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Recent advances in understanding hypertension development in sub-Saharan Africa

Abstract

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 (c) policymakers and health advocates to collectively contribute in creating health-promoting environments in Africa.

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Acknowledgements

The authors of this paper, constituting the Hypertension in Africa Research Team, hereby thank the immense contributions of research support staff towards the data collection, as well as input from collaborators within several challenging research projects performed in South Africa. Also, the participation of many volunteers in our studies is hereby duly acknowledged. This work was supported by the South African Medical Research Council, National Department of Science and Technology and National Research Foundation (NRF). Any opinion, findings, and conclusions or recommendations expressed in this material are those of the authors, and therefore, the NRF does not accept any liability in this regard.

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Schutte, A., Botha, S., Fourie, C. et al. Recent advances in understanding hypertension development in sub-Saharan Africa. J Hum Hypertens 31, 491–500 (2017). https://doi.org/10.1038/jhh.2017.18

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