**5. Conclusions**

146 Antihypertensive Drugs

**c.** The left ventricular hypertrophy(LVH) on ECG; defined by a Cornell product parameter (positive


• Each small 1-mm square represents 0.04sec (40msec) in time and 0.1mV in voltage. • QRS duration: counting 1-mm square cell of the ECG, paper corresponding to the beginning and the end of QRS complex (horizontally), and then multiply the number by


**[3] The sentence "Follow the suitable algorithm- See footnotes" at the end of fig 3 refers to the** 

Whet it refers to the patient affordability, this can be evaluated based on patient-doctor communication but also to the socio-economic data provided in his medical record (file) and on patient interview.

Fig. 3. Hypertension management algorithm at the health centre: the first step (adapted from

Currently in many developing countries the global health initiatives and governments commitment to tackle the non-communicable diseases (De Maeseneer J. and others 2011) provide an optimistic development which will enhance the management of chronic diseases

The health care systems are constantly improving as the primary health care (PHC) programs are starting in various regions (De Maeseneer J 2009). Certainly the Primary Health Care (PHC)-in line with recommendations of the World Health Report 2008 (De Maeseneer J 2009), may play an important role in implementation of all chronic disease treatment strategies. Nowadays international partners put valuable efforts into training of family physicians in developing and particularly in African countries (De Maeseneer J 2009). Most of those family physicians are working in the district health hospital. However, in the future, they are intended to be located in primary health care centers and when a primary health care centre has a family physician, the management algorithm should be adapted, as

About the drug quality (Twagirumukiza and others 2009a) and drug market regulations, it is important to mention that during recent years, there have been efforts to strengthen regulatory systems and the World Health Organization (WHO) has comprehensively assessed more than 20 regulatory authorities in sub-Saharan Africa and in Latina America, south Asia and other developing regions. WHO and others initiatives have trained a number of regulatory officials to strengthen and harmonize the drugs regulatory processes. Even if it's a long way to go to have national regulators and pharmacovigilance centres fully operational in sub-Saharan Africa countries, things have started moving in the right direction. WHO and international donors have also increasingly invested both in

if >2440 mm\*msec). The parameter is calculated as follows:

• 1mV=10mm in the vertical direction.

corresponding to the wave height (amplitude).

[4] The (\*) and (\*\*) signs refer to the same legend as in figure 1.

**algorithm which can be found in subsequent publication (not given here).** 

Twagirumukiza M et al, 2011)(Twagirumukiza and Van Bortel 2011)


and V3 being ECG waves.

40 msec.

**4.6 Challenges and opportunities** 

in general and hypertension in particular.

referral to the hospital will be less needed.


Although it is important to consider the current knowledge of medicine for the treatment of hypertension, particular consideration should be given to cost-effectiveness and affordability of antihypertensive medicines in primary health care settings of the developing countries. This consideration is justified because many low and middle income countries have severe resource constraints and available resources currently do not allow to treat all patients according to some international guidelines. Therefore, strategies have to be developed to maximally reduce risk for and from hypertension within the limited budget. Such strategy should take into account many local socio-economic and demographic particularities. The hypertension management strategy must be based on patient's cardiovascular risk and not only on his blood pressure level. Additionally the common sense says that for the same result and efficacy the cheapest is the best choice. Therefore it's obvious that the drug prices and quality details must constitute an added criterion when choosing an antihypertensive agent. Developing countries should be encouraged to establish a list with medicine prices using the real patient price, and this list has to be updated at least every year, and the prescribers should be encouraged to choose the cheapest between the available drugs which fulfil the quality criteria.

Beyond that, the management of hypertension in primary health care settings suppose a complete rebuild of health care systems and empowering of the community. The detection and monitoring should be done at community levels and early treatment at primary health care level. As already repeated by many authors, the efforts to effectively improve the control of hypertension should be based on a patient-centred care concept, rather than disease centred care. This suppose a thorough understanding of the characteristics of patients, the dynamics of the health care system and, most importantly, on the work and function of the primary care physician as the gatekeeper.
