Recent advances in understanding hypertension development in sub-Saharan Africa.
Consistent reports indicate that hypertension is a particularly common finding in black populations. Hypertension occurs at younger ages and is often more severe in terms of blood pressure levels and organ damage than in whites, resulting in a higher incidence of cardiovascular disease and mortality. This review provides an outline of recent advances in the pathophysiological understanding of blood pressure elevation and the consequences thereof in black populations in Africa. This is set against the backdrop of populations undergoing demanding and rapid demographic transition, where infection with the human immunodeficiency virus predominates, and where under and over-nutrition coexist. Collectively, recent findings from Africa illustrate an increased lifetime risk to hypertension from foetal life onwards. From young ages black populations display early endothelial dysfunction, increased vascular tone and reactivity, microvascular structural adaptions as well as increased aortic stiffness resulting in elevated central and brachial blood pressures during the day and night, when compared to whites. Together with knowledge on the contributions of sympathetic activation and abnormal renal sodium handling, these pathophysiological adaptations result in subclinical and clinical organ damage at younger ages. This overall enhanced understanding on the determinants of blood pressure elevation in blacks encourages (a) novel approaches to assess and manage hypertension in Africa better, (b) further scientific discovery to develop more effective prevention and treatment strategies and
Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.|South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.
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Schutte
Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
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0000-0001-5099-3408
S
Botha
Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
C M T
CMT
Fourie
Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
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LF
Gafane-Matemane
Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
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0000-0001-7680-2032
R
Kruger
Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
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L
Lammertyn
Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
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0000-0003-3187-2410
L
Malan
Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
C M C
CMC
Mels
Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.|South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.|Department of Medicine and Healthcare Science, Anglia Ruskin University, Chelmsford, UK.
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R
Schutte
Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
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W
Smith
Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
J M
JM
van Rooyen
Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
L J
LJ
Ware
Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.|South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.
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Huisman
D017954:Africa South of the Sahara / Q000453:epidemiology; D017668:Age of Onset; D000959:Antihypertensive Agents / Q000627:therapeutic use; D044383:Black People; D001794:Blood Pressure / Q000187:drug effects; D015897:Comorbidity; D015438:Health Behavior / Q000208:ethnology; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000208:ethnology* / Q000503:physiopathology; D008019:Life Style / Q000208:ethnology; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index
D000959:Antihypertensive Agents