Every year, on the 17th of May the global health community celebrates World Hypertension Day. The aim of the day is to promote public awareness of hypertension, encourage prevention, and control efforts. However, this year’s commemorations will be a low-key affair owing to the global COVID-19 pandemic. Despite the shift in attention towards the virus, we shouldn’t lose sight of the fact that hypertension is the world’s leading cause of death and a leading risk factor causing premature death and disability-adjusted life years in the world. Globally, it is estimated that more than a billion people have uncontrolled hypertension (UHTN) and the highest burden (46%) of hypertension is in sub-Saharan Africa (SSA). Uncontrolled hypertension is an established risk factor for life-threatening cardiovascular complications such as stroke and heart disease. Taking antihypertensive treatment substantially reduces the risk of morbidity and mortality related to uncontrolled hypertension.
Hypertension care is a challenge in SSA because of the continued prioritization of communicable diseases which also contribute significantly to the disease burden in SSA. In addition, healthcare systems across the region have an acute shortage of health workers, unreliable medical supply systems, wide variance in quality and safety among other factors, making hypertension care sub-standard. The diversion of health- related efforts in Africa towards the COVID-19 outbreak, only exacerbates these challenges. Health facilities have been tested in ways they did not anticipate and challenges will continue to confront the health system and health workers in the days ahead. The growing number of cases threatens the capacity to provide adequate and quality standards of care for patients with other medical conditions. The COVID-19 impact on hypertension care is already being felt in Kenya as non-communicable disease (NCD) clinics have been closed since the beginning of the COVID-19 outbreak. These clinics provide care to people with hypertension, diabetes among other NCDs. Thus their closure threatens to curtail the gains made in the fight against NCDs and makes it difficult for patients to access treatment, and attend routine check-ups, where issues of urgent attention can be detected and managed early enough thereby reducing avoidable morbidity and mortality.
Current data on characteristics and early outcomes of COVID-19 shows that the virus induces more severe complications in people with pre-existing conditions such as hypertension, diabetes, heart disease. and the elderly population who are more likely to have these conditions.
In these unprecedented times where most people are now confined in homes, it is important now more than ever for people with hypertension to maintain a healthy lifestyle that can reduce stress levels and more importantly continue taking their prescribed medications.
As most SSA countries head into the third month of partial lockdown and curfews, the poor need to make tougher decisions on basic expenses, as revenue- generating activities decline and incomes fall. The economic ramifications of the pandemic put the poor under increased financial stress, which has knock-on implications on their healthcare spending. Major sources of income for the poor are threatened by the measures already put in place. For these reasons, economic safety nets such as cash transfers, and subsidized health insurance need to be put in place to support the poor and vulnerable populations. The high disease burden and life-threatening consequences of missed and delayed screening and management of hypertension make it an essential service to continue providing during this period.
Other actions that can be taken by different stakeholders include:
- Establishment of guidelines on the management of hypertensive patients during COVID-19. These should provide the alternative modes of hospital and community-based care such as mobile phone consultations/mobile clinics/telemedicine for hypertensive patients, screening/routine follow-up options for patients with and at risk of hypertension and clear means of accessing emergency care at any time considering lockdowns and curfews put in place.
- Mechanisms should be put in place to ensure accessibility and uninterrupted provision of antihypertensive medication and supplies, especially to poor and vulnerable patients. This includes: strengthening supply chains and allowing pharmacists to extend ordinary prescriptions. The result will be limited acute exacerbations, reduced need for patient-provider interactions, and minimized visits to the emergency room.
- Ongoing health education and awareness about the prevention and management of hypertension. This can be done through community-based and other non-governmental organizations currently delivering social care services to vulnerable populations, or via mobile messages through collaboration between mobile service and healthcare providers.
Despite having weak health systems, strategic coordination and management to maintain the provision of essential services such as hypertension will go a long way in reducing avoidable morbidity and mortality during the response and recovery phases of the pandemic.