Hypertension: detection and management in South Africa.

High blood pressure in South Africa is estimated to have caused 46,888 deaths and 390,860 disability-adjusted life years in 2000. Detection and management of hypertension remains suboptimal due to inadequate public health care facilities. Mass migration of rural blacks to urban areas and rapid changes in lifestyle and risk factors account for the rising prevalence of hypertension, but genetic factors may also play an important contributory role. Black South Africans also appear to be more prone to complications of hypertension, particularly stroke, heart failure, and hypertensive nephrosclerosis, and respond poorly to ACE inhibitors as monotherapy. Proactive public health interventions at a population level need to be introduced to control this growing epidemic.