11 Aug 2026: The International Society of Hypertension (ISH) Africa Regional Advisory Group (RAG) and the Pan-African Society of Cardiology (PASCAR) have developed the first pan-African clinical guidelines for the management of hypertension - a major step towards addressing one of the continent’s fastest-growing health challenges.
The new guidelines, published in the Journal of Hypertension, were developed by experts in Africa for real-world African healthcare settings, providing practical, evidence-based recommendations tailored to local healthcare systems and communities.
They propose a shift towards simpler, community-based hypertension care across the life course, providing simplified treatment thresholds, protocols and referral pathways for use in primary care. The guidelines focus on supporting frontline non- doctor healthcare workers including nurses, community health workers, clinical officers, physician assistants and pharmacists.
Hypertension is a major and growing problem in Africa, with cardiovascular disease rising by more than 50% over the past 30 years. High blood pressure is a leading driver of heart failure, stroke, kidney disease and death.
Most patients remain undiagnosed or uncontrolled. Among diagnosed adults, only 8- 15% have controlled blood pressure. Following progress in infectious diseases, non- communicable diseases are now the leading cause of death in Africa, with hypertension the leading driver of these conditions.
Most African countries do not have national hypertension guidelines, while many international recommendations do not fit the realities of healthcare delivery across the continent.
The recommendations emphasise early detection and intervention, including diet and lifestyle changes, followed by pharmacological treatment where needed. They call for opportunistic blood pressure screening among both adults and children, particularly in schools, clinics, workplaces, markets, pharmacies and places of worship.
Importantly, the guidelines highlight the need to tackle hypertension in children and adolescents – an area often overlooked in global hypertension guidance.
The development of the guideline was led by Alfred Doku, Chair of the ISH Africa Regional Advisory Group (RAG), who is based at the University of Ghana Medical School. He said: “These recommendations were specifically designed around the realities of healthcare delivery in Africa, where shortages of physicians and specialists mean hypertension care is often delivered in primary care settings by non-physician healthcare workers. The guidelines provide practical approaches that can realistically be implemented in resource-limited settings across the continent.”
The authors of the guidelines call for:
The guideline includes recommendations for both paediatric and adult populations, including screening for children aged five years and above in schools, clinics and community programmes, reflecting evidence that hypertension is increasingly affecting younger people.
Ruan Kruger, member of the ISH Africa RAG and expert in paediatric hypertension, based at North-West University in Potchefstroom, South Africa, said: “Hypertension in children and young people remains under-recognised and under-diagnosed in Africa. Elevated blood pressure and cardiovascular risk begin early in life, which means prevention and early detection must also start in childhood. These guidelines recognise that reality and provide an opportunity to protect long-term cardiovascular health among children and young people before irreversible damage occurs.”
The recommendations incorporate African-specific considerations, including high salt consumption, salt sensitivity, low affordability of medicines, and cultural beliefs surrounding hypertension treatment. The paper addresses widespread misconceptions – such as beliefs that blood pressure medication can be stopped once readings improve, or that herbal remedies or traditional healers can cure hypertension.
The guidelines build on work by the Africa RAG which previously set up and ran the African School of Hypertension for Non-Physician Health Workers, which offered training on diagnosing hypertension, starting patients on drugs and referring patients to specialist physicians when needed. It was through the School that the ISH Africa RAG identified the need for hypertension guidelines for Africa.
The aim of the course is to enable non-physician workers including nurses, pharmacists and community health workers to carry out some of the roles that traditionally only physicians have done.
ISH President George Stergiou said: “These guidelines represent an important milestone for cardiovascular health in Africa. The aim is to empower and support governments, healthcare systems and communities to improve detection, treatment and long-term control of hypertension, helping reduce the growing burden of cardiovascular disease across the continent. An important element is the involvement of non-doctor healthcare professionals in the front line of hypertension care, which is a necessity not only for Africa but for all the healthcare systems in the world.”
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