Hypertension occurs when blood pressure (BP) is 140/90mmHg or higher – and is a major risk factor for heart disease and strokes.
SA has a high prevalence of hypertension, but the extent of the problem varies depending on which source you look at. According to the South African Hypertension Society, one in four men and one in five women over age 25 have hypertension, while a study by Global Epidemiology puts this figure much higher, stating that 45% of men and 48% of women older than 15 years have the condition. The World Health Organization (WHO) estimates that raised blood pressure causes 7.5 million deaths annually around the world.
Hypertension does not usually cause symptoms and many people in SA are unaware that they have the condition. This silent killer can harm the artery walls and cause plaques to accumulate. These plaques can gradually restrict the arteries and lessen blood flow to the heart. In addition, hypertension can make the artery walls stiff and thick, which makes it harder for the heart to pump blood through the veins. While hypertension often leads to a stroke, it is also a leading risk factor in coronary and ischaemic heart disease and can cause heart attacks. The Heart and Stroke Foundation says that hypertension is the leading risk factor for stroke in South Africa, responsible for one in two (50%) strokes and two in five (42%) heart attacks.
The only way to diagnose hypertension is to check BP regularly. Being overweight or obese can increase BP. This goes together with eating a healthy diet that is rich in fruits, vegetables, whole grains, and low-fat dairy products and low in saturated and trans fats and engaging in regular physical activity. It is also important to limit alcohol consumption, as alcohol can also raise BP, and to quit smoking, because smoking can damage blood vessels and increase BP.
The recently published European Society of Hypertension (ESH) 2023 ESH Guidelines for the management of arterial hypertension is the latest in a long series of high BP clinical practice guidelines. It closely resembles the 2018 European Society of Cardiology/ESH guidelines, with some minor changes. Although the ESH guidelines are primarily written for European clinicians and public health workers, there is a high degree of concordance between its recommendations and those in the other major BP guidelines.
Some of the changes compared with the 2018 guideline include a greater emphasis on out-of-office BP measurements, addition of potassium supplementation as a lifestyle recommendation, more explicit advice for use of beta blockers as initial antihypertensive drug therapy, consideration of renal denervation as an additive or alternative to increasing medication in patients with uncontrolled resistant hypertension, a new simplified approach to antihypertensive drug treatment in patients with heart failure, a more detailed set of recommendations for management of patients with chronic kidney disease, including the use of sodium glucose cotransporter-2 (SGLT-2) inhibitors and the nonsteroidal mineralocorticoid antagonist finerenone, a recommendation for antihypertensive therapy to prevent cognitive decline and progression to dementia.
References available on request.