review · BMC Cardiovascular Disorders
A scoping review evaluating sixty-eight articles published between 2000 and 2020 examined the drivers of poor blood pressure control in Eastern Sub-Saharan Africa across four areas: patients, professionals, primary healthcare systems, and public health policy. Across the examined literature, the mean prevalence of hypertension was 20.95 percent, while blood pressure control stood at just 11.5 percent and patient adherence to prescribed medicines was 60 percent. Only three out of ten countries, specifically Kenya, Malawi, and Zambia, had instituted annual hypertension screening programmes for high-risk groups. Key drivers of poor control and nonadherence included limited patient awareness, restricted access to drugs and healthcare services, clinical inertia regarding treatment intensification, lack of guideline knowledge, and weak government commitment. Broader socioeconomic factors, notably poverty and maternal and child malnutrition, further undermined effective blood pressure management.
Hypertension control in Sub-Saharan Africa is among the poorest globally, with fewer than one in ten affected individuals properly managed. Identifying the exact bottlenecks across primary care, clinical practice, and public policy helps health authorities direct resources where they are needed most. Addressing systemic gaps in screening, medicine accessibility, and clinical guideline awareness is critical to reducing preventable cardiovascular disability and death.
The findings point to unmet needs in healthcare delivery rather than tested commercial products. The evidence could guide developers and health systems in creating low-cost diagnostic screening tools, robust adherence monitoring systems, and clinician training programmes. Intended users would include primary care providers, health ministries, and non-governmental organisations, though any translation remains at an early concept stage based on the systemic gaps outlined in the review.
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AIM: Hypertension control in Sub-Saharan Africa (SSA) is the worst (less than one out of ten) when compared to the rest of the world. Therefore, this scoping review was conducted to identify and describe the possible reasons for poor blood pressure (BP) control based on 4Ps' (patient, professional, primary healthcare system, and public health policy) factors. METHODS: PRISMA extension for scoping review protocol was used. We systematically searched articles written in the English language from January 2000 to May 2020 from the following databases: PubMed/Medline, Embase, Scopus, Web of Science, and Google scholar. RESULTS: Sixty-eight articles were included in this scoping review. The mean prevalence of hypertension, BP control, and patient adherence to prescribed medicines were 20.95%, 11.5%, and 60%, respectively. Only Kenya, Malawi, and Zambia out of ten countries started annual screening of the high-risk population for hypertension. Reasons for nonadherence to prescribed medicines were lack of awareness, lack of access to medicines and health services, professional inertia to intensify drugs, lack of knowledge on evidence-based guidelines, insufficient government commitment, and specific health behaviors related laws. Lack of screening for high-risk patients, non-treatment adherence, weak political commitment, poverty, maternal and child malnutrition were reasons for the worst BP control. CONCLUSION: In conclusion, the rate of BP treatment, control, and medication adherence was low in Eastern SSA. Screening for high-risk populations was inadequate. Therefore, it is crucial to improve government commitment, patient awareness, and access to medicines, design country-specific annual screening programs, and empower clinicians to follow individualized treatment and conduct medication adherence research using more robust tools.
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DOI: 10.1186/s12872-021-01934-6
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