HYPERTENSION IN AFRICA AND EFFECTIVENESS OF ITS MANAGEMENT WITH VARIOUS CLASSES OF ANTIHYPERTENSIVE DRUGS AND IN DIFFERENT SOCIOECONOMIC AND CULTURAL ENVIRONMENTS

Hypertension is the commonest cardiovascular disease in Africans occur ring in more than 15% of the adult population in some studies. It occu rs in the lower as much as in the higher socio-economic groups. Recent studies have confirmed earlier findings that essential hypertension i n Africans is characterised by volume loading, low plasma renin activi ty, high salt taste threshold, high urinary sodium and low potassium e xcretion and high plasma aldosterone. The commonest complication of hy pertension in Africans is congestive cardiac failure followed by cereb rovascular accidents. Coronary heart disease is rare. Even in the abse nce of overt heart failure and compounding factors like obesity, alcoh olism, cigarette smoking, diabetes mellitus and myocarditis, evidence of abnormal left ventricular morphology and function is often present in newly diagnosed patients with moderate or severe hypertension. Resp onse to monotherapy with beta-blockers or ACE inhibitors is usually po or but is good with thiazide diuretics or calcium channel blockers. Th e diuretics are an essential component of a two or three drug regime c ontaining other classes of antihypertensive drugs. Cost of drugs is th e most important determinant of compliance with drug treatment and con sequently the likelihood of progression of the diseases to more severe forms in long term follow-up.