**4.6 Physical activity**

Globally, lack of sufficient physical activity is the fourth risk factor to development of NCDs. While physical inactivity is attributed to prevalence of diabetes at 27%, heart diseases caused by heart vessels blockage at 30% and breast and colon cancer at 21–25%; 3.2–5 million deaths globally are associated with physical inactivity [25]. The World Health Organization defines physical activity as a bodily movement produced by muscular and skeletal body systems which require energy expenditure. In other words, physical activity encompasses all activities undertaken while working, playing, carrying out household chores, traveling, recreation; in addition to exercise activities. Physical activity is further classified as moderateand vigorous-intensity physical activity. Also, physical activities are sub-classified as aerobic (those that engage large muscles of the hands and legs; making the

heartbeat and breathing rate to be faster than normal), muscle-strengthening (those that improve the strength, power, and endurance of your muscles) and bonestrengthening (those that strengthen feet, legs arm to support body weight) [26].

In order to gain health benefits of physical activity; it is recommended that children and adolescents should do at least 60 minutes of moderate to vigorousintensity physical activity daily; while adults should do at least 150 minutes of moderate-intensity physical activity throughout the week, or at least 75 minutes of vigorous-intensity physical activity throughout the week. Those with poor mobility should perform physical activity to enhance balance and prevent falls, three or more days per week. The general rule is that two minutes of moderate-intensity activity counts the same as one minute of vigorous-intensity activity and the exercise should continue up to sweating [27].

Regular and sufficient levels of physical activity are attributed to the following cardiovascular benefits;


## **5. Pharmacological treatment of CVDs in Africa**

According to Rizos and Elisaf [28] hypertensive patients with African ancestry are a distinctive population of patients that presents with some unique characteristics. These patients commonly have increased incidence and early onset of hypertension and often-poor BP control. They often present at healthcare facilities with additional concomitant CVD risk factors.

The ADA 2020 standards on pharmacological interventions to CVDs recommend the following:

Patients with confirmed office based blood pressure ≥ 140/90 mmHg should, in addition to lifestyle therapy, have prompt initiation and timely titration of pharmacologic therapy to achieve blood pressure goals.

This is strongly emphasized in the African ancestry population that appropriate TLCs and combination of diuretic and/or calcium channel blocker (CCB) should be initiated promptly. In African black populations, patients receive aggressive treatment at lower BPs compared to non-African, non-black counterparts who are recommended initial combination therapy when they fit the requirement below.

Patients with confirmed office based blood pressure ≥ 160/100 mmHg should, in addition to lifestyle therapy, have prompt initiation and timely titration of two drugs or a single-pill combination of drugs demonstrated to reduce cardiovascular events in patients with diabetes.

Treatment for hypertension should include drug classes demonstrated to reduce cardiovascular events in patients with diabetes (ACE inhibitors, angiotensin receptor blockers, thiazide-like diuretics, or dihydropyridine calcium channel blockers).

Whites generally responded better to β-blockers and ACE inhibitors whereas blacks generally responded better to diuretics and calcium channel blockers [29].

**305**

**Table 2.**

**Adverse drug reaction**

Frequent micturition

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

generally respond poorly to ACE inhibitors [29].

sium levels should be monitored at least annually [11].

inhibitors should not be used.

the other should be substituted.

Multiple-drug therapy is generally required to achieve blood pressure targets. However, combinations of ACE inhibitors and angiotensin receptor blockers and combinations of ACE inhibitors or angiotensin receptor blockers with direct renin

Pharmacologically ACE inhibitors, angiotensin receptor blockers and renin inhibitors act on the renin-aldosterone-angiotensin system to lower the cardiac preand after-load. So giving one class will be sufficient; although black populations

An ACE inhibitor or angiotensin receptor blocker, at the maximum tolerated dose indicated for blood pressure treatment, is the recommended first-line treatment for hypertension in-patients with diabetes and urinary albumin-to-creatinine ratio ≥ 300 mg/g creatinine or 30–299 mg/g creatinine. If one class is not tolerated,

For patients treated with an ACE inhibitor, angiotensin receptor blocker, or diuretic, serum creatinine/estimated glomerular filtration rate and serum potas-

include technological infrastructure, financial and human resources [30].

ing and prevention of adverse effects or any other drug-related problem [31].

**System organ classifications (Medical Dictionary for Regulatory Activities)**

Diarrhea Gastrointestinal disorders ACEIs

Weakness Musculoskeletal and connective tissue disorders

Dry cough Respiratory, thoracic and mediastinal disorders

*ADRS, system organ classifications and suspected causal drug classes.*

**6. Phamacovigilance of antihypertensive medications**

The insufficiencies associated with availability of necessary resources to monitor treatment of CVDs in Low-Middle Income Countries (LMICs) are major barriers to having integrated healthcare system with an effective data flow. These resources

According to the World Health Organization definition, an adverse drug reaction (ADR) is 'a response to a drug that is noxious and unintended and occurs at doses normally used in human for the prophylaxis, diagnosis, and treatment of disease, or for modification of physiological function' [26]. Also, pharmacovigilance (PV) defined by WHO as "the science and activities relating to the detection, assessment, understand-

In Africa, countries differ in terms of a having fully functional PV systems due to differing capacities of national medicines regulatory authorities and performance levels with respect to conducting various pharmacovigilance activities. Therefore, the system for reporting adverse drugs reactions has significant gaps to be strengthened from one country to another [32, 33]. However, in some settings within African countries, the following suspected ADRs were documented as indicated in **Table 2** [34].

Renal and urinary disorders Diuretics, CCBs,

Dizziness Nervous system disorders Diuretics, CCBs, ACEIs, Centrally

Headaches Nervous system disorders Diuretics, CCBs, Centrally acting,

**Drugs class(es)**

ACEIs

acting, β-blockers, α- blockers

Diuretics, CCBs, Centrally acting

*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...*

heartbeat and breathing rate to be faster than normal), muscle-strengthening (those that improve the strength, power, and endurance of your muscles) and bonestrengthening (those that strengthen feet, legs arm to support body weight) [26]. In order to gain health benefits of physical activity; it is recommended that children and adolescents should do at least 60 minutes of moderate to vigorousintensity physical activity daily; while adults should do at least 150 minutes of moderate-intensity physical activity throughout the week, or at least 75 minutes of vigorous-intensity physical activity throughout the week. Those with poor mobility should perform physical activity to enhance balance and prevent falls, three or more days per week. The general rule is that two minutes of moderate-intensity activity counts the same as one minute of vigorous-intensity activity and the exercise

Regular and sufficient levels of physical activity are attributed to the following

• Reduced risk of hypertension (high blood pressure), heart diseases, stroke, diabetes, various types of cancer (including breast and colon) and depression.

According to Rizos and Elisaf [28] hypertensive patients with African ancestry are a distinctive population of patients that presents with some unique characteristics. These patients commonly have increased incidence and early onset of hypertension and often-poor BP control. They often present at healthcare facilities with

The ADA 2020 standards on pharmacological interventions to CVDs recom-

Patients with confirmed office based blood pressure ≥ 140/90 mmHg should, in addition to lifestyle therapy, have prompt initiation and timely titration of pharma-

This is strongly emphasized in the African ancestry population that appropriate TLCs and combination of diuretic and/or calcium channel blocker (CCB) should be initiated promptly. In African black populations, patients receive aggressive treatment at lower BPs compared to non-African, non-black counterparts who are recommended initial combination therapy when they fit the requirement below. Patients with confirmed office based blood pressure ≥ 160/100 mmHg should, in addition to lifestyle therapy, have prompt initiation and timely titration of two drugs or a single-pill combination of drugs demonstrated to reduce cardiovascular

Treatment for hypertension should include drug classes demonstrated to reduce cardiovascular events in patients with diabetes (ACE inhibitors, angiotensin receptor blockers, thiazide-like diuretics, or dihydropyridine calcium channel blockers). Whites generally responded better to β-blockers and ACE inhibitors whereas blacks generally responded better to diuretics and calcium channel blockers [29].

should continue up to sweating [27].

• Reduced risk of heart attack

• Maintained healthy body weight control

**5. Pharmacological treatment of CVDs in Africa**

• Reduced blood cholesterol level

additional concomitant CVD risk factors.

events in patients with diabetes.

cologic therapy to achieve blood pressure goals.

mend the following:

cardiovascular benefits;

• Strengthened heart

**304**

Multiple-drug therapy is generally required to achieve blood pressure targets. However, combinations of ACE inhibitors and angiotensin receptor blockers and combinations of ACE inhibitors or angiotensin receptor blockers with direct renin inhibitors should not be used.

Pharmacologically ACE inhibitors, angiotensin receptor blockers and renin inhibitors act on the renin-aldosterone-angiotensin system to lower the cardiac preand after-load. So giving one class will be sufficient; although black populations generally respond poorly to ACE inhibitors [29].

An ACE inhibitor or angiotensin receptor blocker, at the maximum tolerated dose indicated for blood pressure treatment, is the recommended first-line treatment for hypertension in-patients with diabetes and urinary albumin-to-creatinine ratio ≥ 300 mg/g creatinine or 30–299 mg/g creatinine. If one class is not tolerated, the other should be substituted.

For patients treated with an ACE inhibitor, angiotensin receptor blocker, or diuretic, serum creatinine/estimated glomerular filtration rate and serum potassium levels should be monitored at least annually [11].

The insufficiencies associated with availability of necessary resources to monitor treatment of CVDs in Low-Middle Income Countries (LMICs) are major barriers to having integrated healthcare system with an effective data flow. These resources include technological infrastructure, financial and human resources [30].

### **6. Phamacovigilance of antihypertensive medications**

According to the World Health Organization definition, an adverse drug reaction (ADR) is 'a response to a drug that is noxious and unintended and occurs at doses normally used in human for the prophylaxis, diagnosis, and treatment of disease, or for modification of physiological function' [26]. Also, pharmacovigilance (PV) defined by WHO as "the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug-related problem [31].

In Africa, countries differ in terms of a having fully functional PV systems due to differing capacities of national medicines regulatory authorities and performance levels with respect to conducting various pharmacovigilance activities. Therefore, the system for reporting adverse drugs reactions has significant gaps to be strengthened from one country to another [32, 33]. However, in some settings within African countries, the following suspected ADRs were documented as indicated in **Table 2** [34].


**Table 2.**

*ADRS, system organ classifications and suspected causal drug classes.*
