Control of hypertension in South Africa: time for action.

Editorial Hypertension is an important worldwide public health challenge because of its frequency and associated risk of cardiovascular and kidney disease. It has been identified as the leading causative risk factor of mortality, and is ranked third highest as a cause of Disability-Adjusted Life Years (DALYs). 1 Data from Sub-Saharan Africa have highlighted the increasing importance of non-communicable diseases in this region, and countries have taken steps to develop relevant policies and programmes. 2 Cardiovascular disease (CVD) in this region is particularly poorly detected and treated in the primary healthcare setting. 3,4 In this issue, Maepe and Outhoff highlight an example of this pitfall, in a retrospective, descriptive one-year hypertension prevalence study, conducted at Gauteng Harmony Mine Operations. 5 Of 4 297 subjects, representing 100% of the mining population in the study period, 4 286 (99%) were black, and 90% were male, with a mean age of 44 years. Results showed that 39.5% of subjects had hypertension, only 42% of whom received antihypertensive pharmacological treatment. An adequate target BP of <140/90 mmHg was achieved in 31% of treated subjects (13% of the total hypertensive population). The authors concluded that hypertension remains an important health challenge for the mining industry in South Africa; the detection, treatment and adequate control of this condition should receive high priority from mining authorities. The article portrays just one example of the reality of hypertension control in the country. By 2020, the global burden of fatal and non-fatal CVD is anticipated to grow in importance in both relative and absolute terms. It is estimated that there will be 68 million deaths worldwide, of which approximately 25 million will be attributed to cardiovascular causes. Globally, ischaemic heart disease and stroke are anticipated to remain the first and second leading causes of death, respectively. CVD will remain a major cause of DALYs – a measure of the total burden of disease caused by a combination of premature death and non-fatal events. Developing countries will face a far greater challenge of CVD burden in the 21st century: it has been estimated that there were already twice as many deaths and more than 3 times as many DALYs attributable to CVD in developing countries in 1990 (9.1 million deaths, and 101 million DALYs); compared with 5.2 million deaths and 33 million DALYs in developed countries in the same year. The difference in disease burden between developing and developed countries is …