The recent launch of the first comprehensive hypertension guidelines developed specifically for Africa marks an important step in addressing one of the continent’s most significant health challenges, according to the authors of the document, published in the Journal of Hypertension.
One of the experts who contributed was Professor Ruan Kruger, a researcher in paediatric hypertension and member of North-West University’s (NWU) Hypertension in Africa Research Team (HART).
The International Society of Hypertension Africa Regional Advisory Group and the Pan African Society of Cardiology developed the guidelines, which Kruger said provide practical, evidence-based recommendations tailored to the realities of African healthcare systems to strengthen primary healthcare, expand community-based screening and support non-physician healthcare workers in providing hypertension care.
The guidelines recommends better access to affordable treatment and increased training for nurses, community health workers and other non-physician healthcare professionals, and promotes the integration of hypertension care into broader chronic disease services.
Screening from age five
“Importantly, the recommendations cover both adults and children, with blood pressure screening advised for children from the age of five in schools, clinics and community programmes,” he added.
Hypertension remains one of Africa’s fastest-growing health concerns and a leading contributor to stroke, heart failure, kidney disease and premature death. The challenge is that elevated blood pressure is still often viewed as a condition affecting only adults.
“We increasingly know that elevated blood pressure and the underlying cardiovascular risk begin much earlier in life,” noted Kruger, whose own research focuses on children, adolescents and young adults.
His contribution to the guidelines focused on ensuring they adopt a life-course approach to cardiovascular health, recognising that prevention and early intervention should begin earlier, rather than only in adulthood.
Early detection and prevention
The guidelines represent an important shift in thinking on the continent, he said.
“The current narrative must move from treating disease after it has already developed to prioritising early detection and prevention. We need to begin viewing a child’s blood pressure as an important vital sign.”
A key feature of the guidelines is that blood pressure screening is recommended from the age of five in schools, clinics and community programmes, while also recognised is the realities of healthcare delivery in Africa, where access to doctors and specialists is often limited.
Research has continental impact
At the NWU, HART has built a strong international profile through its research on hypertension and cardiovascular health. One of the team’s strengths is its focus on understanding how cardiovascular risk develops throughout the life course rather than only studying disease after it occurs.
Through collaborations with researchers, clinicians and organisations across South Africa, Africa and internationally, HART seeks to translate research into improved prevention, earlier detection and better clinical practice.
Kruger said the new guidelines demonstrate how research conducted in South Africa can contribute to international science and influence clinical practice across Africa.
“The fact that children and adolescents now form an explicit part of a continental hypertension guideline for Africa sends a very important message,” he added. “We cannot afford to wait until cardiovascular risk becomes evident in adulthood before taking action.”
Guidelines
2026 ISH guidelines for the management of hypertension in Africa: the International Society of Hypertension (ISH) African Regional Advisory Group and the Pan African Society of Cardiology (PASCAR)
Alfred Dokua, Ruan Krugerc, Kofi Asamoahe et al.
Published in the Journal of Hypertension October 2026
Abstract
Hypertension in sub-Saharan Africa is escalating, with many cases undiagnosed and poorly controlled, even among children, despite its significant contribution to cardiovascular disease. Poor blood pressure control is largely due to limited national guidelines, underfunded programs, and a shortage of trained health professionals. Simplified protocols for non-physician health workers, who deliver most of the primary care, are essential. Cultural myths and misconceptions further delay care, underscoring the need for community-based education. Early and opportunistic screening, including in schools, markets, and places of worship, is vital across the life course. Sustainable progress depends on tailored strategies, investment in equipment and training, and leveraging existing infrastructure to improve hypertension detection and management. Africa-centred hypertension guidelines are now a priority because international models fail to address the continent's unique clinical, cultural and resource realities. The African Regional Advisory Group of the International Society of Hypertension worked with the Pan African Society of Cardiology to develop simplified protocols for primary care, particularly for non-physician health care workers, by considering the special situation and condition for managing the vast majority of cases within hypertension in Africa.
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