Pulmonary hypertension in low- and middle-income countries with focus on sub-Saharan Africa

Anastase Dzudie; Bonaventure Suiru Dzekem; Dike B Ojji; Andre Pascal Kengne; Ana Olga Mocumbi; Karen Sliwa; Friedrich Thienemann

doi:10.21037/cdt.2019.07.06

Pulmonary hypertension in low- and middle-income countries with focus on sub-Saharan Africa

Cardiovasc Diagn Ther. 2020 Apr;10(2):316-324. doi: 10.21037/cdt.2019.07.06.

Authors

Anastase Dzudie^{1

2

3}, Bonaventure Suiru Dzekem³, Dike B Ojji⁴, Andre Pascal Kengne⁵, Ana Olga Mocumbi^{6

7}, Karen Sliwa⁸, Friedrich Thienemann^{8

9

10}

Affiliations

¹ Departments of Internal Medicine and Physiology, Faculty of Medicine, University of Yaoundé, Yaoundé, Cameroon.
² Departments of Internal Medicine and Cardiology, Douala General Hospital, Douala, Cameroon.
³ Clinical Research Education, Networking and Consultancy, Douala, Cameroon.
⁴ Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria.
⁵ Non Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa.
⁶ Instituto Nacional de Saúde, Maputo, Mozambique.
⁷ Universidade Eduardo Mondlane, Maputo, Mozambique.
⁸ Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
⁹ Department of Internal Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
¹⁰ Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.

Abstract

Pulmonary hypertension (PH) is a devastating, progressive disease with increasingly debilitating symptoms and usually shortened overall life expectancy. This article reviews the global epidemiology of PH with focus on low- and middle-income countries (LMICs) and sub-Sahara African in particular. Although left ventricular heart disease is the most common cause globally, the main contributing risk factors in LMICs are chronic infectious diseases especially human immunodeficiency virus (HIV) and schistosomiasis. Other important risk factors of PH are rheumatic heart disease, untreated congenital heart disease (CHD), and sickle cell disease. Despite existing epidemiological data of PH risk factors suggesting a high prevalence in sub-Saharan Africa (SSA), the available literature is limited. International registries in LMICs like the pan African pulmonary hypertension cohort (PAPUCO) study are essential to provide information about the causes, treatment, outcome, and the natural course of PH in Africa and other parts of the world. In addition, there is a need to track diagnostic and management practices in order to develop suitable algorithms to diagnose PH in LMICs.

Keywords: Africa; Pulmonary hypertension (PH); epidemiology; low- and middle-income countries (LMICs).

Publication types

Review