Hypertension, or high blood pressure, is a major public health concern in South Africa, with over 8.2 million people reported to be living with the condition.
According to the Heart and Stroke Foundation South Africa, hypertension affects around 45% of men and 48% of women over the age of 15. Despite its high prevalence, many people remain unaware of their condition.
Shonisani Nephalama, nutrition lead at the Heart and Stroke Foundation, says only about 19% of men and 29% of women are aware they’re hypertensive.
According to Nephalama, a staggering 91.1% of people with hypertension are either unscreened, undiagnosed, untreated, or have uncontrolled blood pressure. Only 8.9% have their blood pressure adequately controlled.
Leading cause of cardiovascular disease
Vascular surgeon Dr Vinesh Padayachy warns that untreated high blood pressure gradually damages the arterial system, impacting multiple organs over time.
“Hypertension is one of the leading contributors to cardiovascular disease. Its consequences are both life-altering and, in many cases, irreversible,” he says.
“In vascular surgery, we frequently treat patients with severe complications related to chronic hypertension, such as peripheral arterial disease, stroke, and aneurysms.”
One of the less visible, yet highly damaging, outcomes of uncontrolled hypertension is hypertensive nephropathy, a progressive form of kidney damage.
“As the kidneys deteriorate, patients may progress to end-stage renal disease, requiring lifelong dialysis if a transplant is not an option,” he adds.
Padayachy says vascular surgeons are seeing more young patients, some in their thirties and forties, presenting with kidney failure directly linked to uncontrolled hypertension. This highlights the urgent need for early detection and consistent long-term blood pressure management.
Padayachy describes hypertension as a “silent killer” because patients can feel perfectly well for years, all the while their elevated blood pressure is silently damaging arteries and vital organs.
“This lack of early warning signs often leads to delayed health-seeking behaviour, especially in communities with limited access to routine screening and health education.”
Systemic gaps
Nephalama from the Heart and Stroke Foundation says limited access to healthcare facilities, under-dispensing of prescriptions, and insufficient communication from healthcare professionals all contribute to poor treatment adherence.
“Addressing systemic barriers, such as inadequate services and staff shortages, is crucial for improving hypertension management and medication adherence,” she says.
According to Padayachy, the large number of people with untreated hypertension is contributing significantly to the escalating burden of NCDs, placing severe strain on the country’s already overstretched healthcare system.
“Hospitals are seeing increased admissions for strokes, heart attacks, and kidney failure, all conditions that require specialised, long-term care and rehabilitation,” he says. “It places immense pressure on emergency services and surgical disciplines, including vascular surgery.”
South Africa’s response to hypertension
South Africa has recognised the growing burden of hypertension and has taken steps to address the condition through public health policies, awareness campaigns, and screening initiatives.
One of the key frameworks guiding this effort is the National Strategic Plan (NSP) for the Prevention and Control of Non-Communicable Diseases (NSP), which sets out specific targets that by 2027:
- 90% of people aged 18 and older will know whether they have raised blood pressure;
- 60% of those with raised blood pressure will receive appropriate interventions;
- 50% of those receiving treatment will have controlled blood pressure.
However, experts say South Africa is struggling to meet these goals.
Professor Brian Rayner, Director of Research of the Division of Nephrology and Hypertension at the Groote Schuur Hospital and University of Cape Town, says progress has been limited.
“South Africa is good at developing sound and beneficial policies, but implementation remains poor,” he says.
Rayner, a former President of the Southern African Hypertension Society refers to the “rule of halves”, which highlights significant gaps in awareness, treatment, and control of hypertension.
“The rules of halves is where half of the people are unaware of their condition, half of those who are aware are not being treated, and half of those who are treated have uncontrolled blood pressure. And even among those who do get treated, only half manage to control it. In the end, only about 10% of people have their high blood pressure under control,” he says.
But South Africa has taken some important steps in this area.
“Policies such as salt reduction in processed foods to lower the risk of health problems like high blood pressure and the implementation of a sugar tax on carbonated drinks to reduce sugar consumption and combat obesity are examples of interventions aimed at lowering risk factors at a population level,” Rayner says.
The salt reduction policy in South Africa was introduced in 2013 to set maximum salt levels in a wide range of processed foods. Research shows that many food products were reformulated to meet the legal requirements.
The sugar tax was introduced in South Africa on 1 April 2018 to tackle the rising levels of obesity, type 2 diabetes and other NCDs linked to excessive sugar consumption. A 2021 study by Lancet revealed that purchases of sugary drinks dropped by nearly 30% in urban areas after the tax was introduced.
Levels of intervention
Rayner explains that addressing hypertension effectively requires action at multiple levels of intervention, beginning with prevention.
“Preventative measures should focus on raising awareness and encouraging healthier lifestyles, including reducing salt intake, avoiding fast food, cutting back on sugar, increasing physical activity, and preventing obesity,” he says.
He highlights the potential of digital health tools in supporting patient care.
“Integrating mobile health solutions, such as apps, SMS reminders, and digital follow-ups, can help ensure continuity of care, improve medication adherence, and prompt patients to attend regular check-ups.” – Health-e News
