Hypertension, or high blood pressure, has emerged as a significant public health crisis in South Africa. It silently affects millions and places immense strain on the nation's healthcare system. With over 8.2 million individuals reported to be living with the condition, the prevalence rate is staggering. It is around 45% among men and 48% among women over the age of 15. The scale of the problem is undeniable. Disturbingly, a vast majority of those affected remain unaware of their condition or have poorly controlled blood pressure.
Undiagnosed and Untreated Hypertension
According to Shonisani Nephalama, nutrition lead at the Heart and Stroke Foundation South Africa, a mere 19% of men and 29% of women are aware of their hypertensive status. This lack of awareness contributes to a dire statistic: 91.1% of people with hypertension are either unscreened, undiagnosed, untreated, or have uncontrolled blood pressure. Consequently, only a tiny fraction – 8.9% – have their blood pressure adequately managed.
This widespread lack of control has severe and often irreversible consequences. Vascular surgeon Dr Vinesh Padayachy warns that untreated high blood pressure gradually damages the arterial system. This leads to complications that are both life-altering and, in many cases, permanent.
One particularly insidious outcome of uncontrolled hypertension is hypertensive nephropathy, a progressive form of kidney damage. Dr Padayachy highlights the alarming trend of seeing younger patients. Some in their thirties and forties present with end-stage renal disease directly linked to uncontrolled high blood pressure. Often, they require lifelong dialysis if a transplant is not an option. This underscores the critical need for early detection and consistent, long-term blood pressure management.
The term "silent killer" aptly describes hypertension. Patients can feel perfectly well for years while the elevated pressure silently damages vital organs and arteries. This absence of early warning signs often delays individuals from seeking medical attention. This is especially true in communities with limited access to routine screening and health education.
Systemic Barriers to Effective Management
Nephalama points to several systemic barriers hindering effective hypertension management and medication adherence in South Africa. These include limited access to healthcare facilities, under-dispensing prescriptions, and insufficient communication from healthcare professionals. Addressing these underlying issues, such as inadequate services and staff shortages, is crucial for improving patient outcomes.
The escalating burden of uncontrolled hypertension is also placing immense pressure on South Africa's already overstretched healthcare system. Dr Padayachy notes a significant increase in hospital admissions for strokes, heart attacks, and kidney failure. These conditions demand specialised, long-term care and rehabilitation. They severely strain emergency and surgical services.
Efforts and Persistent Challenges
South Africa has acknowledged the growing burden of hypertension and has implemented public health policies, awareness campaigns, and screening initiatives to combat the condition. A key guiding framework is the National Strategic Plan (NSP) for the Prevention and Control of Non-Communicable Diseases. It sets ambitious targets for 2027. These include 90% of adults knowing their blood pressure status, 60% of those with raised blood pressure receiving interventions, and 50% of treated individuals achieving controlled blood pressure.
However, experts like Professor Brian Rayner, Director of Research of the Division of Nephrology and Hypertension at Groote Schuur Hospital and the University of Cape Town, suggest limited progress. Professor Rayner, a former President of the Southern African Hypertension Society, highlights the "rule of halves." He explains that half of those affected are unaware, and half of those aware are untreated. Only half of those treated achieve control. This ultimately leads to only about 10% of people having their high blood pressure under control.
Promising Policies and Future Directions
Despite these challenges, South Africa has taken necessary preventative steps. They have introduced policies such as the salt reduction in processed foods in 2013, leading to widespread reformulation. Additionally, the implementation of a sugar tax on carbonated drinks in 2018 resulted in a nearly 30% drop in sugary drink purchases in urban areas. These are examples of interventions aimed at lowering population-level risk factors for hypertension and other non-communicable diseases.
Professor Rayner emphasises that effective hypertension management requires a multi-level approach. It starts with prevention. This includes raising awareness and promoting healthier lifestyles: reducing salt intake, avoiding fast food, and reducing sugar intake. Increasing physical activity and preventing obesity are also crucial. He highlights the promising role of digital health tools. Mobile health solutions, SMS reminders, and digital follow-ups ensure continuity of care, improve medication adherence, and encourage regular check-ups. Ultimately, these efforts improve the long-term outlook for millions of South Africans living with this silent, yet deadly, condition.