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Background: A comprehensive ecosystem for hypertension care is needed, particularly in Sub-Saharan Africa (SSA), to address disproportionately increasing hypertension prevalence and poor blood pressure (BP) control. Therefore, this explanatory review was conducted to present the ecosystem for providing hypertension care in resource-limited settings from a sub-Saharan African perspective. Methods: We searched articles written in the English language from January 2000 to January 2020 from the following databases: PubMed, Embase, Scopus, Web of Science, and Google Scholar with a systematic search query. Results: We identified 3,451 articles, abstracted 143 articles, read full text 101 articles, and included 97 articles in the final Review. Hypertension control in SSA is poor due to the interaction of a complex network of factors involving patients (lack of awareness, poor treatment adherence), the healthcare system (lack of early screening, lack of access to medicines, under treatment, poor research involvement), community (inequities), environment (air pollution), economy (poverty), poor political commitment, lack of strong policies and leadership support, and weak networking and collaboration. The Healthcare system in SSA needs strengthening concerning; health promotion and hypertension prevention, scale-up of cost-effective screening approaches, aggressive treatment of hypertension, and researching country-specific approaches for managing hypertension. Conclusion: Hypertension control in SSA needs a comprehensive ecosystem view involving all relevant stakeholders. Therefore, improving health promotion and disease prevention activities to improve patient and public awareness of hypertension prevention and control; restructuring hypertension care approach to environmentally appropriate and cost-efficient methods; introducing cost-effective FDC medications in the national drug lists to improve treatment adherence; designing strategies to address SDH health and reducing health inequities, strengthening implementation of HiAP with due consideration to determinants of hypertension control, and improving collaboration and networking of existing cardiovascular societies, an international society of hypertension and world hypertension league, and other funding agencies are critical success factors for improving hypertension control in SSA. |
