Priorities to reduce the burden of hypertension in Africa through ACHIEVE
Authors: Paul Olowoyo, Prebo Barango, Andrew Moran, Bryan Williams, Paul K Whelton, Mayowa Owolabi, Paul Olowoyo, Prebo Barango, Andrew Moran, Anastase Dzudie, Akinkunmi Paul Okekunle, Reginald Obiako, Ana Mocumbi, Hind Beheiry, Gianfranco Parati, Daniel T. Lackland, Fred S. Sarfo, Augustine Odili, Charles Agyemang, Norman Campbell, Andre Pascal Kengne, Pierpaolo Pellicori, Ad Adams Ebenezer, Oladimeji Adebayo, Oladotun Olalusi, Ezinne Uvere, Tomasz J. Guzik, Collins Kokuro, Fred Bukachi, Kufor Osi, Okechukwu S. Ogah, Christian Delles, Pasquale Maffia, Rufus Akinyemi, Dike Ojji, Bryan Williams, Paul K. Whelton, Mayowa Owolabi
Journal: The Lancet Global Health (2024)

Hypertension is a leading cause of premature deaths in Africa.1Yuyun MF Sliwa K Kengne AP Mocumbi AO Bukhman G Cardiovascular diseases in sub-Saharan Africa compared to high-income countries: an epidemiological perspective.Glob Heart. 2020; 15: 15Crossref PubMed Google Scholar Its prevalence of up to 54% in adults in Africa2Sharma JR Mabhida SE Myers B et al.Prevalence of hypertension and its associated risk factors in a rural black population of Mthatha town, South Africa.Int J Environ Res Public Health. 2021; 18: 1215Crossref Scopus (17) Google Scholar, 3Akpa OM Made F Ojo A et al.Regional patterns and association between obesity and hypertension in Africa: evidence from the H3Africa CHAIR study.Hypertension. 2020; 75: 1167-1178Crossref PubMed Google Scholar is among the highest rates in the world.4WHO Hypertension. World Health Organization, March 16, 2023.https://www.who.int/news-room/fact-sheets/detail/hypertensionDate accessed: August 24, 2023Google Scholar More disturbingly, only 7% of individuals with hypertension have their blood pressure controlled, with 93% of individuals at high risk of complications, including stroke, myocardial infarction, heart failure, kidney disease, and blindness.5Parati G Lackland DT Campbell NRC et al.How to improve awareness, treatment, and control of hypertension in Africa, and how to reduce its consequences: a call to action from the World Hypertension League.Hypertension. 2022; 79: 1949-1961Crossref PubMed Scopus (0) Google Scholar In Africa, the estimated number of people with hypertension has consistently increased over the past three decades, and is projected to reach 216·8 million people by 2030.6Adeloye D Basquill C Estimating the prevalence and awareness rates of hypertension in Africa: a systematic analysis.PLoS One. 2014; 9: e104300Crossref PubMed Scopus (164) Google Scholar In response to this rapidly increasing burden of hypertension and its complications, the Accelerating African Control of Hypertension through Innovative Epidemiology and a Vibrant Ecosystem (ACHIEVE)7Owolabi M Olowoyo P Mocumbi A et al.African Control of Hypertension through Innovative Epidemiology and a Vibrant Ecosystem (ACHIEVE): novel strategies for accelerating hypertension control in Africa..J Hum Hypertens. 2023; (published online April 19. https://doi.org/10.1038/s41371-023-00828-8)Google Scholar conference was convened to develop implementation pathways for achieving the World Hypertension League's targets of ensuring that 80% of Africans with hypertension are diagnosed, 80% of individuals diagnosed with hypertension are treated, and 80% of treated individuals have controlled blood pressure by 2030.8Parati G Lackland DT Campbell NRC et al.How to improve awareness, treatment, and control of hypertension in africa, and how to reduce its consequences: a call to action from the World Hypertension League.Hypertension. 2022; 79: 1949-1961Crossref PubMed Scopus (0) Google Scholar Controlling the blood pressure of 80% of people with hypertension receiving treatment (ie, 51% of all people with hypertension) requires at least a 7-fold improvement from the current rate of 7% of all people with hypertension. Accomplishing this ambitious target mandates the active and synergistic participation of all stakeholders, including patients, policymakers, health-care providers, payers or health insurance organisations, and the general population.7Owolabi M Olowoyo P Mocumbi A et al.African Control of Hypertension through Innovative Epidemiology and a Vibrant Ecosystem (ACHIEVE): novel strategies for accelerating hypertension control in Africa..J Hum Hypertens. 2023; (published online April 19. https://doi.org/10.1038/s41371-023-00828-8)Google Scholar Therefore, the experts in implementation science and hypertension control from eight African countries (Cameroon, Egypt, Ghana, Kenya, Mozambique, Nigeria, Rwanda, and Sudan), policymakers (including from ministries of health and WHO), patients, clinicians, and representatives from various hypertension-related societies (appendix p 3) who attended the ACHIEVE conference generated a 12-item communique with the Delphi technique (panel).9Niederberger M Köberich S Coming to consensus: the Delphi technique.Eur J Cardiovasc Nurs. 2021; 20: 692-695Crossref PubMed Scopus (0) Google Scholar The communique was endorsed for advocacy in the African Union by the Minister of Health of Ghana.PanelThe 12 co-created priorities for accelerating the detection, treatment, and control of hypertension in Africa1Screening for and management of hypertension should be supported and mandatory at every clinical encounter, irrespective of the reason for the encounter2Policies and protocols on regulated task-shifting and task-sharing, including decentralisation to primary health-care and community services, should be developed3Access to genuine essential medicines for the treatment of hypertension should be improved through the encouragement of local manufacturing in Africa under the control of relevant regulatory agencies to ensure ready availability and affordability4Policies and legislations should be developed and implemented against the production, sale, and consumption of unhealthy diets to reduce the dietary intake of sodium, sugars, and saturated fats in accordance with the required minimum for body metabolisms by placing higher taxation on their consumption, using appropriate content labelling, and improving the use of salt substitutes5African governments should institute policies to promote physical activity by creating safe and enabling environments such as pedestrian walkways and recreational facilities6African governments should support the implementation and expansion of the ACHIEVE–WHO HEARTS technical package for hypertension control7African governments should incorporate screening for and treatment of hypertension into universal health coverage8African governments should encourage the integration of mobile health into hypertension control by providing the telecommunication industry with the necessary support and incentives9African countries should prioritise and promote public enlightenment and education on risk factors for hypertension, hypertension prevention, treatment, and medication adherence across the life course10African countries should leverage existing chronic care programmes (eg. HIV management models) to improve the prevention, detection, and treatment of hypertension11African governments, development partners, and academics should make deliberate efforts to invest in high-quality research on hypertension to produce reliable evidence to guide the implementation of strategies to control hypertension and other non-communicable diseases in Africa12The ACHIEVE ecosystem should establish a continental organogram, including a supreme committee comprising African Ministers of Health and the leaders of ACHIEVE; the main functions of the supreme committee will include: the presentation of a proposal for a resolution to control hypertension in Africa to the African Union, effective advocacy and engagement through active communication to integrate all African countries into the ACHIEVE ecosystem, the development of a Memorandum of Understanding to be signed by all African member countries for hypertension control, and the follow-up, monitoring, and evaluation of the fulfillment and progress of ACHIEVE goals in all African member countries 1Screening for and management of hypertension should be supported and mandatory at every clinical encounter, irrespective of the reason for the encounter2Policies and protocols on regulated task-shifting and task-sharing, including decentralisation to primary health-care and community services, should be developed3Access to genuine essential medicines for the treatment of hypertension should be improved through the encouragement of local manufacturing in Africa under the control of relevant regulatory agencies to ensure ready availability and affordability4Policies and legislations should be developed and implemented against the production, sale, and consumption of unhealthy diets to reduce the dietary intake of sodium, sugars, and saturated fats in accordance with the required minimum for body metabolisms by placing higher taxation on their consumption, using appropriate content labelling, and improving the use of salt substitutes5African governments should institute policies to promote physical activity by creating safe and enabling environments such as pedestrian walkways and recreational facilities6African governments should support the implementation and expansion of the ACHIEVE–WHO HEARTS technical package for hypertension control7African governments should incorporate screening for and treatment of hypertension into universal health coverage8African governments should encourage the integration of mobile health into hypertension control by providing the telecommunication industry with the necessary support and incentives9African countries should prioritise and promote public enlightenment and education on risk factors for hypertension, hypertension prevention, treatment, and medication adherence across the life course10African countries should leverage existing chronic care programmes (eg. HIV management models) to improve the prevention, detection, and treatment of hypertension11African governments, development partners, and academics should make deliberate efforts to invest in high-quality research on hypertension to produce reliable evidence to guide the implementation of strategies to control hypertension and other non-communicable diseases in Africa12The ACHIEVE ecosystem should establish a continental organogram, including a supreme committee comprising African Ministers of Health and the leaders of ACHIEVE; the main functions of the supreme committee will include: the presentation of a proposal for a resolution to control hypertension in Africa to the African Union, effective advocacy and engagement through active communication to integrate all African countries into the ACHIEVE ecosystem, the development of a Memorandum of Understanding to be signed by all African member countries for hypertension control, and the follow-up, monitoring, and evaluation of the fulfillment and progress of ACHIEVE goals in all African member countries These action items will be implemented by stakeholders of the ACHIEVE ecosystem10Bayaraa N Azahar NM Kitaoka K Kobayashi Y Yano Y African Control of Hypertension through Innovative Epidemiology and a Vibrant Ecosystem (ACHIEVE): a holistic approach for hypertension control in Africa..J Hum Hypertens. 2023; (published online June 29. https://doi.org/10.1038/s41371-023-00845-7)Crossref Scopus (2) Google Scholar at the continental, national, subnational, and local (or primary) health-care level through community-based care and service delivery models for long-term control of arterial hypertension. The community-based model will deliver the ACHIEVE–WHO HEARTS technical package7Owolabi M Olowoyo P Mocumbi A et al.African Control of Hypertension through Innovative Epidemiology and a Vibrant Ecosystem (ACHIEVE): novel strategies for accelerating hypertension control in Africa..J Hum Hypertens. 2023; (published online April 19. https://doi.org/10.1038/s41371-023-00828-8)Google Scholar to people with hypertension by involving primary health-care workers. Resources for implementation will be provided through partnerships and networking for cross-learning and capacity building, funding for material resources (such as automated blood pressure devices, laboratory equipment, and essential medicines), and adequate remuneration for sustainable policies and action plans. We declare no competing interests. Download .pdf (.3 MB) Help with pdf files Supplementary appendix