Hypertension in South Africa : a growing epidemic and evolving treatment paradigms

Abstract

BACKGROUND : Hypertension is a major public health concern in South Africa, affecting 40–50% of adults, with control rates below 50% despite available treatments. It is a key driver of cardiovascular morbidity and mortality, particularly in populations with limited healthcare access, poor medication adherence, and high rates of comorbidities such as diabetes and obesity. This review examines the epidemiology, pathophysiology, diagnosis, treatment strategies, and public health approaches to hypertension in South Africa, highlighting gaps in care and opportunities for intervention. RESULTS : Pharmacological interventions such as fixed-dose combinations (FDCs) improve adherence but remain underutilised in public healthcare due to cost constraints. Community-based screening programmes (e.g. HealthRise South Africa) have successfully identified high-risk individuals, yet less than 30% of screened patients attend follow-ups due to referral challenges. Primary healthcare (PHC) infrastructure is overburdened, with workforce shortages, inconsistent medication availability, and weak referral systems limiting hypertension management. Public health policies targeting salt and sugar reduction have been implemented, but enforcement remains weak, and public awareness is insufficient. CONCLUSION AND POLICY IMPLICATIONS : Addressing hypertension in South Africa requires a multi-pronged strategy focusing on: 1. Expanding access to cost-effective FDCs in public clinics to improve adherence and BP control. 2. Strengthening PHC capacity through workforce training, task-shifting, and improved referral pathways. 3. Scaling up community-based screening and linkage-to-care programmes for early detection. 4. Enhancing enforcement of dietary policies and launching nationwide awareness campaigns on lifestyle modifications. 5. Implementing national BP monitoring registries to track trends and guide policy adjustments. A patient-centred, equity-driven approach that integrates pharmacological advances with robust public health interventions is critical to reversing the current trends of uncontrolled hypertension in South Africa.