The recent launch of the first comprehensive hypertension guidelines developed specifically for Africa marks an important step in addressing one of the continent’s most significant health challenges. Among the experts who contributed to the guidelines is Prof. Ruan Kruger, a researcher in paediatric hypertension and member of North-West University’s (NWU’s) Hypertension in Africa Research Team (HART).
The International Society of Hypertension Africa Regional Advisory Group and the Pan African Society of Cardiology developed the guidelines, which were recently published in the Journal of Hypertension.
Prof. Kruger says the guidelines provide practical, evidence-based recommendations tailored to the realities of African healthcare systems to strengthen primary healthcare, expand community-based screening and support non-physician healthcare workers in providing hypertension care.
He explains that the guidelines call for stronger primary healthcare systems, expanded community-based screening programmes, better access to affordable treatment and increased training for nurses, community health workers and other non-physician healthcare professionals. It also promotes the integration of hypertension care into broader chronic disease services.
Screening from age five
“Importantly, the recommendations cover both adults and children, with blood pressure screening advised for children from the age of five in schools, clinics and community programmes. This reflects growing evidence that hypertension and cardiovascular risk are becoming increasingly common among youth populations.”
Hypertension remains one of Africa’s fastest-growing health concerns and a leading contributor to stroke, heart failure, kidney disease and premature death. The challenge is that elevated blood pressure is still often viewed as a condition that affects only adults.
“We increasingly know that elevated blood pressure and the underlying cardiovascular risk begin much earlier in life,” says Prof. Kruger, whose own research focuses on children, adolescents and young adults.
His contribution to the guidelines focused on ensuring that they adopt a life-course approach to cardiovascular health, recognising that prevention and early intervention should begin during childhood and adolescence rather than only in adulthood. “My particular contribution was to help ensure that hypertension in children and adolescents forms part of the continental approach.”
Early detection and prevention
The guidelines represent an important shift in thinking on the continent, Prof. Kruger says.
“The current narrative must move from treating disease after it has already developed to prioritising early detection and prevention,” he says. “We need to begin viewing a child’s blood pressure as an important vital sign.”
A key feature of the guidelines is that blood pressure screening is recommended from the age of five in schools, clinics and community programmes.
Prof. Kruger argues that identifying cardiovascular risk earlier in life creates opportunities to intervene before long-term damage occurs and could help reduce the future burden of cardiovascular disease across the continent.
The guidelines also recognise the realities of healthcare delivery in Africa, where access to doctors and specialists is often limited. They therefore place significant emphasis on the role of nurses, community health workers and other non-physician healthcare professionals in delivering care and identifying at-risk patients.
Research that has continental impact
At the NWU, HART has built a strong international profile through its research on hypertension and cardiovascular health. One of the team’s strengths is its focus on understanding how cardiovascular risk develops throughout the life course rather than only studying disease after it occurs.
Through collaborations with researchers, clinicians and organisations across South Africa, Africa and internationally, HART seeks to translate research into improved prevention, earlier detection and better clinical practice.
Prof. Kruger says the new guidelines demonstrate how research conducted in South Africa can contribute to international science and influence clinical practice across Africa.
“The fact that children and adolescents now form an explicit part of a continental hypertension guideline for Africa sends a very important message,” he says. “We cannot afford to wait until cardiovascular risk becomes evident in adulthood before taking action.”
For him, the guidelines are not only a framework for clinical care but also an opportunity to improve prevention and strengthen cardiovascular health outcomes for future generations across Africa.
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Prof. Ruan Kruger
