in the south-east region of Morocco (Tafilalet). , 2002, Journal of ethnopharmacology.

[39]  R. Kessler,et al.  Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. , 1998, JAMA.

[40]  Thomas Kahan,et al.  [2018 ESC/ESH Guidelines for the management of arterial hypertension]. , 2019, Kardiologia polska.