South African Hypertension Guideline 2011

This is the 5th hypertension guideline published by the Southern African Hypertension Society (SAHS). It is an important step towards implementing a national standard to improve the quality of care for persons living with hypertension. The realistic objectives described can be applied widely and aim to diminish the impact of hypertension and related cardiovascular disease (CVD) risk in South Africa. Previous versions of the SAHS guideline emphasised improved diagnosis and treatment, tighter control and risk factor stratification.1-4 Other guidelines support the same trends and the movement to evidence-based strategies.5-10 The SAHS continuously reviews its guideline, given the changing nature of the evidence. Using criteria of BP ≥160/95 mmHg or persons aged >18 years receiving antihypertensive medication, the 1998 South African Demographic and Health Survey estimated that there were 3.3 million people with hypertension in the country.11 Acceptance of the international definition of hypertension (BP ≥140/90 mmHg; used in this guideline) adds a further 2.7 million people to this hypertensive population.11 CVD was previously ranked as the second highest cause-of-death category in South Africa.12 This has major cost implications for a developing country and requires a national strategy for prevention and management. Hypertension is a global health burden affecting developed and developing countries, including South Africa.13 The high prevalence of hypertension worldwide contributes to the present and anticipated pandemic of CVD, which is of particular concern in developing countries.13 The control of hypertension, together with the curbing of other major risk factors such as cigarette smoking, dyslipidaemia and diabetes mellitus, constitutes the ideal approach to the primary prevention of atherosclerotic disease, and remains a major challenge for the community. The trend towards comprehensive cardiovascular (CV) risk factor management is the internationally accepted model of care.14 Hypertension is a major and costly contributor to CVD: it accounted for R4 5 billion in direct and indirect expenditure in 1991,15 and was previously shown to constitute 7.5% of the direct total healthcare spend in South Africa.16 This guideline has adopted an evidence-based approach to the estimation of CVD risk, intended to allow the treatment of patients at highest risk and those who can benefit most from lifestyle and drug interventions at the lowest cost, given the country’s limited resources.17