Rationale for the hypertension guidelines for primary care in South Africa.
New South African guidelines are proposed by the Hypertension Society of Southern Africa for the management of hypertension by primary health care services in South Africa. Specific South African guidelines are appropriate for hypertension, which is now recognised as one of the five major diseases that must be given priority by the new Government. Furthermore, patient participation and empowerment in blood pressure (BP) control become feasible through the new concept of lifestyle modification. This article gives the rationale underpinning these guidelines. The correct methods to measure blood pressure (BP), with patients sitting for 5 minutes, correct cuff-size and repeated readings, are emphasised to eliminate the 'white coat' effect and ensure accurate BP readings. The rationale for the overall management of all atherosclerosis-related risk factors is given, as are the principles of non-drug hypertension treatment and patient education. We emphasise that patients must understand hypertension to be a risk factor and not a disease. Patients should also be empowered to contribute to effective BP control. The justification for the chosen BP levels at which specific action is required by the primary health care team is given. The BP levels span the range from mild hypertension, requiring conservative treatment schedules, to possible malignant hypertension, which requires urgent management and referral to the appropriate level of care. The motivation for cost-effective antihypertensive drug therapy is provided. The recommended initiation of drug therapy is with effective, safe low-cost drugs. Suggested first-line therapy comprises lifestyle management and low-dose diuretics. The second-line drugs, in order of increasing price, are low-dose reserpine, or a beta-blocker, or a calcium blocker, or an ACE inhibitor. For third-line therapy hydralazine is chosen, or other second-line drugs could be added. Where possible, the examples of specific drugs given are those for which a generic is available, to ensure cost-containment. The motivation for drug choices for hypertension in special cases such as pregnancy, the elderly, blacks and patients with diabetes and renal disease is given. The management of malignant hypertension receives special attention.
Opie
L H
LH
Heart Research Unit, University of Cape Town.
Steyn
K
K
D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use; D001795:Blood Pressure Determination; D002318:Cardiovascular Diseases / Q000150:complications; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006974:Hypertension, Malignant / Q000188:drug therapy; D008019:Life Style; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D012307:Risk Factors; D013019:South Africa
D000959:Antihypertensive Agents