Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

The prevalence of hypertension is rapidly increasing in low-income and middle-income countries (LMICs). To effectively target interventions and monitor progress in hypertension care, it is essential to determine country-specific deficiencies in the hypertension care continuum. However, estimates of health system performance in hypertension care from nationally representative studies in LMICs are sparse. In this cross-sectional study, 192,441 patients with hypertension from 44 LMICs were evaluated to determine at which stages in the hypertension care cascade patients are lost, and how these losses vary between and within countries. Hypertension was defined as a systolic blood pressure of at least 140 mm Hg, a diastolic blood pressure of at least 90 mm Hg, or reported use of medication for hypertension. Researchers analyzed the hypertension cascade of care by computing the proportion of individuals who 1) had ever had their blood pressure measured, 2) had been diagnosed with hypertension, 3) had been treated for hypertension, and 4) had achieved control of their hypertension. Researchers found that 73.6% of patients (95% CI 72.9% to 74.3%) had ever had their blood pressure measured, 39.2% (95% CI 38.2% to 40.3%) had been diagnosed with hypertension, 29.9% (95% CI 28.6% to 31.3%) received treatment for hypertension, and 10.3% (95% CI 9.6% to 11.0%) achieved control of their hypertension. Countries in Latin America and the Caribbean had the highest proportion of individuals reaching each stage of the hypertension care cascade, whereas sub-Saharan Africa had the lowest proportion. Bangladesh, Brazil, Costa Rica, Ecuador, Kyrgyzstan, and Peru all performed significantly better on all care cascade steps than predicted based on GDP per capita. Individuals who were female, older, did not currently smoke, and who were in higher quintiles for household wealth were more likely to reach each step of the hypertension care cascade. Additionally, being overweight or obese was associated with a higher probability of reaching each cascade step in all regressions except for the last step, from treatment to control of blood pressure. This study was limited by differences in how survey questions were translated into local languages and in how blood pressure was measured, which may have been responsible for some of the variation observed between countries and regions. Overall, this study underlines the fact that targeted interventions to improve hypertension care in LMICs are urgently needed, and identifies specific areas for opportunity in the hypertension care cascade in 44 different countries.

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