Hypertension and its management in countries in Africa and the Middle East, with special reference to the place of β-blockade

Abstract

Background:

The prevalence and clinical consequences of hypertension in countries in Africa and the Middle East have not been studied as well as in other regions.

Scope:

We have reviewed the literature on the epidemiology and management of hypertension and related cardiovascular complications in countries within Africa and the Middle East. A PubMed search for countries in the region and ‘hypertension’ was supplemented by articles identified from reviews, and by literature suggested by the authors.

Findings:

The prevalence of hypertension is >20% in some countries in the Middle East and Africa, despite an average population age that is some 10–15 years lower than those of developed countries. Hypertension in these countries is associated with an increased risk of cardiovascular risk factors and cardiovascular disease, as elsewhere. Awareness rates of hypertension are low. Hypertension and its complications are undertreated, and mortality rates from cardiovascular disease are higher than in developed countries.

Conclusion:

Available resources should be brought to bear on the management of hypertension in these countries. In particular, a recent downgrading of the importance of β-blockers in hypertension management guidelines needs to be reassessed. These agents are as effective as other antihypertensive classes both on blood pressures and on cardiovascular event rates. General concerns over an increased rate of new-onset diabetes with β-blockers have been overstated, although these agents should be avoided in metabolic syndrome.

Key words::

• β-blockers
• Cardiovascular disease
• Diabetes mellitus
• Hypertension
• Metabolic syndrome

Transparency

Declaration of funding

The meeting on which this article was based was funded by an unrestricted educational grant from Merck Serono SA, Geneva, an affiliate of Merck KGaA, Darmstadt, Germany.

Declaration of financial/other relationships

Authors received an honorarium for attending this meeting, but not for contributing to this article. Merck Serono has had no role in the collection and interpretation of data, nor in the writing of this article. Merck Serono has performed a scientific review of the publication, but the views and opinions described in the publication do not necessarily reflect those of Merck Serono.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgements

Dr Mike Gwilt of GT Communications helped to draft the manuscript under the guidance of the authors. All co-authors contributed to the development of this manuscript.