Two-Thirds Of People In Low & Middle-Income Countries With Hypertension Don’t Get Treatment

Hypertension, which has been called a silent killer because it often goes unnoticed, is one of the world’s leading causes of death – potentially leading to heart attack, stroke, and kidney failure, as well as blindness. Now, a new study in The Lancet has found that two-thirds of people in low- and middle-income countries, where the prevalence of hypertension is rising most rapidly, don’t receive any treatment at all.

People in sub-Saharan Africa, which has the highest incidence of hypertension, or high blood pressure, had the least access to treatment, according to the study, The state of hypertension care in 44 low-income and middle-income countries: a cross-sectional study of nationally representative individual-level data from 1·1 million adults, published Thursday.

Photo: REUTERS/Baz Ratner

The study noted that “even if care is provided free of charge, time lost from income-generating activities and transport costs can still pose a substantial obstacle to accessing care for those with little income and savings.” It added that “individuals with lower educational attainment might be less well equipped to engage with relevant health promotion messages and to actively negotiate an effective treatment plan with health-care providers.”

Lindsay Jaacks, assistant professor of global health at Harvard Chan School School of Public Health and one of the study’s lead authors, told Health Policy Watch that:

“Addressing the gaps in treatment, is going to require government investments to keep out-of-pocket expenses for anti-hypertensive medications low and ensure that they are consistently available at primary health centers. Improving gaps in blood pressure control among hypertensives is a bit more complicated and will involve overcoming challenges outside the health system, such as social awareness of the risks associated with high blood pressure, tobacco, air pollution, and salty diets, among others. Coherent multi-sector actions with robust accountability mechanisms are really what’s going to raise that bar.”

The Lancet study, which examined the data of people living in 44 low- and middle-income countries, also found that less than half of suspected hypertension cases are properly diagnosed. A mere 10 percent of people with hypertension have their blood pressure under control. To evaluate how well health systems were responding, the authors used a “cascade of care approach,” looking country by country at the numbers of people with hypertension who had been screened, diagnosed, treated, and had their condition under control.

Urgent Need for Prevention: Reduce Air Pollution, Sugar, Transfats & Alcohol Consumption

“The low proportion of patients with high blood pressure getting the treatment they need, along with the growing number of patients with high blood pressure, suggests the very urgent need for population-level prevention,” Jaacks was quoted as saying in a press release.

This, she said, refers especially to preventative policies “that get salt and trans-fat out of the food supply, promote fruits and vegetables, reduce air pollution, and address excessive consumption of tobacco and alcohol.”

While countries in sub-Saharan African had the worst performance on average, in terms of access to care along all four steps of the “cascade”, Latin American and Caribbean countries scored the best.

However, wide differences were also noted between countries, with some doing better than might be expected in relation to their level of economic development. The study authors cited Bangladesh, Brazil, Costa Rica, Ecuador, Kyrgyzstan, and Peru, which “performed significantly better on all care cascade steps than predicted based on GDP per capita.”

The study also found that certain factors made it more likely people would advance to diagnosis and treatment regardless of where they live: “Being a woman, older, more educated, wealthier, and not being a current smoker were all positively associated with attaining each of the four steps of the care cascade.”

Rising Rate of Hypertension Worldwide

The number of people with hypertension has nearly doubled over the past 40 years, says the World Health Organization, increasing from 594 million people in 1975 to 1.13 billion in 2015, with low and middle-income countries bearing most of the increased burden of disease.

According to WHO, the highest hypertension prevalence today is in fact in in Africa (27 percent), closely followed by the Eastern Mediterranean region (26 percent), by South East Asia (25 percent), and by Europe (23 percent). The lowest incidence can be found in the Americas (18 percent), and in the Western Pacific region (19 percent).

The World Health Organization describes hypertension as a “condition in which the blood vessels have persistently raised pressure… Blood pressure is created by the force of blood pushing against the walls of blood vessels (arteries) as it is pumped by the heart. The higher the pressure, the harder the heart has to pump.”

One out of four adult men and one out of five adult women suffer from high blood pressure, according to WHO. However, as few as one in five people with hypertension have it under control.

Main contributors to the rise in hypertension are unhealthy diets, physical inactivity, alcohol and tobacco, and air pollution exposures, according to WHO.

Global HEARTS Initiative

The WHO and the United States Center for Disease Control and Prevention in 2016 launched the “Global HEARTS Initiative” that aims to curb the prevalence of hypertension by 25 percent by 2025. The initiative is primarily geared to support governments to prevent and treat cardiovascular diseases.

Fifteen countries have started implementing HEARTS’ five technical packages: Healthy-lifestyle counseling; Evidence-based treatment protocols; Access to essential medicines and technology; Team-based care; and Systems for monitoring. Those countries are: Barbados, Bhutan, Colombia, Chile, China, Cuba, Ethiopia, India, Iran, Morocco, Nepal, Philippines, Tajikistan, Thailand, and Viet Nam.

Cardiovascular diseases prevention is also promoted through other WHO initiatives: MPOWER (control tobacco), Active (increase physical activity), SHAKE (reduce salt consumption) and REPLACE (eliminate trans-fat).

WHO’s factsheet on hypertension shows no region is escaping the issue, with the greatest prevalence in Africa (27 percent), closely followed by the Eastern Mediterranean region (26 percent), by South East Asia (25 percent), and by Europe (23 percent). The lowest incidence can be found in the Americas (18 percent), and in the Western Pacific region (19 percent).

Image Credits: REUTERS/Baz Ratner.

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