**Abstract**

This topic explores current treatments of cardiovascular diseases; what treatment outcomes emanate from current drug treatment. It also covers the reasons why many studies show poor treatment outcomes. It deals with adverse drug reaction and their drug management where necessary. Current cost effective interventions including prevention strategies including drug treatments are discussed. Issues relating to patients' knowledge about medication and benefits of adhering to treatment, method of delivery of patient information, are dealt with in detail. It highlights the issues of barriers to adherence to drug treatment and non-drug life style modifications. It also deals with dispensing models that encourage adherence to medication. It explores reasons for late diagnosis and treatment. This chapter will be informed by current studies published in Africa and elsewhere.

**Keywords:** treatment, adherence, knowledge, cost – effective analysis, dispensing models, late diagnosis, treatment outcomes

## **1. Introduction**

According to the World Health Organization (WHO), Non-Communicable Diseases (NCDs) refers to the non-infectious and the non-transmissible medical conditions or diseases. These diseases generally progress slowly and are of long duration. The prevalence of NCDs and risk factors varies considerably between countries, urban/rural location and other sub-populations [1]. The four main types of NCDs are cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. Globally, NCDs are the leading causes of deaths; accounting for over 70% of world deaths (56 million in 2015). Some of these deaths are regarded premature as 27% of these deaths occur in people aged between 30 and 70 years. It has been found that 80% of these premature deaths occur in the low-and middle-income countries.

The World Health Organization estimates that mortality due to NCDs will rise by 17% globally in the next decade; while the African region only will experience 27% increase by 2030. Some African countries such as Algeria (76%), Egypt (84%), Libya (72%), Mauritius (89%), Morocco (80%), Sao Tome and Principe (55%), Seychelles (81%), South Africa (51%), Sudan (52%) and Tunisia (86%) have already witnessed over 50% deaths attributed to NCDs since 2018 [2]. Deaths solely attributed to cardiovascular disease (CVD) are the leading almost globally of all other NCDs. The implications to the increasing prevalence of NCDs are that NCDs will soon be the leading causes of illness, disability and death (including premature deaths) in Africa.

There are eight behavioral and physiological risk factors associated with high and continually increasing burden of NCDs, namely, tobacco use, harmful use

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*Lifestyle and Epidemiology - The Double Burden of Poverty and Cardiovascular Diseases...*

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of alcohol, consumption of unhealthy diet, physical inactivity, overweight and obesity, high blood pressure, raised blood glucose and raised total cholesterol in blood [3]. Since 2011, NCDs have been elevated onto global, regional and national development agendas through a series of political commitments. These include the 2011 United Nations (UN) Political Declaration on NCD Prevention and Control, 2011 Brazzaville Declaration on NCD Prevention and Control in the WHO African Region, WHO Global NCD Action Plan 2013–2020, 2025 Global NCD targets and 2015 Sustainable Development Goals [4, 5].

With the above global and regional background of NCDs and initiatives, the aim of this chapter is to.

### **2. Cardiovascular diseases**

Cardiovascular diseases (CVDs) refers to a group of disorders affecting the heart and the blood vessels supplying the heart itself (coronary heart disease, rheumatic heart disease, and congenital heart disease), the brain (cerebrovascular disease), the arms and legs (peripheral artery disease, deep vein thrombosis and pulmonary embolism) [6]. Cardiovascular diseases are usually associated with a build-up of fatty deposits inside the arteries (atherosclerosis) and increasing the risk of blood clotting and vessel damage; leading to heart attacks and strokes [7]. Depending on the organ by which blood vessels are damaged, CVDs are also associated with eye, brain, kidney and heart diseases.

More often, CVDs may not have symptoms relating to underlying disease to blood vessels; but heart attack and stroke as usually the first warning of underlying CVD. Heart attack, also known as myocardial infarction, occurs because of failure to supply oxygen-rich blood to a certain part of the heart muscle due to blockade of the blood vessels supplying that part; leading to muscle cell death in that oxygen deprived area (infarct) [8]. Heart attack manifests as sharp chest pain and discomfort at the center of the chest; radiating to the arms, left shoulder, elbows, jaw and back. During the attack episode, the person may also have trouble in breathing. According to Centers for Disease Control, similar to heart attack, stroke occurs because of failure to supply oxygen-rich blood to a certain part of the brain due to blockade of the blood vessels supplying that part; and bursting of the blood vessel in the brain; leading to death of that part of the brain that is deprived of oxygenrich blood [9]. Strokes are characterized by sudden symmetrical weakness of the limbs, face. The person experiences confusion, difficulty in speaking, vision, walking and there is loss of balance, coordination and unconsciousness may happen.

According to Plotnikoff and Dusek, hypertension (HTN) is the most important risk factor to getting ill and dying from a CVD [10]. The World Health Organization defined hypertension, also known as high blood pressure (BP), as the condition in which the blood vessels have persistently high pressure. The blood pressure is increased by the sympathetic nervous system and the renin-aldosterone-angiotensin system (RAAS). A drop in blood pressure is detected by pressure-sensitive receptors (baroceptors) which send signals to the cardiovascular centers in the spinal cord. This prompts a reflex response of increased sympathetic nervous system activity on the heart and blood vessels; resulting in increased cardiac output and vasoconstriction. The baroceptors in the kidneys respond to a decrease in blood pressure by releasing the enzyme hormone called renin. Renin converts angiotensinogen component of blood to angiotensin I; that ultimately gets converted to angiotensin II by angiotensin converting enzyme (ACE). Angiotensin II is a potent vasoconstrictor, constricting both arteries and veins. The activity of both sympathetic nervous system and RAAS result in increase in blood pressure [11].

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by WHO [17].

*Exploring Cardiovascular Diseases Treatment in Africa DOI: http://dx.doi.org/10.5772/intechopen.95871*

**3. Current treatments of CVDs**

**4. Therapeutic lifestyle changes (TLCs)**

**4.1 Smoking cessation**

**4.2 Reduced intake of sodium diet**

The seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7) define a normal BP as less than 120 mm Hg systolic and less than 80 mm Hg diastolic. If left uncontrolled and untreated, high blood pressure can result in an enlargement of the heart, heart attack, heart failure and eventually to death. Hypertension is also associated with loss of vision, cognitive and erectile dysfunction. The higher the pressure above normal, the greater is the risk of complications [12]. Hypertension is the culprit with end-organ damage in terms of all CVDs (stroke, kidney failure and peripheral vascular disease).

Despite advances made to the treatment and prevention, CVDs are still the leading

causes of death of all NCDs. Nevertheless, majority of CVDs are preventable with just lifestyle changes alone. An integrative approach has been adopted to the prevention and treatment of CVDs; as the approach address the root causes influenced by lifestyle. The approach acknowledges that the great value and potential life-saving benefits of modern pharmacology and procedures cannot use only one approach since each has own limitation [13]. The combinatory approach allows for counteracting limitations of one approach with the other approach. The goal of treating CVDs is to improve cardiovascular health and reduce deaths from heart disease and stroke.

Therapeutic lifestyle changes are the foundation for non-drug management of HTN and/or CVD. These include smoking cessation, reduced intake of sodium diet, the Dietary Approach to Stop Hypertension (DASH), body weight management, moderation of alcohol consumption and physical activity. The American Diabetes Association (ADA) 2020 standards of medical care recommend that for patients with blood pressure > 120/80 mmHg, lifestyle intervention consists of weight loss if overweight or obese, DASH-style eating pattern including reducing sodium and increasing potassium intake, moderation of alcohol intake, and increased physical activity [14].

Smoking increases the risk of developing serious health problems and death. It is estimated that there are 1.1 billion people who smoke and 80% of them come from the low-to-middle income countries (LMICs). Further estimates reveal that smokers are likely to develop heart disease and stroke 2–4 times higher compared to nonsmokers. The **Table 1** below is a summary of the health benefits of quitting smoking from 20 minutes to 15 years adapted from the forefront UChicago Medicine [15].

High sodium intake, estimated at >2 grams per day which is equivalent to 5 grams of table salt per day, contributes to high blood pressure and increases risk of heart disease and stroke. If global salt intake could be reduced to recommended levels, an estimated 2.5 million deaths could be prevented [16]. In a systematic review and meta regression done on salt intake in sub-Saharan Africa, the results of the study revealed high sodium intake in many adult population (and some populations of children) above the 2 g intake recommended as the upper limit established

*Exploring Cardiovascular Diseases Treatment in Africa DOI: http://dx.doi.org/10.5772/intechopen.95871*

*Lifestyle and Epidemiology - The Double Burden of Poverty and Cardiovascular Diseases...*

2015 Sustainable Development Goals [4, 5].

of this chapter is to.

**2. Cardiovascular diseases**

brain, kidney and heart diseases.

of alcohol, consumption of unhealthy diet, physical inactivity, overweight and obesity, high blood pressure, raised blood glucose and raised total cholesterol in blood [3]. Since 2011, NCDs have been elevated onto global, regional and national development agendas through a series of political commitments. These include the 2011 United Nations (UN) Political Declaration on NCD Prevention and Control, 2011 Brazzaville Declaration on NCD Prevention and Control in the WHO African Region, WHO Global NCD Action Plan 2013–2020, 2025 Global NCD targets and

With the above global and regional background of NCDs and initiatives, the aim

Cardiovascular diseases (CVDs) refers to a group of disorders affecting the heart and the blood vessels supplying the heart itself (coronary heart disease, rheumatic heart disease, and congenital heart disease), the brain (cerebrovascular disease), the arms and legs (peripheral artery disease, deep vein thrombosis and pulmonary embolism) [6]. Cardiovascular diseases are usually associated with a build-up of fatty deposits inside the arteries (atherosclerosis) and increasing the risk of blood clotting and vessel damage; leading to heart attacks and strokes [7]. Depending on the organ by which blood vessels are damaged, CVDs are also associated with eye,

More often, CVDs may not have symptoms relating to underlying disease to blood vessels; but heart attack and stroke as usually the first warning of underlying CVD. Heart attack, also known as myocardial infarction, occurs because of failure to supply oxygen-rich blood to a certain part of the heart muscle due to blockade of the blood vessels supplying that part; leading to muscle cell death in that oxygen deprived area (infarct) [8]. Heart attack manifests as sharp chest pain and discomfort at the center of the chest; radiating to the arms, left shoulder, elbows, jaw and back. During the attack episode, the person may also have trouble in breathing. According to Centers for Disease Control, similar to heart attack, stroke occurs because of failure to supply oxygen-rich blood to a certain part of the brain due to blockade of the blood vessels supplying that part; and bursting of the blood vessel in the brain; leading to death of that part of the brain that is deprived of oxygenrich blood [9]. Strokes are characterized by sudden symmetrical weakness of the limbs, face. The person experiences confusion, difficulty in speaking, vision, walking and there is loss of balance, coordination and unconsciousness may happen. According to Plotnikoff and Dusek, hypertension (HTN) is the most important risk factor to getting ill and dying from a CVD [10]. The World Health Organization defined hypertension, also known as high blood pressure (BP), as the condition in which the blood vessels have persistently high pressure. The blood pressure is increased by the sympathetic nervous system and the renin-aldosterone-angiotensin system (RAAS). A drop in blood pressure is detected by pressure-sensitive receptors (baroceptors) which send signals to the cardiovascular centers in the spinal cord. This prompts a reflex response of increased sympathetic nervous system activity on the heart and blood vessels; resulting in increased cardiac output and vasoconstriction. The baroceptors in the kidneys respond to a decrease in blood pressure by releasing the enzyme hormone called renin. Renin converts angiotensinogen component of blood to angiotensin I; that ultimately gets converted to angiotensin II by angiotensin converting enzyme (ACE). Angiotensin II is a potent vasoconstrictor, constricting both arteries and veins. The activity of both sympa-

thetic nervous system and RAAS result in increase in blood pressure [11].

**300**

The seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7) define a normal BP as less than 120 mm Hg systolic and less than 80 mm Hg diastolic. If left uncontrolled and untreated, high blood pressure can result in an enlargement of the heart, heart attack, heart failure and eventually to death. Hypertension is also associated with loss of vision, cognitive and erectile dysfunction. The higher the pressure above normal, the greater is the risk of complications [12]. Hypertension is the culprit with end-organ damage in terms of all CVDs (stroke, kidney failure and peripheral vascular disease).
