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Liang W, Zhang X, Wang Q, Yu H, Yu J. Assessing the evolution of hypertension management in Gansu, China: A comparative study of prevalence, awareness, treatment, and control in 2012 and 2022. J Clin Hypertens (Greenwich) 2024; 26:674-686. [PMID: 38577938 PMCID: PMC11180686 DOI: 10.1111/jch.14809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 03/07/2024] [Accepted: 03/13/2024] [Indexed: 04/06/2024]
Abstract
The aim of this study is to evaluate the developments in the treatment and prevalence of hypertension by demographic subgroups in least developed area of China in 2012 and 2022. This population-based cross-sectional study was conducted in 2012 and 2022, we applied stratified multistage random sampling to investigate residents aged 18 years or older in Gansu, the least developed province in the northwest of China. Questionnaires and anthropometric measurements were given to all respondents. The standardized prevalence of hypertension in adults in Gansu increased from 26.1% in 2012 to 28.8% in 2022. Compared with 2012, the control rate remains decreased despite the significantly improved awareness and treatment rates of hypertension in 2022. Apart from the reversal of the control rate, the trend of higher prevalence in men and higher awareness and treatment rates in women has not changed. There was an obviously increase in the proportion of participants who had received health education and hypertension management services from medical workers. The treatment was still primarily monotherapy, and there was no significant improvement in the prescription of medication. The prevalence of hypertension has increased mildly in the least developed region of China over the past decade, and the challenge of hypertension management has shifted from increasing awareness and treatment rates to increasing control rates. The onset and control of hypertension are affected by education methods, BMI, local economic conditions and other factors, and targeted strategies can be adopted to strengthen the management of hypertension in economically underdeveloped areas of China.
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Affiliation(s)
- Wei Liang
- Department of CardiologyLanzhou University Second HospitalLanzhouChina
| | - Xiaowei Zhang
- Department of CardiologyLanzhou University Second HospitalLanzhouChina
| | - Qiongying Wang
- Department of CardiologyLanzhou University Second HospitalLanzhouChina
| | - Heng Yu
- Department of CardiologyLanzhou University Second HospitalLanzhouChina
| | - Jing Yu
- Department of CardiologyLanzhou University Second HospitalLanzhouChina
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Murphy R, Damasceno A, Reddin C, Hankey GJ, Iversen HK, Oveisgharan S, Lanas F, Czlonkowska A, Langhorne P, Ogunniyi A, Wasay M, Rumboldt Z, Judge C, Oguz A, Mondo C, Winter Y, Rosengren A, Pogosova N, Avezum A, Nilanont Y, Penaherrera E, Xavier D, Lopez-Jaramillo P, Wang X, Yusuf S, O'Donnell M. Variations in the prevalence of atrial fibrillation, and in the strength of its association with ischemic stroke, in countries with different income levels: INTERSTROKE case-control study. Int J Stroke 2024; 19:559-568. [PMID: 38204182 DOI: 10.1177/17474930241227783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
BACKGROUND The contribution of atrial fibrillation (AF) to the etiology and burden of stroke may vary by country income level. AIMS We examined differences in the prevalence of AF and described variations in the magnitude of the association between AF and ischemic stroke by country income level. METHODS In the INTERSTROKE case-control study, participants with acute first ischemic stroke were recruited across 32 countries. We included 10,363 ischemic stroke cases and 10,333 community or hospital controls who were matched for age, sex, and center. Participants were grouped into high-income (HIC), upper-middle-income (subdivided into two groups-UMIC-1 and UMIC-2), and lower-middle-income (LMIC) countries, based on gross national income. We evaluated the risk factors for AF overall and by country income level, and evaluated the association of AF with ischemic stroke. RESULTS AF was documented in 11.9% (n = 1235) of cases and 3.2% (n = 328) of controls. Compared to HIC, the prevalence of AF was significantly lower in UMIC-2 (aOR 0.35, 95% CI 0.29-0.41) and LMIC (aOR 0.50, 95% CI 0.41-0.60) on multivariable analysis. Hypertension, female sex, valvular heart disease, and alcohol intake were stronger risk factors for AF in lower-income countries, and obesity a stronger risk factor in higher-income countries. The magnitude of association between AF and ischemic stroke was significantly higher in lower-income countries compared to higher-income countries. The population attributable fraction for AF and stroke varied by region and was 15.7% (95% CI 13.7-17.8) in HIC, 14.6% (95% CI 12.3-17.1) in UMIC-1, 5.7% (95% CI 4.9-6.7) in UMIC-2, and 6.3% (95% CI 5.3-7.3) in LMIC. CONCLUSION Risk factors for AF vary by country income level. AF contributes to stroke burden to a greater extent in higher-income countries than in lower-income countries, due to a higher prevalence and despite a lower magnitude of odds ratio.
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Affiliation(s)
- Robert Murphy
- HRB Clinical Research Facility Galway, School of Medicine, University of Galway, Galway, Ireland
| | | | - Catriona Reddin
- HRB Clinical Research Facility Galway, School of Medicine, University of Galway, Galway, Ireland
| | - Graeme J Hankey
- School of Medicine and Pharmacology, The University of Western Australia, Perth, WA, Australia
| | - Helle K Iversen
- Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Shahram Oveisgharan
- Rush Alzheimer's Disease Research Center, Rush University Medical Center, Chicago, IL, USA
| | - Fernando Lanas
- Faculty of Medicine, Universidad de La Frontera, Temuco, Chile
| | | | - Peter Langhorne
- Academic Section of Geriatric Medicine, Glasgow Royal Infirmary, University of Glasgow, Glasgow, UK
| | - Adesola Ogunniyi
- Division of Cardiovascular Medicine, Department of Medicine, University College Hospital, Ibadan, Nigeria
| | | | | | - Conor Judge
- HRB Clinical Research Facility Galway, School of Medicine, University of Galway, Galway, Ireland
| | - Aytekin Oguz
- Metabolic Syndrome Association, Istanbul, Turkey
| | - Charles Mondo
- Department of Cardiology, Kiruddu National Referral Hospital, Kampala, Uganda
| | - Yaroslav Winter
- Department of Neurology, Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Annika Rosengren
- Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nana Pogosova
- National Medical Research Center of Cardiology Named After Academician E.I. Chazov, Moscow, Russia
| | - Alvaro Avezum
- Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | - Yongchai Nilanont
- Neurology Division, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Denis Xavier
- St. John's Research Institute, St. John's Medical College, Bangalore, India
| | - Patricio Lopez-Jaramillo
- Fundacion Oftalmologica de Santander-Clinica Carlos Ardila Lulle (FOSCAL), Bucaramanga, Colombia
| | - Xingyu Wang
- Laboratory of Human Genetics, Beijing Hypertension League Institute, Beijing, China
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Martin O'Donnell
- HRB Clinical Research Facility Galway, School of Medicine, University of Galway, Galway, Ireland
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
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Badacho AS, Woltamo DD, Demissie DB, Mahomed OH. Mapping evidence on barriers to and facilitators of diagnosing noncommunicable diseases among people living with human immunodeficiency virus in low- and middle-income countries in Africa: A scoping review. SAGE Open Med 2024; 12:20503121241253960. [PMID: 38784122 PMCID: PMC11113038 DOI: 10.1177/20503121241253960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Objectives To map the evidence on the barriers to and facilitators of diagnosing noncommunicable diseases among people living with HIV in low- and middle-income countries in Africa. Introduction Noncommunicable diseases are increasing among people living with HIV. Thus, strengthened and sustained diagnosis of noncommunicable diseases through integrated noncommunicable diseases and HIV care is needed to improve patient outcomes. However, there is paucity of evidence on the barriers and facilitators diagnosing noncommunicable diseases among people living with HIV in low- and middle-income countries. Methods The Arksey and O'Malley methodological framework was used. A comprehensive systematic search of academic databases (MEDLINE, Academic Search Complete, APA PsycInfo, CAB, and Health Source/Nursing) was performed via EBSCO search and PubMed. The articles were reviewed independently by three reviewers. The results were structured using Capability-Opportunity-Motivation-Behavior model and Theoretical Domains Framework. Results A total of 152 articles were retrieved for full-text review. Forty-one articles met the inclusion criteria. The identified barriers were relevant to all the Capability-Opportunity-Motivation-Behavior constructs and 14 Theoretical Domains Framework domains. A lack of knowledge and awareness of noncommunicable diseases, fear of stigma, financial problems and out-of-pocket payments were the most cited patient-level barriers. Healthcare providers (knowledge and awareness gaps, skill and competence deficiencies, unwillingness, burnout, low motivation, and apathy) were frequently cited. Lack of equipment, noncommunicable disease medications and supply chain challenges, lack of integrated noncommunicable disease and HIV care, and shortage of trained healthcare providers were identified as health-system-level barriers. Conclusion This scoping review is the first to identify barriers and facilitators using a theoretical framework. The most cited barriers include a lack of integrated HIV and noncommunicable disease care, equipment and logistics chain challenges for noncommunicable diseases, patients' and healthcare providers' lack of knowledge and awareness of noncommunicable diseases, and healthcare provider's skill and competency deficiencies. Addressing these issues is crucial for improving patient outcomes and reducing the burden on healthcare providers and health systems.
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Affiliation(s)
- Abebe Sorsa Badacho
- School of Nursing and Public Health, Public Health Medicine Discipline, University of KwaZulu-Natal, Durban, South Africa
- School Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Deginesh Dawit Woltamo
- School of Nursing and Public Health, Public Health Medicine Discipline, University of KwaZulu-Natal, Durban, South Africa
| | | | - Ozayr Haroon Mahomed
- School of Nursing and Public Health, Public Health Medicine Discipline, University of KwaZulu-Natal, Durban, South Africa
- Dasman Diabetes Institute, Kuwait City, Kuwait
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4
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Hu M, Li B, Yang T, Yang Y, Yin C. Effect of Household Income on Cardiovascular Diseases, Cardiovascular Biomarkers, and Socioeconomic Factors. Clin Ther 2024; 46:239-245. [PMID: 38350757 DOI: 10.1016/j.clinthera.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/07/2023] [Accepted: 01/08/2024] [Indexed: 02/15/2024]
Abstract
PURPOSE To examine whether household income is causally related to cardiovascular diseases and investigate the potential reasons. METHODS Using 2-sample Mendelian randomization analyses, we obtained summary statistics from genome-wide association studies of household income and a range of cardiovascular diseases, biomarkers, and socioeconomic factors. FINDINGS Higher household income was causally associated with lower risks of coronary heart disease (odd ratio [OR] = 0.63; 95% CI: 0.49-0.79; P = 0.0001), myocardial infarction (OR = 0.64; 95% CI: 0.50-0.82; P = 0.0003), and hypertension (OR = 0.71; 95% CI: 0.58-0.88; P = 0.0015). With increasing household income, the cardiovascular biomarkers including triglycerides, C-reactive protein, body mass index, fasting glucose were decreased whereas telomere length and high-density lipoprotein cholesterol were increased. Besides, individuals with higher household income were less likely to smoke (β = -0.34; 95% CI: -0.47 to -0.21; P = 1.91×10-07), intake salt (β = -0.14; 95% CI: -0.21 to -0.07; P = 0.0001), or be exposed to air pollution (β = -0.10; 95% CI: -0.15 to -0.06; P = 8.81×10-06) or depression state (β = -0.03; 95% CI: -0.04 to -0.02; P = 5.16×10-07). They were more likely to take physical activity (β = 0.06; 95% CI: 0.02 to 010; P = 0.0016) and have long years of schooling (β = 0.70; 95% CI: 0.62 to 0.78; P = 5.32×10-67). IMPLICATIONS Higher household income is causally associated with better socioeconomic factors and improved cardiovascular biomarkers, which translates into a reduced prevalence of cardiovascular diseases. Policies to improve income equality may result in a reduced burden of cardiovascular diseases.
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Affiliation(s)
- Mengjin Hu
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Boyu Li
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tao Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuejin Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Chunlin Yin
- Xuanwu Hospital, Capital Medical University, Beijing, China.
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Stein DT, Reitsma MB, Geldsetzer P, Agoudavi K, Aryal KK, Bahendeka S, Brant LCC, Farzadfar F, Gurung MS, Guwatudde D, Houehanou YCN, Malta DC, Martins JS, Saeedi Moghaddam S, Mwangi KJ, Norov B, Sturua L, Zhumadilov Z, Bärnighausen T, Davies JI, Flood D, Marcus ME, Theilmann M, Vollmer S, Manne-Goehler J, Atun R, Sudharsanan N, Verguet S. Hypertension care cascades and reducing inequities in cardiovascular disease in low- and middle-income countries. Nat Med 2024; 30:414-423. [PMID: 38278990 DOI: 10.1038/s41591-023-02769-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 12/15/2023] [Indexed: 01/28/2024]
Abstract
Improving hypertension control in low- and middle-income countries has uncertain implications across socioeconomic groups. In this study, we simulated improvements in the hypertension care cascade and evaluated the distributional benefits across wealth quintiles in 44 low- and middle-income countries using individual-level data from nationally representative, cross-sectional surveys. We raised diagnosis (diagnosis scenario) and treatment (treatment scenario) levels for all wealth quintiles to match the best-performing country quintile and estimated the change in 10-year cardiovascular disease (CVD) risk of individuals initiated on treatment. We observed greater health benefits among bottom wealth quintiles in middle-income countries and in countries with larger baseline disparities in hypertension management. Lower-middle-income countries would see the greatest absolute benefits among the bottom quintiles under the treatment scenario (29.1 CVD cases averted per 1,000 people living with hypertension in the bottom quintile (Q1) versus 17.2 in the top quintile (Q5)), and the proportion of total CVD cases averted would be largest among the lowest quintiles in upper-middle-income countries under both diagnosis (32.0% of averted cases in Q1 versus 11.9% in Q5) and treatment (29.7% of averted cases in Q1 versus 14.0% in Q5) scenarios. Targeted improvements in hypertension diagnosis and treatment could substantially reduce socioeconomic-based inequalities in CVD burden in low- and middle-income countries.
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Affiliation(s)
- Dorit Talia Stein
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Marissa B Reitsma
- Department of Health Policy, Stanford School of Medicine, Stanford University, Stanford, CA, USA
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Stanford University, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Kokou Agoudavi
- Noncommunicable Disease Program, Ministry of Health, Lomé, Togo
| | - Krishna Kumar Aryal
- Bergen Centre for Ethics and Priority Setting in Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Public Health Promotion and Development Organization, Kathmandu, Nepal
| | - Silver Bahendeka
- MKPGMS-Uganda Martyrs University, Kampala, Uganda
- St. Francis Hospital, Nsambya, Kampala, Uganda
| | - Luisa C C Brant
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - David Guwatudde
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | | | - Deborah Carvalho Malta
- Department Maternal Child and Public Health, Nursing School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - João Soares Martins
- Faculty of Medicine and Health Sciences, Universidade Nacional Timor Lorosa'e, Díli, Timor-Leste
| | - Sahar Saeedi Moghaddam
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Kiel Institute for the World Economy, Kiel, Germany
| | - Kibachio Joseph Mwangi
- World Health Organization, Pretoria, South Africa
- Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
| | - Bolormaa Norov
- Nutrition Department, National Center for Public Health, Ulaanbaatar, Mongolia
| | - Lela Sturua
- National Center for Disease Control and Public Health, Tbilisi, Georgia
- Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
| | | | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Harvard Center for Population and Development Studies, Cambridge, MA, USA
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Justine I Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa
| | - David Flood
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Center for Indigenous Health Research, Wuqu' Kawoq, Tecpán, Guatemala
| | - Maja E Marcus
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Michaela Theilmann
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Professorship of Behavioral Science for Disease Prevention and Health Care, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Sebastian Vollmer
- Department of Economics & Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Nikkil Sudharsanan
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Professorship of Behavioral Science for Disease Prevention and Health Care, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Weng J, Mao Y, Xie Q, Sun K, Kong X. Gender differences in the association between healthy eating index-2015 and hypertension in the US population: evidence from NHANES 1999-2018. BMC Public Health 2024; 24:330. [PMID: 38297284 PMCID: PMC10829399 DOI: 10.1186/s12889-023-17625-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/31/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Diet has long been recognized as an important modifiable risk factor for hypertension. Herein, our research goal was to decipher the association of healthy eating index-2015 (HEI-2015) with hypertension, and to explore potential gender differences. METHODS We collected the cross-sectional data of 42,391 participants of the National Health and Nutrition Examination Survey (NHANES) 1999-2018. The association of HEI-2015 with hypertension was estimated using weighted multivariate logistic regression, with restricted cubic spline (RCS) regression being adopted to examine the nonlinearity of this association in both genders, and the stability of the results were examined by sensitivity analysis. We also performed subgroup analysis to detect potential difference in the link between HEI-2015 and hypertension stratified by several confounding factors. RESULTS After eliminating potential confounding bias, the adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for hypertension across higher HEI-2015 quartiles were 0.93 (0.85-1.03), 0.84 (0.77-0.93), and 0.78 (0.72-0.86) compared to the lowest quartile, respectively. HEI-2015 was nonlinearly and inversely associated with hypertension in all participants. The gender-specific RCS curves presented a U-shaped correlation in males, while showed a linear and inverse correlation in females. Besides, subgroup analyses showed a lower risk of hypertension in participants who were females, younger than 40 years, Whites, obese, and diabetic patients. CONCLUSIONS We determined a nonlinear and inverse association between HEI-2015 and hypertension in the US general population, and revealed a remarkable gender difference when adhering to a HEI-2015 diet for preventing hypertension.
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Affiliation(s)
- Jiayi Weng
- Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, 215008, China
| | - Yukang Mao
- Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, 215008, China
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Qiyang Xie
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Kangyun Sun
- Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, 215008, China.
| | - Xiangqing Kong
- Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, 215008, China.
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
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7
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Mahalie R, Angula P, Mitonga KH, Oladimeji O. Patterns of availability and accuracy of risk factor data for cardiovascular diseases among people initiated on antiretroviral therapy at selected health facilities in Khomas region, Namibia: a retrospective, cross-sectional, quantitative study. Pan Afr Med J 2024; 47:33. [PMID: 38586067 PMCID: PMC10998256 DOI: 10.11604/pamj.2024.47.33.25340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/27/2023] [Indexed: 04/09/2024] Open
Abstract
Introduction quality data is a prerequisite for timely decision-making and measuring health outcomes in public health settings. Comorbidities such as cardiovascular diseases (CVDs) among people living with HIV (PLHIV), require a robust system that ensures credible data at all data-producing levels. The study at determining the level of availability and completeness of CVDs risk factors data of PLHIV. Methods a quantitative study was conducted to extract CVDs risk factors data retrospectively from 529 patient care booklets (PCBs) between 2004 and 2017. The analysis was done with the Statistical Package for Social Sciences (SPSS) version 25. Pearson Chi-Square was used to test for associations. The level of significance was at p ≤ 0.05. Results the study revealed that 72.8% of patients are at risk of CVDs due to incomplete demographics (73.72%) and other systemic data (41.18%). A significant association was found (Pearson Chi-Square test 19.907; p-value of 0.001) between average visits per year, accurate data recording, and active status of the patient. Lost to follow-up (15%) and true retention (27.2%) was significantly associated with the last Antiretroviral Therapy (ART) status of a patient (Pearson Chi-Square test 87.754; p-value of 0.001). Conclusion the study that despite concerted efforts to improve data quality, the availability and completeness of data remain unsatisfactory. Lack of harmonised data screening and analysis efforts for CVDs risk factors is found to be a significant risk factor in ensuring integrated routine measuring of CVDs health outcomes for PLHIV.
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Affiliation(s)
- Roswitha Mahalie
- Faculty of Health and Applied Sciences, Namibia University of Science and Technology, Windhoek, Namibia
| | - Penehafo Angula
- School of Public Health, Oshakati Campus, Faculty of Health Sciences, University of Namibia, Oshakati, Namibia
| | - Kabwebwe Honoré Mitonga
- School of Public Health, Oshakati Campus, Faculty of Health Sciences, University of Namibia, Oshakati, Namibia
| | - Olanrewaju Oladimeji
- Department of Epidemiology and Biostatistics, School of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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8
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Laranjo L, Lanas F, Sun MC, Chen DA, Hynes L, Imran TF, Kazi DS, Kengne AP, Komiyama M, Kuwabara M, Lim J, Perel P, Piñeiro DJ, Ponte-Negretti CI, Séverin T, Thompson DR, Tokgözoğlu L, Yan LL, Chow CK. World Heart Federation Roadmap for Secondary Prevention of Cardiovascular Disease: 2023 Update. Glob Heart 2024; 19:8. [PMID: 38273995 PMCID: PMC10809857 DOI: 10.5334/gh.1278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/16/2023] [Indexed: 01/27/2024] Open
Abstract
Background Secondary prevention lifestyle and pharmacological treatment of atherosclerotic cardiovascular disease (ASCVD) reduce a high proportion of recurrent events and mortality. However, significant gaps exist between guideline recommendations and usual clinical practice. Objectives Describe the state of the art, the roadblocks, and successful strategies to overcome them in ASCVD secondary prevention management. Methods A writing group reviewed guidelines and research papers and received inputs from an international committee composed of cardiovascular prevention and health systems experts about the article's structure, content, and draft. Finally, an external expert group reviewed the paper. Results Smoking cessation, physical activity, diet and weight management, antiplatelets, statins, beta-blockers, renin-angiotensin-aldosterone system inhibitors, and cardiac rehabilitation reduce events and mortality. Potential roadblocks may occur at the individual, healthcare provider, and health system levels and include lack of access to healthcare and medicines, clinical inertia, lack of primary care infrastructure or built environments that support preventive cardiovascular health behaviours. Possible solutions include improving health literacy, self-management strategies, national policies to improve lifestyle and access to secondary prevention medication (including fix-dose combination therapy), implementing rehabilitation programs, and incorporating digital health interventions. Digital tools are being examined in a range of settings from enhancing self-management, risk factor control, and cardiac rehab. Conclusions Effective strategies for secondary prevention management exist, but there are barriers to their implementation. WHF roadmaps can facilitate the development of a strategic plan to identify and implement local and national level approaches for improving secondary prevention.
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Affiliation(s)
- Liliana Laranjo
- Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | | | - Marie Chan Sun
- Department of Medicine, University of Mauritius, Réduit, Mauritius
| | | | - Lisa Hynes
- Croí, the West of Ireland Cardiac & Stroke Foundation, Galway, Ireland
| | - Tasnim F. Imran
- Department of Medicine, Division of Cardiology, Warren Alpert Medical School of Brown University, Providence VA Medical Center, Lifespan Cardiovascular Institute, Providence, US
| | - Dhruv S. Kazi
- Department of Medicine (Cardiology), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, US
| | - Andre Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Maki Komiyama
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | | | - Jeremy Lim
- Global Health Dpt, National University of Singapore Saw Swee Hock School of Public Health, Singapore
| | - Pablo Perel
- Non Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine and World Heart Federation, London, UK
| | | | | | | | - David R. Thompson
- School of Nursing and Midwifery, Queen’s University Belfast, United Kingdom
- European Association of Preventive Cardiology, Sophia Antipolis, UK
| | - Lale Tokgözoğlu
- Department of Cardiology, Hacettepe University, Ankara, Turkey
| | - Lijing L. Yan
- Global Health Research Center, Duke Kunshan University, China
| | - Clara K. Chow
- Faculty of Medicina and Health, Westmead Applied Research Centre, University of Sydney, Australia
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Lane J, Nakambale H, Kadakia A, Dambisya Y, Stergachis A, Odoch WD. A systematic scoping review of medicine availability and affordability in Africa. BMC Health Serv Res 2024; 24:91. [PMID: 38233851 PMCID: PMC10792840 DOI: 10.1186/s12913-023-10494-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/18/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND The most recent World Medicines Situation Report published in 2011 found substantial medicine availability and affordability challenges across WHO regions, including Africa. Since publication of the 2011 report, medicine availability and affordability has risen on the international agenda and was included in the Sustainable Development Goals as Target 3.8. While numerous medicine availability and affordability studies have been conducted in Africa since the last World Medicines Situation Report, there has not been a systematic analysis of the methods used in these studies, measures of medicine availability and affordability, categories of medicines studied, or geographic distribution. Filling this knowledge gap can help inform future medicine availability and affordability studies, design systems to monitor progress toward Sustainable Development Goal Target 3.8 in Africa and beyond, and inform policy and program decisions to improve medicine availability and affordability. METHODS We conducted a systematic scoping review of studies assessing medicine availability or affordability conducted in the WHO Africa region published from 2009-2021. RESULTS Two hundred forty one articles met our eligibility criteria. 88% of the articles (213/241) reported descriptive studies, while 12% (28/241) reported interventional studies. Of the 198 studies measuring medicine availability, the most commonly used measure of medicine availability was whether a medicine was in stock on the date of a survey (124/198, 63%). We also identified multiple other availability methods and measures, including retrospective stock record reviews and self-reported medicine availability surveys. Of the 59 articles that included affordability measures, 32 (54%) compared the price of the medicine to the daily wage of the lowest paid government worker. Other affordability measures were patient self-reported affordability, capacity to pay measures, and comparing medicines prices with a population-level income standard (such as minimum wage, poverty line, or per capita income). The most commonly studied medicines were antiparasitic and anti-bacterial medicines. We did not identify studies in 22 out of 48 (46%) countries in the WHO Africa Region and more than half of the studies identified were conducted in Ethiopia, Kenya, Tanzania, and/or Uganda. CONCLUSION Our results revealed a wide range of medicine availability and affordability assessment methodologies and measures, including cross-sectional facility surveys, population surveys, and retrospective data analyses. Our review also indicated a need for greater focus on medicines for certain non-communicable diseases, greater geographic diversity of studies, and the need for more intervention studies to identify approaches to improve access to medicines in the region.
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Affiliation(s)
- Jeff Lane
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA.
| | - Hilma Nakambale
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Asha Kadakia
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Yoswa Dambisya
- East Central and Southern Africa Health Community, Arusha, Tanzania
| | - Andy Stergachis
- Departments of Pharmacy and Global Health, Schools of Pharmacy and Public Health, University of Washington, Seattle, WA, USA
| | - Walter Denis Odoch
- Afya Research and Development Institute, Kampala, Uganda
- World Health Organization, Harare, Zimbabwe
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Lane J, Stergachis A. Combining legal epidemiology and implementation science to improve global access to medicines: challenges and opportunities. FRONTIERS IN HEALTH SERVICES 2024; 3:1291183. [PMID: 38264186 PMCID: PMC10803399 DOI: 10.3389/frhs.2023.1291183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/08/2023] [Indexed: 01/25/2024]
Abstract
Laws and policies affecting access to medicines have been in the global health spotlight for decades, yet our understanding of their effects remains substantially underdeveloped. The emerging field of legal epidemiology combined with the methods of implementation science presents an opportunity to help address this gap. Legal epidemiology refers to the scientific study and deployment of law as a factor in the cause, distribution, and prevention of disease and injury in a population. Legal epidemiology studies consist of a systematic collection and coding of laws and policies relating to a particular topic. Quasi-experimental or observational research methods can then be applied to take advantage of natural experiments resulting from heterogenous adoption and/or implementation of laws and policies. Often legal epidemiology studies fail to account for heterogenous law implementation processes, presenting a need and opportunity to integrate implementation science methods. Researchers may face challenges in integrating these methods for access to medicines studies, including data access issues and a complex legal and implementation environment. Yet, the opportunities presented by increasingly transparent legal environments, improved monitoring of medicine availability, universal health coverage expansion, and electronic health and insurance records integration may facilitate overcoming these challenges. Improved collaboration and communication between researchers, health authorities, manufacturers, and health providers from public and private sectors will be critical. In spite of the challenges, combining the fields of legal epidemiology and implementation science may present an important strategy toward creating a legal and policy environment that supports global and equitable access to medicines.
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Affiliation(s)
- Jeff Lane
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA, United States
| | - Andy Stergachis
- Departments of Pharmacy and Global Health, Schools of Pharmacy and Public Health, University of Washington, Seattle, WA, United States
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11
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Kunwar A, Kaur P, Durgad K, Parasuraman G, Sharma M, Gupta S, Bhargava B. Improving the availability of antihypertensive drugs in the India Hypertension Control Initiative, India, 2019-2020. PLoS One 2023; 18:e0295338. [PMID: 38096180 PMCID: PMC10721057 DOI: 10.1371/journal.pone.0295338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 11/20/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Antihypertensive drug supply is sometimes inadequate in public sector health facilities in India. One of the core strategies of the India Hypertension Control Initiative (IHCI) is to improve the availability of antihypertensive drugs in primary and secondary care facilities. We quantified the availability of antihypertensive drugs in 2019-20 and described the practices in supply chain management in 22 districts across four states of India. METHODS Twenty-two districts from 4 states (Punjab, Madhya Pradesh, Telangana, and Maharashtra) were studied. We described the practices and challenges in supply chain management. We collected data on drug procurement from 2018 to 2020 and drug availability from April 2019 to March 2020. Quantity procured, the proportion of facilities with stockout at the end of each quarter, and availability of drugs in patient days were tabulated. RESULTS All states selected drug- and dose-specific protocols with Amlodipine as the initial drug and shifted to morbidity-based forecasting. The total number of antihypertensive tablets procured for the 22 districts increased from 16 million in 2017-2018 to 160 million in 2019-2020. The proportion of facilities with Amlodipine stock-out was below 5% during the study period. Amlodipine stock was available for at least 60 patient days from the third quarter of 2019 onward in all districts. CONCLUSIONS This study demonstrates that including best practices can gradually strengthen the procurement and supply chain for antihypertensives in a low-resource setting. As the program was rapidly growing, there were still gaps in the procurement and distribution system which needed to be addressed to ensure the adequacy of drugs. We recommend that best practices, including choosing a single protocol, basing supply on projected patient load rather than an increment from historical levels, and using simple stock management tools, be replicated in other districts in India to increase and sustain coverage of hypertension treatment.
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Affiliation(s)
- Abhishek Kunwar
- Dept of Noncommunicable Diseases, WHO Country Office for India, New Delhi, India
| | - Prabhdeep Kaur
- Division of Noncommunicable Diseases, ICMR-National Institute of Epidemiology, Chennai, India
| | - Kiran Durgad
- Dept of Noncommunicable Diseases, WHO Country Office for India, New Delhi, India
| | - Ganeshkumar Parasuraman
- Division of Noncommunicable Diseases, ICMR-National Institute of Epidemiology, Chennai, India
| | | | - Sudhir Gupta
- Directorate General of Health Services, Ministry and Health, and Family Welfare, New Delhi, India
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12
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Gooden TE, Mkhoi ML, Mdoe M, Mwalukunga LJ, Senkoro E, Kibusi SM, Thomas GN, Nirantharakumar K, Manaseki-Holland S, Greenfield S. Barriers and facilitators of people living with HIV receiving optimal care for hypertension and diabetes in Tanzania: a qualitative study with healthcare professionals and people living with HIV. BMC Public Health 2023; 23:2235. [PMID: 37957584 PMCID: PMC10644467 DOI: 10.1186/s12889-023-17069-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND People living with HIV (PLWH) are at a higher risk for developing diabetes and hypertension. Often services are separate for HIV and non-communicable diseases (NCDs), but how this impacts NCD care among PLWH is unknown. We aimed to understand the barriers and facilitators for prevention, early diagnosis and safe effective care for diabetes and hypertension among PLWH. METHODS Semi-structured interviews (SSIs) were conducted with 10 healthcare professionals (HCPs) that care for PLWH, 10 HCPs that care for people with diabetes and hypertension and 16 PLWH with a comorbidity of diabetes and/or hypertension. Participants were recruited from two healthcare facilities in Dodoma, Tanzania and purposively sampled based on age and sex. Interviews were conducted in Swahili using pre-developed topic guides, audio recorded then translated verbatim into English. An inductive thematic analysis was conducted using The Framework Method. RESULTS Three themes were found: organisational/healthcare system factors, individual factors and syndemic factors. Organisational/healthcare system factors comprised the only facilitators for prevention (education on lifestyle behaviours and counselling on adherence), but included the most barriers overall: fragmented services, no protocol for NCD screening and lack of access to diagnostic equipment were barriers for early diagnosis whereas the former plus lack of continuity of NCD care were barriers for safe effective care. Individual factors comprised four sub-themes, three of which were considered facilitators: HCPs' knowledge of NCDs for early diagnosis, self-monitoring of NCDs for safe effective care and HCPs' personal practice for both early diagnosis and safe effective care. HCPs' knowledge was simultaneously a barrier for prevention and PLWH knowledge was a barrier for prevention and safe effective care. Syndemic factors comprised three sub-themes; all were barriers for prevention, early diagnosis and/or safe effective care: poverty and mental health of PLWH and HIV stigma. CONCLUSIONS Organisational/healthcare system, individual and syndemic factors were found to be interlinked with barriers and facilitators that contribute to the prevention, early diagnosis and safe effective care of diabetes and hypertension among PLWH in Tanzania; these findings can inform future initiatives for making small and large health system changes to improve the health of aging PLWH.
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Affiliation(s)
- Tiffany E Gooden
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Mkhoi L Mkhoi
- Department of Microbiology and Parasitology, University of Dodoma, Dodoma, Tanzania
| | - Mwajuma Mdoe
- Department of Public Health, University of Dodoma, Dodoma, Tanzania
| | | | | | - Stephen M Kibusi
- Department of Public Health, University of Dodoma, Dodoma, Tanzania
| | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | | | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
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Lopez-Lopez JP, Gonzalez AM, Lanza P, Lopez-Jaramillo P. Benefits of the Polypill on Medication Adherence in the Primary and Secondary Prevention of Cardiovascular Disease: A Systematic Review. Vasc Health Risk Manag 2023; 19:605-615. [PMID: 37719697 PMCID: PMC10504901 DOI: 10.2147/vhrm.s421024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/22/2023] [Indexed: 09/19/2023] Open
Abstract
Background Higher medication adherence reduces the risk of new cardiovascular events. However, there are individual and health system barriers that lead to lower adherence. The polypill has demonstrated benefits in cardiovascular morbidity and mortality mainly driven by an increase in adherence. We aim to evaluate the impact of the polypill on adherence to cardiovascular medication, its efficacy and safety in cardiovascular disease (CVD) prevention. Methods A systematic review following PRISMA guidelines was conducted. Databases were searched from January 2003 to December 2022. We included randomized, pragmatic, or real-world clinical trials and observational studies. The primary outcome was medication adherence, secondary outcomes were efficacy in cardiovascular disease in primary and secondary prevention and safety. Results From the 490 publications screened, 13 met the inclusion criteria and were incorporated into a comparative table Of those included, 70% were randomized controlled trials (RCTs) and 53.8% focused on secondary prevention. Most of the studies received a high and moderate quality rating. Self-report, pill counting and, the Morisky scale were the most frequent methods to evaluate adherence (84.6%). Compared with standard medication, the polypill improved overall medication adherence by 13%, with percentages ranging from 7.6% to 34.9%. Moreover, a potential benefit was also observed in reducing Major Adverse Cardiovascular Events (MACE), particularly in secondary prevention studies, with hazard ratios ranged between 0.43 to 0.76. Compared to standard care, the profile of side effects was similar. Conclusion The polypill is an effective, safe, and practical strategy to improve adherence in people at risk of CVD. Although there is a demonstrated benefit in reducing MACE, predominantly in secondary prevention, there are still gaps in its efficacy in primary prevention and reducing total mortality. Therefore, the importance of obtaining long-term results of the polypill effect and how this strategy can be implemented in real practice.
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Affiliation(s)
- Jose P Lopez-Lopez
- MASIRA Research Institute, Universidad de Santander (UDES), Bucaramanga, Santander, Colombia
- Department of Internal Medicine. Cardiology Unit, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Ana Maria Gonzalez
- MASIRA Research Institute, Universidad de Santander (UDES), Bucaramanga, Santander, Colombia
| | - Paola Lanza
- MASIRA Research Institute, Universidad de Santander (UDES), Bucaramanga, Santander, Colombia
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Liao F, Yousif M, Huang R, Qiao Y, Hu Y. Network pharmacology- and molecular docking-based analyses of the antihypertensive mechanism of Ilex kudingcha. Front Endocrinol (Lausanne) 2023; 14:1216086. [PMID: 37664830 PMCID: PMC10470839 DOI: 10.3389/fendo.2023.1216086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/27/2023] [Indexed: 09/05/2023] Open
Abstract
Herein, network pharmacology was used to identify the active components in Ilex kudingcha and common hypertension-related targets. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were conducted, and molecular docking was performed to verify molecular dynamic simulations. Six active components in Ilex kudingcha were identified; furthermore, 123 target genes common to hypertension were identified. Topological analysis revealed the strongly associated proteins, with RELA, AKT1, JUN, TP53, TNF, and MAPK1 being the predicted targets of the studied traditional Chinese medicine. In addition, GO enrichment analysis revealed significant enrichment of biological processes such as oxidative stress, epithelial cell proliferation, cellular response to chemical stress, response to xenobiotic stimulus, and wound healing. Furthermore, KEGG enrichment analysis revealed that the genes were particularly enriched in lipid and atherosclerosis, fluid shear stress and atherosclerosis, and other pathways. Molecular docking revealed that the key components in Ilex kudingcha exhibited good binding potential to the target genes RELA, AKT1, JUN, TP53, TNF, and IL-6. Our study results suggest that Ilex kudingcha plays a role in hypertension treatment by exerting hypolipidemic, anti-inflammatory, and antioxidant effects and inhibiting the transcription of atherosclerosis-related genes.
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Affiliation(s)
- Fei Liao
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, College of Veterinary Medicine, Sichuan Agricultural University, Wenjiang, China
- Department of Animal Husbandry and Fisheries, Guizhou Vocational College of Agriculture, Qingzhen, China
| | - Muhammad Yousif
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, College of Veterinary Medicine, Sichuan Agricultural University, Wenjiang, China
| | - Ruya Huang
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, College of Veterinary Medicine, Sichuan Agricultural University, Wenjiang, China
| | - Yanlong Qiao
- Department of Animal Husbandry and Fisheries, Guizhou Vocational College of Agriculture, Qingzhen, China
| | - Yanchun Hu
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, College of Veterinary Medicine, Sichuan Agricultural University, Wenjiang, China
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Harrison MA, Marfo AFA, Annan A, Ankrah DNA. Access to cardiovascular medicines in low- and middle-income countries: a mini review. Glob Health Res Policy 2023; 8:17. [PMID: 37221559 DOI: 10.1186/s41256-023-00301-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 05/07/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Many cardiovascular (CV) medicines are required for long term. However, with their limited resources, low- and middle-income countries (LMICs) may have challenges with access to cardiovascular medicines. The aim of this review was to provide a summary of available evidence on access to cardiovascular medicines in LMICs. METHODS We searched PubMed and Google scholar for English language articles on access to cardiovascular medicines for the period 2010-2022. We also searched for articles reporting measures for challenges in access to CV medicines from 2007 to 2022. Studies conducted in LMICs, and reporting availability and affordability were included for review. We also reviewed studies reporting affordability or availability using the World Health Organisation/Health Action International (WHO/HAI) method. Levels of affordability and availability were compared. RESULTS Eleven articles met the inclusion criteria for review on availability and affordability. Although availability appears to have improved, many countries did not meet the availability target of 80%. Between economies and within countries, there are equity gaps in access to CV medicines. Availability is lower in public health facilities than private facilities. Seven out of 11 studies reported availability less than 80%. Eight studies which investigated availability in the public sector reported less than 80% availability. Overall, CV medicines, especially combined treatments are not affordable in the majority of countries. Simultaneous achievement of availability and affordability target is low. In the studies reviewed, less than 1-53.5 days wages were required to purchase one month supply of CV medicines. Failure to meet affordability was 9-75%. Five studies showed that, on average 1.6 days' wages of the Lowest-Paid Government Worker (LPGW) was required to purchase generic CV medicines in the public sector. Efficient forecasting and procurement, increased public financing and policies to improve generic use, among others are measures for improving availability and affordability. CONCLUSIONS Significant gaps exist in access to cardiovascular medicines in LMICs, and in many low-and lower middle-income countries access to cardiovascular medicines is low. To improve access and achieve the Global Action Plan on non-communicable diseases in these countries, policy interventions must be urgently instituted.
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Affiliation(s)
- Mark Amankwa Harrison
- Pharmacy Department, Korle Bu Teaching Hospital, Korle Bu, P.O. Box 77, Accra, Ghana.
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Afia Frimpomaa Asare Marfo
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Augustine Annan
- Pharmacy Department, Korle Bu Teaching Hospital, Korle Bu, P.O. Box 77, Accra, Ghana
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Lu J, Yang T, Tang D, Zhang Y, Hu Y, Dai S, Gao X, Zhang X, Zhang G, Zhao X, Xiao X. Associations between major dietary patterns and blood pressure among Southwest Chinese: A cross-sectional analysis based on the China Multi-Ethnic Cohort (CMEC) study. Nutr Metab Cardiovasc Dis 2023; 33:987-997. [PMID: 36958972 DOI: 10.1016/j.numecd.2023.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND AND AIMS In the less developed multi-ethnic regions (LEMRs) of Southwest China, the associations between dietary patterns and blood pressure (BP) values remain unclear. We aimed to investigate such associations and related effect modifiers. METHODS AND RESULTS This study included 81,433 participants from the China Multi-Ethnic Cohort Study. Dietary intakes during the year before the interview were measured with the Quantitative Food Frequency Questionnaire. Three major dietary patterns that were highly in line with geographical and ethnic distributions of the study population, i.e., "Sichuan Basin," "Yunnan-Guizhou Plateau," and "Qinghai-Tibet Plateau," were derived using principal component factor analysis. The multilinear regression model combined with inverse probability of exposure weighting was used to estimate the associations between dietary patterns and BP values. Comparing the highest with the lowest quintiles, the Sichuan Basin dietary pattern (characterized by urban lifestyles) was associated with 2.67 mmHg lower systolic blood pressure (SBP) (95% CI: -3.07 to -2.27) and 0.89 mmHg lower diastolic blood pressure (95% CI: -1.12 to -0.65). In contrast, both the Yunnan-Guizhou Plateau (characterized by agricultural lifestyles) and the Qinghai-Tibet Plateau dietary patterns (characterized by nomadic lifestyles) showed positive associations with BP. In the stratified analysis, the associations between dietary patterns and SBP were significantly stronger in women than in men for all three kinds of dietary patterns. CONCLUSION Both major dietary patterns and their associations with BP showed a substantial disparity in LEMRs of Southwest China. Dietary patterns in regions of higher socioeconomic status are more conducive to reducing the rising of BP, especially for women and urban residents, which might provide insights into the BP control in LEMRs of Southwest China.
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Affiliation(s)
- Jiaojiao Lu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Tingting Yang
- School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
| | - Dan Tang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yuan Zhang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yifan Hu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Suyao Dai
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xufang Gao
- Chengdu Center for Disease Control and Prevention, Chengdu, China
| | - Xuehui Zhang
- School of Public Health, Kunming Medical University, Kunming, China
| | - Guiting Zhang
- Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Xing Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xiong Xiao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
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Harrison MA, Marfo AFA, Buabeng KO, Annan A, Nelson F, Boateng DP, Nkansah FA, Owusu Aboagye G, Ankrah D. Blood pressure—lowering medication prescribing, its adherence to guidelines and relationship with blood pressure control at a family medicine department. Health Sci Rep 2023; 6:e1185. [PMID: 37021012 PMCID: PMC10069237 DOI: 10.1002/hsr2.1185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/06/2023] [Accepted: 03/13/2023] [Indexed: 04/05/2023] Open
Abstract
Background In many resource‐constrained countries, control of blood pressure (BP) is low. Antihypertensive drug prescribing practices may influence BP control. However, adherence of prescribing to treatment guidelines may not be optimal in resource‐constrained settings. The aim of this study was to evaluate the pattern of blood pressure‐lowering medication prescribing, and how it adheres to treatment guidelines, and to identify the relationship between medication prescriptions and BP control. Methods It was a cross‐sectional study of hypertensive outpatients at the Korle Bu Teaching Hospital (KBTH) Family Medicine department (FMD)/Polyclinic. Data was collected with a validated structured form. Adherence of “prescribing” to recommendations of the 2017 Standard Treatment Guidelines of Ghana and 2018 European Society of Cardiology guidelines was assessed using a composite measure. We analyzed data with SPSS. Results About 81% (247/304) of patients received two or more antihypertensive drugs. Most patients (41%; 267/651) received calcium channel blockers (CCB), and 21.8% (142/651), 15.7% (102/651) and 12.7% (83/651) were on diuretics, angiotensin‐receptor blockers (ARBs) and angiotensin converting enzyme (ACE) inhibitors respectively. CCB plus RAS inhibitor (50%) was the most prescribed two‐drug combination. Number of BP drugs per patient had a statistically significant inverse relationship with BP control (beta Coefficient = –0.402; 95% Cl: 1.252–2.470; p = 0.015). The composite adherence score was 0.73 (moderate adherence) but Single‐pill combination (SPC) was poor (3.2%; n = 8). Conclusion Most patients received multiple‐pill combination treatment, and overall adherence to guidelines was suboptimal, largely owing to complex drug therapy. Number of drugs predicted BP control. Our findings suggest a need to prioritize simplified treatment, and implement other strategies to improve hypertension guideline adherence. Further research on the influence of SPC on BP control may inform future hypertension guidelines in Ghana and elsewhere in Africa.
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Affiliation(s)
- Mark Amankwa Harrison
- Pharmacy DepartmentKorle Bu Teaching HospitalAccraGhana
- Department of Pharmacy Practice, College of Health Sciences, Faculty of Pharmacy and Pharmaceutical SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Afia F. A. Marfo
- Department of Pharmacy Practice, College of Health Sciences, Faculty of Pharmacy and Pharmaceutical SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Kwame O. Buabeng
- Department of Pharmacy Practice, College of Health Sciences, Faculty of Pharmacy and Pharmaceutical SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
| | | | - Frempomaa Nelson
- Pharmacy DepartmentKorle Bu Teaching HospitalAccraGhana
- Department of Pharmacy Practice, College of Health Sciences, Faculty of Pharmacy and Pharmaceutical SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Dorcas P. Boateng
- Pharmacy DepartmentKorle Bu Teaching HospitalAccraGhana
- Department of Pharmacy Practice, College of Health Sciences, Faculty of Pharmacy and Pharmaceutical SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Florence A. Nkansah
- Pharmacy DepartmentKorle Bu Teaching HospitalAccraGhana
- Department of Pharmacy Practice, College of Health Sciences, Faculty of Pharmacy and Pharmaceutical SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Grace Owusu Aboagye
- Pharmacy DepartmentKorle Bu Teaching HospitalAccraGhana
- Department of Pharmacy Practice, College of Health Sciences, Faculty of Pharmacy and Pharmaceutical SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Daniel Ankrah
- Pharmacy DepartmentKorle Bu Teaching HospitalAccraGhana
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He J, Ouyang N, Guo X, Sun G, Li Z, Mu J, Wang DW, Qiao L, Xing L, Ren G, Zhao C, Yang R, Yuan Z, Wang C, Shi C, Liu S, Miao W, Li G, Chen CS, Sun Y. Effectiveness of a non-physician community health-care provider-led intensive blood pressure intervention versus usual care on cardiovascular disease (CRHCP): an open-label, blinded-endpoint, cluster-randomised trial. Lancet 2023; 401:928-938. [PMID: 36871573 DOI: 10.1016/s0140-6736(22)02603-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/30/2022] [Accepted: 12/09/2022] [Indexed: 03/06/2023]
Abstract
BACKGROUND Effectiveness of a non-physician community health-care provider-led intensive blood pressure intervention on cardiovascular disease has not been established. We aimed to test the effectiveness of such an intervention compared with usual care on risk of cardiovascular disease and all-cause death among individuals with hypertension. METHODS In this open-label, blinded-endpoint, cluster-randomised trial, we recruited individuals aged at least 40 years with an untreated systolic blood pressure of at least 140 mm Hg or a diastolic blood pressure of at least 90 mm Hg (≥130 mm Hg and ≥80 mm Hg for those at high risk for cardiovascular disease or if currently taking antihypertensive medication). We randomly assigned (1:1) 326 villages to a non-physician community health-care provider-led intervention or usual care, stratified by provinces, counties, and townships. In the intervention group, trained non-physician community health-care providers initiated and titrated antihypertensive medications according to a simple stepped-care protocol to achieve a systolic blood pressure goal of less than 130 mm Hg and diastolic blood pressure goal of less than 80 mm Hg with supervision from primary care physicians. They also delivered discounted or free antihypertensive medications and health coaching for patients. The primary effectiveness outcome was a composite outcome of myocardial infarction, stroke, heart failure requiring hospitalisation, and cardiovascular disease death during the 36-month follow-up in the study participants. Safety was assessed every 6 months. This trial is registered with ClinicalTrials.gov, NCT03527719. FINDINGS Between May 8 and Nov 28, 2018, we enrolled 163 villages per group with 33 995 participants. Over 36 months, the net group difference in systolic blood pressure reduction was -23·1 mm Hg (95% CI -24·4 to -21·9; p<0·0001) and in diastolic blood pressure reduction, it was -9·9 mm Hg (-10·6 to -9·3; p<0·0001). Fewer patients in the intervention group than the usual care group had a primary outcome (1·62% vs 2·40% per year; hazard ratio [HR] 0·67, 95% CI 0·61-0·73; p<0·0001). Secondary outcomes were also reduced in the intervention group: myocardial infarction (HR 0·77, 95% CI 0·60-0·98; p=0·037), stroke (0·66, 0·60-0·73; p<0·0001), heart failure (0·58, 0·42-0·81; p=0·0016), cardiovascular disease death (0·70, 0·58-0·83; p<0·0001), and all-cause death (0·85, 0·76-0·95; p=0·0037). The risk reduction of the primary outcome was consistent across subgroups of age, sex, education, antihypertensive medication use, and baseline cardiovascular disease risk. Hypotension was higher in the intervention than in the usual care group (1·75% vs 0·89%; p<0·0001). INTERPRETATION The non-physician community health-care provider-led intensive blood pressure intervention is effective in reducing cardiovascular disease and death. FUNDING The Ministry of Science and Technology of China and the Science and Technology Program of Liaoning Province, China.
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Affiliation(s)
- Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, and Tulane University Translational Science Institute, New Orleans, LA, USA.
| | - Nanxiang Ouyang
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Xiaofan Guo
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Guozhe Sun
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Zhao Li
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Jianjun Mu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Lixia Qiao
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Liying Xing
- Department of Chronic Disease Control, Disease Control and Prevention Centre of Liaoning Province, Shenyang, China
| | | | - Chunxia Zhao
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | | | - Zuyi Yuan
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chang Wang
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Chuning Shi
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Songyue Liu
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Wei Miao
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Guangxiao Li
- Department of Medical Record Management Center, First Hospital of China Medical University, Shenyang, China
| | - Chung-Shiuan Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, and Tulane University Translational Science Institute, New Orleans, LA, USA
| | - Yingxian Sun
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China.
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Carrillo-Larco RM, Guzman-Vilca WC, Xu X, Bernabe-Ortiz A. Mean systolic blood pressure above the control threshold in people with treated uncontrolled hypertension: a pooled, cross-sectional analysis of 55 national health surveys. EClinicalMedicine 2023; 57:101833. [PMID: 36793480 PMCID: PMC9923190 DOI: 10.1016/j.eclinm.2023.101833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/04/2023] [Accepted: 01/09/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The hypertension care cascade has been characterized worldwide, yet it has not been quantified how far above the blood pressure control threshold people with uncontrolled treated hypertension are. We summarized the mean systolic blood pressure (SBP; mmHg) in people treated for hypertension but SBP not <130/80. METHODS We did a cross-sectional analysis of 55 WHO STEPS Surveys (n = 10,658), comprising six world regions (Africa, Americas, Eastern Mediterranean, Europe, Southeast Asia and Western Pacific); we only included the most recent survey by country regardless of when it was conducted. Adults, men and women, aged between 25 and 69 years, with self-reported hypertension receiving antihypertensive medication and whose blood pressure was >130/80 mmHg were included. We quantified the mean SBP overall and by socio-demographic (sex, age, urban/rural location, education) and cardiometabolic (current smoking, self-reported diabetes) risk factors. FINDINGS The lowest SBP was observed in Kuwait (146.6; 95% CI: 143.8-149.4 mmHg) and the highest in Libya (171.9; 95% CI: 167.8-176.0 mmHg). In 29 countries, the SBP was higher in men, and SBP tended to be higher in older groups except in six countries. In 17 countries, the SBP was higher in rural than in urban sites, for example in Turkmenistan the SBP was 162.3 (95% CI: 158.4-166.2) mmHg in rural versus 151.6 (95% CI: 148.7-154.4) mmHg in urban areas. In 25 countries, the SBP was higher in adults with no education, for example in Benin the SBP in people without formal education was 175.3 (95% CI: 168.8-181.9) mmHg versus 156.4 (95% CI: 148.8-164.0) mmHg in people with higher education. INTERPRETATION Stronger interventions to improve and secure access to effective management are needed in most countries and specific groups, to reach hypertension control in people with hypertension already receiving antihypertensive medication. FUNDING The Wellcome Trust International Training Fellowship (214185/Z/18/Z).
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Affiliation(s)
- Rodrigo M. Carrillo-Larco
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Universidad Continental, Lima, Peru
- Corresponding author. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
| | - Wilmer Cristobal Guzman-Vilca
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
- Sociedad Científica de Estudiantes de Medicina Cayetano Heredia (SOCEMCH), Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Xiaolin Xu
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Antonio Bernabe-Ortiz
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Universidad Cientifica del Sur, Lima, Peru
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20
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Zhang J, Mao Y, Li Y, Zhao K, Xie Q, Wang K, Shi J. Association between migraine or severe headache and hypertension among US adults: A cross-sectional study. Nutr Metab Cardiovasc Dis 2023; 33:350-358. [PMID: 36604265 DOI: 10.1016/j.numecd.2022.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/02/2022] [Accepted: 11/10/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND AIMS Epidemiological evidence of the association between migraines, severe headaches, and hypertension is contradictory. Hypertension is a critical risk factor for cardiovascular diseases. Migraine is a common neurological disease and a major cause of disability worldwide. Therefore, we aimed to investigate the relationship between migraine, severe headaches, and hypertension among US adults. METHODS AND RESULTS Cross-sectional data from 5716 subjects were obtained from the National Health and Nutrition Examination Survey between 1999 and 2004. Weighted logistic regression models investigated the association between migraines, severe headaches, and hypertension. In total, 5716 subjects were enrolled in the present study, of whom 1134 (19.8%) had migraine or severe headaches. Participants with migraine were predominantly younger females and had a higher body mass index (BMI), lower educational level, lower dietary intake of potassium and calcium, lower serum levels of total cholesterol (TC), creatinine, and hemoglobin, as well as a higher estimated glomerular filtration rate (eGFR) (all P < 0.05). After fully adjusting for potential confounders, migraine or severe headaches were positively associated with hypertension (OR 1.25, 95% CI: 1.03-1.53). CONCLUSION Our study found a positive association between migraine, severe headaches, and hypertension. Further studies are needed to verify the causality of this association and elucidate the underlying mechanisms.
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Affiliation(s)
- Jing Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu, 210029, China
| | - Yukang Mao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu, 210029, China; Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, 215000, China
| | - Yansong Li
- Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu, 210029, China
| | - Kun Zhao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu, 210029, China
| | - Qiyang Xie
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu, 210029, China
| | - Kai Wang
- Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu, 210029, China.
| | - Jing Shi
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu, 210029, China.
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Oude Griep LM, Bentham J, Mahadevan P. Worldwide associations of fruit and vegetable supply with blood pressure from 1975 to 2015: an ecological study. BMJ Nutr Prev Health 2023; 6:28-38. [PMID: 37559966 PMCID: PMC10407360 DOI: 10.1136/bmjnph-2022-000455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 10/10/2022] [Indexed: 02/03/2023] Open
Abstract
Low fruit and vegetable consumption is a major modifiable risk factor for raised blood pressure (BP), but it is unknown how heterogeneity in national supply has contributed to BP trends. To address this, we characterised supply trends from 1975 to 2015 and whether it met WHO recommendations. We then examined associations with three metrics: systolic, diastolic and raised BP. We used ecological data on fruit and vegetable supply and on BP for 159 countries. We examined trends in fruit and vegetable supply from 1975 to 2015 by country and World Bank income region. Multivariable linear regression was used to examine cross-sectional associations with BP. Global fruit and vegetable supply increased from 1975 to 2015, but with heterogeneous national and regional trends. While WHO recommendations were met globally, this target was not met in almost half the countries, of which many were low-income countries. Significant associations between combined fruit and vegetable supply and raised BP were observed. Over the past four decades, combined fruit and vegetable supply has been consistently and strongly associated with lower prevalence of raised BP globally. However, the heterogeneous regional trends in fruit and vegetable supply underpin the need for international organisations and individual governments to introduce or strengthen policies for increased fruit and vegetable supply to reduce the burden of non-communicable diseases at national and global levels.
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Affiliation(s)
- Linda M Oude Griep
- NIHR Biomedical Research Centre, Diet, Anthropometry, and Physical Activity Group, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - James Bentham
- School of Mathematics, Statistics and Actuarial Science, University of Kent, Canterbury, UK
| | - Preveina Mahadevan
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
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22
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Jafar TH, Tavajoh S, de Silva HA, Naheed A, Jehan I, Kanatiwela de Silva C, Chakma N, Huda M, Legido-Quigley H. Post-intervention acceptability of multicomponent intervention for management of hypertension in rural Bangladesh, Pakistan, and Sri Lanka- a qualitative study. PLoS One 2023; 18:e0280455. [PMID: 36656903 PMCID: PMC9851540 DOI: 10.1371/journal.pone.0280455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 01/03/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND COBRA-BPS (Control of Blood Pressure and Risk Attenuation-Bangladesh, Pakistan, Sri Lanka), a multicomponent, community health-worker (CHW)-led hypertension management program, has been shown to be effective in rural communities in South Asia. This paper presents the acceptability of COBRA-BPS multicomponent intervention among the key stakeholders. METHODS We conducted post-implementation interviews of 87 stakeholder including 23 community health workers (CHWs), 19 physicians and 45 patients in 15 rural communities randomized to COBRA-BPS multicomponent intervention in in Bangladesh, Pakistan, and Sri Lanka. We used Theoretical Framework for Acceptability framework (TFA) with a focus on affective attitude, burden, ethicality, intervention coherence, opportunity cost, perceived effectiveness and self-efficacy. RESULTS COBRA-BPS multicomponent intervention was acceptable to most stakeholders. Despite some concerns about workload, most CHWs were enthusiastic and felt empowered. Physicians appreciated the training sessions and felt trusted by their patients. Patients were grateful to receive the intervention and valued it. However, patients in Pakistan and Bangladesh expressed the need for supplies of free medicines from the primary health facilities, while those in Sri Lanka were concerned about supplies' irregularities. All stakeholders favoured scaling-up COBRA-BPS at a national level. CONCLUSIONS COBRA-BPS multicomponent intervention is acceptable to the key stakeholders in Bangladesh, Pakistan and Sri Lanka. Community engagement for national scale-up of COBRA-BPS is likely to be successful in all three countries.
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Affiliation(s)
- Tazeen H. Jafar
- Program in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - Saeideh Tavajoh
- Program in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - H. Asita de Silva
- Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Aliya Naheed
- Initiative for Noncommunicable Diseases, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Imtiaz Jehan
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Chamini Kanatiwela de Silva
- Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Nantu Chakma
- Initiative for Noncommunicable Diseases, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Maryam Huda
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Helena Legido-Quigley
- Program in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
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Zhang M, Shi Y, Zhou B, Huang Z, Zhao Z, Li C, Zhang X, Han G, Peng K, Li X, Wang Y, Ezzati M, Wang L, Li Y. Prevalence, awareness, treatment, and control of hypertension in China, 2004-18: findings from six rounds of a national survey. BMJ 2023; 380:e071952. [PMID: 36631148 PMCID: PMC10498511 DOI: 10.1136/bmj-2022-071952] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/24/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To assess the recent trends in prevalence and management of hypertension in China, nationally and by population subgroups. DESIGN Six rounds of a national survey, China. SETTING China Chronic Disease and Risk Factors Surveillance, 2004-18. PARTICIPANTS 642 523 community dwelling adults aged 18-69 years (30 501 in 2004, 47 353 in 2007, 90 491 in 2010, 156 836 in 2013, 162 293 in 2015, and 155 049 in 2018). MAIN OUTCOME MEASURES Hypertension was defined as a blood pressure of ≥140/90 mm Hg or taking antihypertensive drugs. The main outcome measures were hypertension prevalence and proportion of people with hypertension who were aware of their hypertension, who were treated for hypertension, and whose blood pressure was controlled below 140/90 mm Hg. RESULTS The standardised prevalence of hypertension in adults aged 18-69 years in China increased from 20.8% (95% confidence interval 19.0% to 22.5%) in 2004 to 29.6% (27.8% to 31.3%) in 2010, then decreased to 24.7% (23.2% to 26.1%) in 2018. During 2010-18, the absolute annual decline in prevalence of hypertension among women was more than twice that among men (-0.83 percentage points (95% confidence interval -1.13 to -0.52) v -0.40 percentage points (-0.73 to -0.07)). Despite modest improvements in the awareness, treatment, and control of hypertension since 2004, rates remained low in 2018, at 38.3% (36.3% to 40.4%), 34.6% (32.6% to 36.7%), and 12.0% (10.6% to 13.4%). Of 274 million (95% confidence interval 238 to 311 million) adults aged 18-69 years with hypertension in 2018, control was inadequate in an estimated 240 million (215 to 264 million). Across all surveys, women with low educational attainment had higher prevalence of hypertension than those with higher education, but the finding was mixed for men. The gap in hypertension control between urban and rural areas persisted, despite larger improvements in diagnosis and control in rural than in urban areas. CONCLUSIONS The prevalence of hypertension in China has slightly declined since 2010, but treatment and control remain low. The findings highlight the need for improving detection and treatment of hypertension through the strengthening of primary care in China, especially in rural areas.
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Affiliation(s)
- Mei Zhang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Yu Shi
- National Clinical Research Center for Cardiovascular Diseases, Heart Failure Ward, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong Province, China
| | - Bin Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- The Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, UK
| | - Zhengjing Huang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Zhenping Zhao
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Chun Li
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Xiao Zhang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Guiyuan Han
- National Clinical Research Center for Cardiovascular Diseases, Heart Failure Ward, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong Province, China
| | - Ke Peng
- National Clinical Research Center for Cardiovascular Diseases, Heart Failure Ward, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong Province, China
| | - Xinhua Li
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- People's Medical Publishing House, Beijing, China
| | - Youfa Wang
- Global Health Institute, School of Public Health, Xi'an Jiaotong University, Xi'an, China
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- The Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, UK
| | - Limin Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Yichong Li
- National Clinical Research Center for Cardiovascular Diseases, Heart Failure Ward, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong Province, China
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Khan Mamun MMR, Sherif A. Advancement in the Cuffless and Noninvasive Measurement of Blood Pressure: A Review of the Literature and Open Challenges. BIOENGINEERING (BASEL, SWITZERLAND) 2022; 10:bioengineering10010027. [PMID: 36671599 PMCID: PMC9854981 DOI: 10.3390/bioengineering10010027] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022]
Abstract
Hypertension is a chronic condition that is one of the prominent reasons behind cardiovascular disease, brain stroke, and organ failure. Left unnoticed and untreated, the deterioration in a health condition could even result in mortality. If it can be detected early, with proper treatment, undesirable outcomes can be avoided. Until now, the gold standard is the invasive way of measuring blood pressure (BP) using a catheter. Additionally, the cuff-based and noninvasive methods are too cumbersome or inconvenient for frequent measurement of BP. With the advancement of sensor technology, signal processing techniques, and machine learning algorithms, researchers are trying to find the perfect relationships between biomedical signals and changes in BP. This paper is a literature review of the studies conducted on the cuffless noninvasive measurement of BP using biomedical signals. Relevant articles were selected using specific criteria, then traditional techniques for BP measurement were discussed along with a motivation for cuffless measurement use of biomedical signals and machine learning algorithms. The review focused on the progression of different noninvasive cuffless techniques rather than comparing performance among different studies. The literature survey concluded that the use of deep learning proved to be the most accurate among all the cuffless measurement techniques. On the other side, this accuracy has several disadvantages, such as lack of interpretability, computationally extensive, standard validation protocol, and lack of collaboration with health professionals. Additionally, the continuing work by researchers is progressing with a potential solution for these challenges. Finally, future research directions have been provided to encounter the challenges.
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Affiliation(s)
| | - Ahmed Sherif
- School of Computing Sciences and Computer Engineering, The University of Southern Mississippi, Hattiesburg, MS 39406, USA
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25
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Lamy A, Tong W, Joseph P, Gao P, Pais P, Lopez-Jaramillo P, Walli-Attaei M, Dans AL, Xavier D, Talukder S, Santoso A, Gamra H, Yusuf S. The cost implications of a polypill for primary prevention in the TIPS-3 trial. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 8:899-908. [PMID: 34962984 DOI: 10.1093/ehjqcco/qcab101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/02/2021] [Accepted: 12/23/2021] [Indexed: 12/29/2022]
Abstract
AIMS The International Polycap Study 3 (TIPS-3) trial demonstrated that a polypill containing cholesterol- and multiple blood-pressure-lowering drugs reduces cardiovascular events by 20% compared with placebo in people without cardiovascular disease. The polypill plus aspirin led to a 31% relative risk reduction in cardiovascular disease events compared with double placebo. We report regional variations in costs and affordability of a polypill based on the TIPS-3 trial. METHODS AND RESULTS Countries were categorized using World Bank economic groups: lower-middle-income, upper-middle-income, and high-income countries. Country-specific costs were obtained for hospitalization events, procedures, and non-study medications (2019 US dollars). Polypill price was based on the cheapest equivalent substitute (CES) for each component. For the polypill vs. placebo, the difference in cost over the 4.6 years of the trial was $291 [95% confidence interval (CI): $243-339] per participant in lower-middle-income countries, $1068 (95% CI: $992-1144) in upper-middle-income countries, and $48 (95% CI: -$271 to $367) in high-income countries. Results were similar for the polypill plus aspirin vs. a double placebo. In both cases, the polypill was affordable in all groups using monthly household capacity to pay or a threshold of 4% of the gross national income per capita. CONCLUSION The use of a polypill (CES) in TIPS-3 increases costs in lower-middle-income countries and upper-middle-income countries but is affordable in countries at various economic levels and is cost neutral (dominant) in high-income countries.
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Affiliation(s)
- Andre Lamy
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, DBCVSRI, 20 Copeland Avenue, Hamilton, ON L8L 2X2, Canada
| | - Wesley Tong
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, DBCVSRI, 20 Copeland Avenue, Hamilton, ON L8L 2X2, Canada
| | - Philip Joseph
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, DBCVSRI, 20 Copeland Avenue, Hamilton, ON L8L 2X2, Canada
| | - Peggy Gao
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, DBCVSRI, 20 Copeland Avenue, Hamilton, ON L8L 2X2, Canada
| | - Prem Pais
- St. John's Medical College, Division of Clinical Research and Training, Bangalore, India
| | | | - Marjan Walli-Attaei
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, DBCVSRI, 20 Copeland Avenue, Hamilton, ON L8L 2X2, Canada
| | - Antonio L Dans
- Department of Medicine, UP College of Medicine, University of the Philippines Manila, Padre Faura Street, Ermita, Manila, Metro Manila, Phillipines
| | - Denis Xavier
- St. John's Medical College, Division of Clinical Research and Training, Bangalore, India
| | | | - Anwar Santoso
- Department of Cardiology and Vascular Medicine, Universitas Indonesia, National Cardiovascular Center, Jakarta, Indonesia
| | - Habib Gamra
- Fattouma Bourguiba Hospital and University of Monastir, Monastir, Tunisia
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, DBCVSRI, 20 Copeland Avenue, Hamilton, ON L8L 2X2, Canada
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Akalu Y, Yeshaw Y, Tesema GA, Tiruneh SA, Teshale AB, Angaw DA, Gebrie M, Dagnew B. Suboptimal blood pressure control and its associated factors among people living with diabetes mellitus in sub-Saharan Africa: a systematic review and meta-analysis. Syst Rev 2022; 11:220. [PMID: 36243876 PMCID: PMC9569048 DOI: 10.1186/s13643-022-02090-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 09/29/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Suboptimal blood pressure control among people living with diabetes mellitus (DM) is one of the primary causes of cardiovascular complications and death in sub-Saharan Africa (SSA). However, there is a paucity of evidence on the prevalence and associated factors of suboptimal blood pressure control in SSA. Therefore, this review aimed to estimate its pooled prevalence and associated factors among people living with DM in SSA. METHODS: We systematically searched PubMed, African Journals OnLine, HINARI, ScienceDirect, Google Scholar, and direct Google to access observational studies conducted in SSA. Microsoft Excel spreadsheet was used to extract the data, which was exported into STATA/MP version 16.0 for further analyses. Heterogeneity across studies was checked using Cochran's Q test statistics and I2 test, and small study effect was checked using Funnel plot symmetry and Egger's statistical test at a 5% significant level. A random-effects model was used to estimate the pooled prevalence and associated factors of suboptimal blood pressure control at a 95% confidence interval (CI) and significance level of p < 0.05. RESULTS Of the 7329 articles retrieved, 21 articles were eligible for the meta-analysis. After performing random-effects model, the pooled prevalence of suboptimal blood pressure control was 69.8% (95% CI: 63.43, 76.25%). Poor adherence to antihypertensive treatment (OR = 1.7; 95% CI: 1.03-2.80, I2 = 0.0%, p = 0.531) and overweight (OR = 2.4, 95% CI: 1.57-3.68, I2 = 0.00%, p = 0.47) were significantly associated with suboptimal blood pressure control. CONCLUSIONS The prevalence of suboptimal blood pressure control among diabetic patients in SSA was high, and poor adherence to antihypertensive treatment and overweight were significantly associated with suboptimal blood pressure control. Hence, there is an urgent need for initiatives to improve and control hypertension, and preventive measures should concentrate on modifiable risk factors. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020187901.
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Affiliation(s)
- Yonas Akalu
- Department of Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia.
| | - Yigizie Yeshaw
- Department of Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia.,Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Sofonyas Abebaw Tiruneh
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Dessie Abebaw Angaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Misganew Gebrie
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Baye Dagnew
- Department of Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
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Valdez-Tiburcio O, Gonzalez-Medina A, Valdez-Valoy L, Santillan-Pascual M, Baez-Noyer N, Diaz-Montero B, Wang W, Beaney T, Poulter NR. May Measurement Month 2017-2019: an analysis of blood pressure screening results from Dominican Republic . Eur Heart J Suppl 2022; 24:F12-F15. [PMID: 36225279 PMCID: PMC9547510 DOI: 10.1093/eurheartjsupp/suac040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Arterial hypertension is the main risk factor that contributes to cardiovascular disease and represents a leading cause of morbidity and mortality globally. May Measurement Month (MMM) is a global screening campaign with the aim of improving awareness of hypertension at the individual and population level, an initiative that has been supported in the Dominican Republic (DR) since 2017. Adults (≥18 years) were recruited by sampling in different places in the DR, three blood pressure (BP) readings were performed per participant, and data on risk factors and comorbidities were collected. Hypertension was defined as systolic BP ≥140 mm Hg, diastolic BP ≥ 90 mm Hg (mean of second and third readings), and/or taking antihypertensive medication. Multiple imputation was used to estimate participants' mean BP when three readings were not available. Of 3693 participants, 2134 (57.8%) had hypertension, of whom 1646 (77.1%) were taking medication, but only 38.6% of those on treatment had their BP under control(<140/90 mmHg). The remaining 61.4% of the participants received inadequate treatment. A total of 66% of treated patients were taking a single antihypertensive drug. MMM provides an important platform for the standardized compilation of BP data and the creation of awareness of hypertension in the DR and other nations of the world. The data generated from the 2017-2019 MMM campaigns highlight the importance of adequate detection, knowledge, and control of BP.
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Affiliation(s)
| | - Angel Gonzalez-Medina
- Escuela de Medicina de Universidad Autonoma de Santo Domingo, Ciudad Universitaria, Av. Correa y Cidron, Santo Domingo 10105, Dominican Republic
| | - Laura Valdez-Valoy
- Departamento de Cardiologia Hospital Central Romana, La Romana, Batey Central #1, La Romana 22003, Dominican Republic
| | - Marcos Santillan-Pascual
- Centro de Especialidades Medicas Romana, Calle Gregorio Luperon #22, La Romana 22000, Dominican Republic
| | - Nelson Baez-Noyer
- Nelson Baez Noyer, Clinica Corominas, Santiago 51000, Dominican Republic
| | - Belianix Diaz-Montero
- Belianix Diaz-Montero, Centro Medico Pasticnet, Santo Domingo 10119, Dominican Republic
| | - Wei Wang
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Thomas Beaney
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK,Department of Primary Care and Public Health, Imperial College London, St Dunstan’s Road, London W6 8RP, UK
| | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
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Guzman-Vilca WC, Quispe-Villegas GA, Carrillo-Larco RM. Predicted heart age profile across 41 countries: A cross-sectional study of nationally representative surveys in six world regions. EClinicalMedicine 2022; 52:101688. [PMID: 36313150 PMCID: PMC9596311 DOI: 10.1016/j.eclinm.2022.101688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Predicted heart age (PHA) can simplify communicating the absolute cardiovascular disease (CVD) risk. Few studies have characterized PHA across multiple populations, and none has described whether people with excess PHA are eligible for preventive treatment for CVD. METHODS Pooled analysis of 41 World Health Organization (WHO) STEPS surveys conducted in 41 countries in six world regions between 2013 and 2019. PHA was calculated as per the non-laboratory Framingham risk score in adults without history of CVD. We described the differences between chronological age and PHA, the distribution of PHA, and the proportion of people with excess PHA that were eligible for antihypertensive and lipid-lowering treatment following the WHO guidelines. Logistic regression models were fitted to assess sociodemographic and health-related variables associated with PHA excess. FINDINGS 94,655 individuals aged 30-74 years were included. 36% of those aged 30-34 years had a PHA of 30-34 years; 9% of those aged 60-64 years had a PHA of 60-64 years. Countries in Africa had the lowest prevalence of very high PHA (i.e., PHA exceeding chronological age in ≥5 years) and countries in Western Pacific had the highest. ≥50% of the population with PHA excess (i.e., PHA exceeding chronological age in ≥1 year) was not eligible for antihypertensive nor lipid-lowering treatment. Abdominal obesity, high total cholesterol, smoking and having diabetes were associated with higher odds of having PHA excess, whereas higher education and employment were inversely associated with excess PHA. INTERPRETATION PHA is generally higher than chronological age in LMICs and there are regional disparities. Most people with excess PHA would not be eligible to receive preventive medication. FUNDING RMC-L is supported by a Wellcome Trust International Training Fellowship (214185/Z/18/Z).
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Affiliation(s)
- Wilmer Cristobal Guzman-Vilca
- School of Medicine “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Sociedad Científica de Estudiantes de Medicina Cayetano Heredia (SOCEMCH), Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gustavo A. Quispe-Villegas
- School of Medicine “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
- Sociedad Científica de Estudiantes de Medicina Cayetano Heredia (SOCEMCH), Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rodrigo M. Carrillo-Larco
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Universidad Continental, Lima, Peru
- Correspondence author at: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London.
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Chivardi C, Hutchinson B, Molina V, Moreno E, Fajardo I, Giraldo-Arcila GP, Malo HM, Ordunez P, Rodríguez-Franco R, Moran AE, Kostova D. Assessing costs of a hypertension program in primary care: evidence from the HEARTS program in Mexico. Rev Panam Salud Publica 2022; 46:e144. [PMID: 36128473 PMCID: PMC9473450 DOI: 10.26633/rpsp.2022.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/16/2022] [Indexed: 12/04/2022] Open
Abstract
Objective. In 2021, Mexico launched the HEARTS program to improve the prevention and control of cardiovascular disease (CVD) risk factors in 20 primary care facilities in the states of Chiapas and Yucatán. This study projects the annual cost of program implementation and discusses budgetary implications for scaling up the program. Methods. We obtained district-level data on treatment protocols, medication costs, and other resources required to prevent and treat CVD. We used the HEARTS Costing Tool to estimate total and per-patient costs. A “partial implementation” scenario calculated the costs of implementing HEARTS if existing pharmacological treatment protocols are left in place. The second scenario, “full implementation,” examined costs if programs use HEARTS pharmacological protocol. Results. Respectively in the partial and full implementation scenarios, total annual costs to implement and operate HEARTS were $260 023 ($32.1 per patient/year) and $255 046 ($31.5 per patient/year) in Chiapas, and $1 000 059 ($41.3 per patient/year) and $1 013 835 ($43.3 per patient/year) in Yucatán. In Chiapas, adopting HEARTS standardized treatment protocols resulted in a 9.7 % reduction in annual medication expenditures relative to maintaining status-quo treatment approaches. In Yucatán, adoption was $12 875 more expensive, in part because HEARTS hypertension treatment regimens were more intensive than status quo regimens. Conclusion. HEARTS in the Americas offers a standardized strategy to treating and controlling CVD risk factors. In Mexico, approaches that may lead to improved program affordability include adoption of the recommended HEARTS treatment protocols with preferred medications and task shifting of services from physicians to nurses and other providers.
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Affiliation(s)
- Carlos Chivardi
- National Institute of Public Health, Mexico City, Mexico; Center for Health Economics, University of York, York, United Kingdom (current)
| | - Brian Hutchinson
- Center for Global Noncommunicable Diseases, RTI International, Seattle, United States of America
| | | | - Elena Moreno
- Department of Prevention and Control of Communicable and Non-
Communicable Diseases, Institute of Health of the State of Chiapas, Tuxtla Gutierrez, Mexico
| | - Ileana Fajardo
- Directorate of Nutrition and Chronic Diseases of Yucatan Health Services,
Merida, Yucatán, Mexico
| | - Gloria P. Giraldo-Arcila
- Department of Non-Communicable Diseases and Mental Health, Pan American
Health Organization, Washington, DC, United States of America
| | | | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American
Health Organization, Washington, DC, United States of America
| | - Roxana Rodríguez-Franco
- Center of Demographic, Urban, and Environmental Studies, El Colegio de México, Mexico City, Mexico
| | | | - Deliana Kostova
- Division of Global Health Protection, Centers for Disease Control and
Prevention, Atlanta, United States of America
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Tran DN, Kangogo K, Amisi JA, Kamadi J, Karwa R, Kiragu B, Laktabai J, Manji IN, Njuguna B, Szkwarko D, Qian K, Vedanthan R, Pastakia SD. Community-based medication delivery program for antihypertensive medications improves adherence and reduces blood pressure. PLoS One 2022; 17:e0273655. [PMID: 36084087 PMCID: PMC9462824 DOI: 10.1371/journal.pone.0273655] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 08/14/2022] [Indexed: 11/18/2022] Open
Abstract
Non-adherence to antihypertensive medications is a major cause of uncontrolled hypertension, leading to cardiovascular morbidity and mortality. Ensuring consistent medication possession is crucial in addressing non-adherence. Community-based medication delivery is a strategy that may improve medication possession, adherence, and blood pressure (BP) reduction. Our program in Kenya piloted a community medication delivery program, coupled with blood pressure monitoring and adherence evaluation. Between September 2019 and March 2020, patients who received hypertension care from our chronic disease management program also received community-based delivery of antihypertensive medications. We calculated number of days during which each patient had possession of medications and analyzed the relationship between successful medication delivery and self-reported medication adherence and BP. A total of 128 patient records (80.5% female) were reviewed. At baseline, mean systolic blood pressure (SBP) was 155.7 mmHg and mean self-reported adherence score was 2.7. Sixty-eight (53.1%) patients received at least 1 successful medication delivery. Our pharmacy dispensing records demonstrated that medication possession was greater among patients receiving medication deliveries. Change in self-reported medication adherence from baseline worsened in patients who did not receive any medication delivery (+0.5), but improved in patients receiving 1 delivery (-0.3) and 2 or more deliveries (-0.8). There was an SBP reduction of 1.9, 6.1, and 15.5 mmHg among patients who did not receive any deliveries, those who received 1 delivery, and those who received 2 or more medication deliveries, respectively. Adjusted mixed-effect model estimates revealed that mean SBP reduction and self-reported medication adherence were improved among individuals who successfully received medication deliveries, compared to those who did not. A community medication delivery program in western Kenya was shown to be implementable and enhanced medication possession, reduced SBP, and significantly improved self-reported adherence. This is a promising strategy to improve health outcomes for patients with uncontrolled hypertension that warrants further investigation.
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Affiliation(s)
- Dan N. Tran
- Department of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, Pennsylvania, United States of America
| | - Kibet Kangogo
- The Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - James A. Amisi
- Department of Family Medicine, Medical Education and Community Health, Moi University School of Medicine, Eldoret, Kenya
| | - James Kamadi
- The Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Rakhi Karwa
- Department of Pharmacy Practice, Purdue University School of Pharmacy, Indianapolis, Indiana, United States of America
| | - Benson Kiragu
- The Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Jeremiah Laktabai
- Department of Family Medicine, Medical Education and Community Health, Moi University School of Medicine, Eldoret, Kenya
| | - Imran N. Manji
- Department of Clinical Pharmacy and Practice, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Benson Njuguna
- Department of Clinical Pharmacy and Practice, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Daria Szkwarko
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Kun Qian
- Department of Population Health, NYU Grossman School of Medicine, New York, United States of America
| | - Rajesh Vedanthan
- Department of Population Health, NYU Grossman School of Medicine, New York, United States of America
| | - Sonak D. Pastakia
- Department of Pharmacy Practice, Purdue University School of Pharmacy, Indianapolis, Indiana, United States of America
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Castillo-Laborde C, Hirmas-Adauy M, Matute I, Jasmen A, Urrejola O, Molina X, Awad C, Frey-Moreno C, Pumarino-Lira S, Descalzi-Rojas F, Ruiz TJ, Plass B. Barriers and Facilitators in Access to Diabetes, Hypertension, and Dyslipidemia Medicines: A Scoping Review. Public Health Rev 2022; 43:1604796. [PMID: 36120091 PMCID: PMC9479461 DOI: 10.3389/phrs.2022.1604796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/27/2022] [Indexed: 12/03/2022] Open
Abstract
Objective: Identify barriers and facilitators in access to medicines for diabetes, hypertension, and dyslipidemia, considering patient, health provider, and health system perspectives. Methods: Scoping review based on Joanna Briggs methodology. The search considered PubMed, Cochrane Library, CINAHL, Academic Search Ultimate, Web of Science, SciELO Citation Index, and grey literature. Two researchers conducted screening and eligibility phases. Data were thematically analyzed. Results: The review included 219 documents. Diabetes was the most studied condition; most of the evidence comes from patients and the United States. Affordability and availability of medicines were the most reported dimension and specific barrier respectively, both cross-cutting concerns. Among high- and middle-income countries, identified barriers were cost of medicines, accompaniment by professionals, long distances to facilities, and cultural aspects; cost of transportation emerges in low-income settings. Facilitators reported were financial accessibility, trained health workers, medicines closer to communities, and patients’ education. Conclusion: Barriers and facilitators are determined by socioeconomic and cultural conditions, highlighting the role of health systems in regulatory and policy context (assuring financial coverage and free medicines); providers’ role bringing medicines closer; and patients’ health education and disease management.
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Affiliation(s)
- Carla Castillo-Laborde
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- *Correspondence: Carla Castillo-Laborde,
| | - Macarena Hirmas-Adauy
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Isabel Matute
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Anita Jasmen
- Biblioteca Biomédica, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Oscar Urrejola
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Xaviera Molina
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Camila Awad
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Catalina Frey-Moreno
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Sofia Pumarino-Lira
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Fernando Descalzi-Rojas
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Tomás José Ruiz
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Barbara Plass
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
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Flood D, Geldsetzer P, Agoudavi K, Aryal KK, Brant LCC, Brian G, Dorobantu M, Farzadfar F, Gheorghe-Fronea O, Gurung MS, Guwatudde D, Houehanou C, Jorgensen JMA, Kondal D, Labadarios D, Marcus ME, Mayige M, Moghimi M, Norov B, Perman G, Quesnel-Crooks S, Rashidi MM, Moghaddam SS, Seiglie JA, Bahendeka SK, Steinbrook E, Theilmann M, Ware LJ, Vollmer S, Atun R, Davies JI, Ali MK, Rohloff P, Manne-Goehler J. Rural-Urban Differences in Diabetes Care and Control in 42 Low- and Middle-Income Countries: A Cross-sectional Study of Nationally Representative Individual-Level Data. Diabetes Care 2022; 45:1961-1970. [PMID: 35771765 PMCID: PMC9472489 DOI: 10.2337/dc21-2342] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 05/18/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes prevalence is increasing rapidly in rural areas of low- and middle-income countries (LMICs), but there are limited data on the performance of health systems in delivering equitable and effective care to rural populations. We therefore assessed rural-urban differences in diabetes care and control in LMICs. RESEARCH DESIGN AND METHODS We pooled individual-level data from nationally representative health surveys in 42 countries. We used Poisson regression models to estimate age-adjusted differences in the proportion of individuals with diabetes in rural versus urban areas achieving performance measures for the diagnosis, treatment, and control of diabetes and associated cardiovascular risk factors. We examined differences across the pooled sample, by sex, and by country. RESULTS The pooled sample from 42 countries included 840,110 individuals (35,404 with diabetes). Compared with urban populations with diabetes, rural populations had ∼15-30% lower relative risk of achieving performance measures for diabetes diagnosis and treatment. Rural populations with diagnosed diabetes had a 14% (95% CI 5-22%) lower relative risk of glycemic control, 6% (95% CI -5 to 16%) lower relative risk of blood pressure control, and 23% (95% CI 2-39%) lower relative risk of cholesterol control. Rural women with diabetes had lower achievement of performance measures relating to control than urban women, whereas among men, differences were small. CONCLUSIONS Rural populations with diabetes experience substantial inequities in the achievement of diabetes performance measures in LMICs. Programs and policies aiming to strengthen global diabetes care must consider the unique challenges experienced by rural populations.
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Affiliation(s)
- David Flood
- Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
- Center for Indigenous Health Research, Wuqu’ Kawoq, Tecpán, Guatemala
- Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Stanford University, Stanford, CA
- Chan Zuckerberg Biohub, San Francisco, CA
| | | | - Krishna K. Aryal
- Public Health Promotion and Development Organization, Kathmandu, Nepal
| | - Luisa Campos Caldeira Brant
- Serviço de Cardiologia e Cirurgia Cardiovascular, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Garry Brian
- The Fred Hollows Foundation New Zealand, Auckland, New Zealand
| | - Maria Dorobantu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Oana Gheorghe-Fronea
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Cardiology Department, Emergency Hospital Bucharest, Bucharest, Romania
| | | | - David Guwatudde
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Corine Houehanou
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | | | - Dimple Kondal
- Public Health Foundation of India, Gurugram, India
- Centre for Chronic Disease Control, New Delhi, India
| | - Demetre Labadarios
- Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Maja E. Marcus
- Department of Economics and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Mary Mayige
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Mana Moghimi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bolormaa Norov
- Division of Nutrition, National Center for Public Health, Ulaanbaatar, Mongolia
| | - Gastón Perman
- Department of Public Health, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Sarah Quesnel-Crooks
- Non-Communicable Diseases, Caribbean Public Health Agency, Port of Spain, Trinidad and Tobago
| | - Mohammad-Mahdi Rashidi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Silver K. Bahendeka
- Saint Francis Hospital Nsambya, Kampala, Uganda
- Uganda Martyrs University, Kampala, Uganda
| | | | - Michaela Theilmann
- Heidelberg Institute of Global Health, Heidelberg University and University Hospital, Heidelberg, Germany
| | - Lisa J. Ware
- South African Medical Research Council–Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Innovation–National Research Foundation Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA
| | - Justine I. Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, U.K
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Mohammed K. Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA
| | - Peter Rohloff
- Center for Indigenous Health Research, Wuqu’ Kawoq, Tecpán, Guatemala
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Sorato MM, Davari M, Kebriaeezadeh A, Sarrafzadegan N, Shibru T. Antihypertensive prescribing pattern, prescriber adherence to ISH 2020 guidelines, and implication of outpatient drug price on blood pressure control at selected hospitals in Southern Ethiopia. Eur J Clin Pharmacol 2022; 78:1487-1502. [PMID: 35708747 DOI: 10.1007/s00228-022-03352-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 06/08/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine the impact of drug prescribing pattern, outpatient drug price of medicines, and level of adherence to evidence-based international guidelines on blood pressure (BP) control at selected hospitals in Southern Ethiopia. METHODS Hospital-based cross-sectional study was conducted. The data entry and analysis were done by using SPSS version 21.0. RESULTS A mean age of participants was 55.87 ± 11.02 years. The rate of BP control was 17.5% based on International Society of Hypertension (ISH) guidelines 2020. In about two-thirds of patients, 270 (66.5%) were taking combination therapy. Mean annual cost of drugs for hypertension was 11.39 ± 3.98 US dollar (USD). Treatment was affordable for only 91 (22.4%) of patients. There was considerable variation on prescriber's adherence to evidence-based guidelines. Body mass index (BMI) of 18-24.9 kg/m2, adjusted odds ratio (AOR) = 3.63 (95% confidence interval (C.I), 1.169-11.251, p = 0.026), physically activity, AOR = 12.69 (95% C.I, 1.424-113.17, p = 0.023), presence of no comorbidity, AOR = 12.82 (95% C.I, 4.128-39.816, p = 0.000), and taking affordable antihypertensive regimen, AOR = 3.493 (95% C.I, 1.4242-9.826, p = 0.018), were positively associated BP control. CONCLUSION The level of BP control, affordability of drugs for the management of hypertension and related comorbidities, and the prescriber's adherence to evidence-based guidelines were inadequate. Therefore, addressing factors associated with good BP control including affordability and clinician adherence to evidence-based guidelines by responsible stakeholders could improve BP control and reduce associated complications.
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Affiliation(s)
- Mende Mensa Sorato
- Tehran University of Medical Sciences, Tehran, Iran. .,College of Medicine and Health Sciences, Department of Pharmacy, Arba Minch University, Arba Minch, Ethiopia.
| | - Majid Davari
- Faculty of Pharmacy, Department of Pharmacoeconomics and Pharmaceutical Administration, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Kebriaeezadeh
- Faculty of Pharmacy, Department of Pharmacoeconomics and Pharmaceutical Administration, Tehran University of Medical Sciences, Tehran, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, WHO Collaborating Center in EMR, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Tamiru Shibru
- College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Birhanu MM, Evans RG, Zengin A, Riddell M, Kalyanram K, Kartik K, Suresh O, Thomas NJ, Srikanth VK, Thrift AG. Absolute cardiovascular risk scores and medication use in rural India: a cross-sectional study. BMJ Open 2022; 12:e054617. [PMID: 35459666 PMCID: PMC9036467 DOI: 10.1136/bmjopen-2021-054617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES We compared the performance of laboratory-based cardiovascular risk prediction tools in a low-income and middle-income country setting, and estimated the use of antihypertensive and lipid-lowering medications in those deemed at high risk of a cardiovascular event. DESIGN A cross-sectional study. SETTING The study population comprised adult residents (aged ≥18 years) of the Rishi Valley region located in Chittoor District, south-western Andhra Pradesh, India. PARTICIPANTS 7935 participants were surveyed between 2012 and 2015. We computed the 10-year cardiovascular risk and undertook pair-to-pair analyses between various risk tools used to predict a fatal or non-fatal cardiovascular event (Framingham Risk Score (FRS), World Health Organization Risk Score (WHO-RS) and Australian Risk Score (ARS)), or a fatal cardiovascular event (Systematic COronary Risk Evaluation (SCORE-high and SCORE-low)). Concordance was assessed by ordinary least-products (OLP) regression (for risk score) and quadratic weighted kappa (κw, for risk category). RESULTS Of participants aged 35-74 years, 3.5% had prior cardiovascular disease. The relationships between risk scores were quasi-linear with good agreement between the FRS and ARS (OLP slope=0.96, κw=0.89). However, the WHO-RS underestimated cardiovascular risk compared with all other tools. Twenty per cent of participants had ≥20% risk of an event using the ARS; 5% greater than the FRS and nearly threefold greater than the WHO-RS. Similarly, 16% of participants had a risk score ≥5% using SCORE-high which was 6% greater than for SCORE-low. Overall, absolute cardiovascular risk increased with age and was greater in men than women. Only 9%-12% of those deemed 'high risk' were taking lipid-lowering or antihypertensive medication. CONCLUSIONS Cardiovascular risk prediction tools perform disparately in this setting of disadvantage. Few deemed at high risk were receiving the recommended treatment.
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Affiliation(s)
- Mulugeta Molla Birhanu
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Roger G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Clayton, Victoria, Australia
| | - Ayse Zengin
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Michaela Riddell
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Kartik Kalyanram
- Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh, India
| | - Kamakshi Kartik
- Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh, India
| | - Oduru Suresh
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
- Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh, India
| | - Nihal Jacob Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Velandai K Srikanth
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
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Carrillo-Larco RM, Guzman-Vilca WC, Neupane D. Estimating the gap between demand and supply of medical appointments by physicians for hypertension care: a pooled analysis in 191 countries. BMJ Open 2022; 12:e059933. [PMID: 35379646 PMCID: PMC8981295 DOI: 10.1136/bmjopen-2021-059933] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION With a growing number of people with hypertension, the limited number of physicians could not provide treatment to all patients. We quantified the gap between medical appointments available and needed for hypertension care, overall and in relation to hypertension treatment cascade metrics. METHODS Ecological descriptive analysis. We combined country-year-specific data on hypertension prevalence, awareness, treatment and control (from Non-Communicable Disease Risk Factor Collaboration) and number of physicians (from WHO). We estimated from 1 to 12 medical appointments per year for patients with hypertension. We assumed that physicians could see 25 patients per day, work 200 days/year and dedicate 10% of their time to hypertension care. RESULTS We studied 191 countries. Forty-one countries would not have enough physicians to provide at least one medical appointment per year to all the population with hypertension; these countries were low/lower middle income and in sub-Saharan Africa or East Asia and Pacific. Regardless of the world region, ≥50% of countries would not have enough physicians to provide ≥8 medical appointments to their population with hypertension. Countries where the demand exceeded the offer of medical appointments for hypertension care had worse hypertension diagnosis, treatment and control rates than countries where the demand did not exceed the offer. There were positive correlations between the physician density and hypertension diagnosis (r=0.70, p<0.001), treatment (r=0.70, p<0.001) and control (r=0.59, p<0.001). CONCLUSIONS Where physicians are the only healthcare professionals allowed to prescribe antihypertensive medications, particularly in low and middle-income countries, the healthcare system may struggle to deliver antihypertensive treatment to patients with hypertension.
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Affiliation(s)
- Rodrigo M Carrillo-Larco
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Universidad Continental, Lima, Peru
| | - Wilmer Cristobal Guzman-Vilca
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine "Alberto Hurtado", Universidad Peruana Cayetano Heredia, Lima, Peru
- Sociedad Científica de Estudiantes de Medicina Cayetano Heredia (SOCEMCH), Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Dinesh Neupane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Lotfizadeh A, Palafox B, Takallou A, Balabanova D, McKee M, Murphy A. Factors associated with the availability and affordability of essential cardiovascular disease medicines in low- and middle-income countries: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000072. [PMID: 36962256 PMCID: PMC10021589 DOI: 10.1371/journal.pgph.0000072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/24/2021] [Indexed: 11/19/2022]
Abstract
Despite their potential to prevent or delay the onset and progression of cardiovascular disease (CVD), medicines for CVD remain unavailable and unaffordable to many in low- and middle-income countries (LMICs). We systematically reviewed the literature to identify factors associated with availability and affordability of CVD medicines in LMICs. A protocol for this study was registered on the PROSPERO register of systematic reviews (CRD42019135393). We searched Medline, EMBASE, Global Health, Cumulative Index to Nursing and Allied Health Literature, EconLit, Social Policy and Practice, and Africa Wide Information for studies analyzing factors associated with the presence of medicines (availability) or the price of these medicines as it relates to ability to pay (affordability) in LMICs. We performed a narrative synthesis of the results using an access to medicines framework that examines influences at different levels of the health system. We did not conduct a meta-analysis because of the differences in analytic approaches and outcome measures in different studies. The search was conducted in accordance with PRISMA guidelines. Of 43 studies meeting inclusion criteria, 41 were cross-sectional. Availability and affordability were defined and measured in different ways. A range of factors such as sociodemographic characteristics, facility tier, presence of medicines on national essential medicine lists, and international subsidy programs were examined. The studies had variable quality and findings were often inconsistent. We find gaps in the literature on factors associated with availability and affordability of CVD medicines, particularly at the health program level. We conclude that there is a need for experimental and quasi-experimental studies that could identify causal factors and effective responses. Such studies would help further our understanding of how complex multifactorial influences impact these outcomes, which could inform policy decisions. Along with this, greater standardization of definitions and measurement approaches of availability and affordability are needed to allow for more effective comparisons.
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Affiliation(s)
- Ali Lotfizadeh
- PASHA, Los Angeles, California, United States of America
- Department of Health Services Research and Policy, Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Benjamin Palafox
- Department of Health Services Research and Policy, Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Armin Takallou
- School of Medicine, Oregon Health and Science University, Portland, Oregon, United States of America
| | - Dina Balabanova
- Department of Global Health and Development, Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Martin McKee
- Department of Health Services Research and Policy, Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Adrianna Murphy
- Department of Health Services Research and Policy, Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Hakim S, Chowdhury MAB, Ahmed NU, Uddin MJ. The availability of essential medicines for diabetes at health facilities in Bangladesh: evidence from 2014 and 2017 national surveys. BMC Health Serv Res 2022; 22:377. [PMID: 35317808 PMCID: PMC8941751 DOI: 10.1186/s12913-022-07738-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 03/01/2022] [Indexed: 11/12/2022] Open
Abstract
Background Bangladesh ranks among the world’s top ten countries in the number of diabetic patients. The prevention of this disease requires treating patients with essential medicines, and the first crucial step in the uptake of these medicines is availability. We aimed to assess the availability of essential medicines for diabetes (EM-Diabetes) and to explore health facility characteristics associated with the availability of those medicines. Methods We performed the analysis using nationally representative data from the two waves of the cross-sectional Bangladesh Health Facility Survey (BHFS) in 2014 and 2017. Data are available for 1548 and 1524 health facilities in the 2014 and 2017 BHFS. Study samples of this study were 217 facilities (73 from 2014 and 144 from 2017) that offer diabetes diagnosis and treatment services. The outcome variable ‘EM-Diabetes availability’ was calculated as a counting score of the tracer medicines: metformin, glibenclamide, injectable insulin, and injectable glucose solution. A multivariable Poisson regression model was used to identify the health facility characteristics (such as, managing authority, location, external supervision, regular quality assurance activities, national guidelines for diagnosis and management of diabetes, etc.) associated with EM-Diabetes availability. Results Since 2014, there have been minimal increases in Bangladeshi health facilities that provide diabetes screening and treatment services (from 4.7% to 9.4%). Among facilities offering diabetes services, 64.5% (BHFS 2014) and 55.7% (BHFS 2017) facilities had no EM-Diabetes on-site at all. Between 2014 and 2017, the availability of metformin increased (from 27.5% to 40.1%), but there was a decrease in the availability of glibenclamide (from 16.5% to 9.1%), injectable insulin (from 20.4% to 11.4%), and injectable glucose solution (from 20.4% to 19.2%). Furthermore, publicly owned facilities [relative risk (RR) = 0.44, 95% confidence interval (CI): 0.25–0.78 for 2014 and RR= 0.54, 95% CI: 0.41–0.71 for 2017] and facilities in rural settings [RR= 0.26, 95% CI: 0.12–0.55 for 2014 and RR= 0.60, 95% CI: 0.44–0.81 for 2017] were significantly associated with decreased availability of EM-Diabetes in both survey years. Moreover, routine user fees [RR=3.70, 95% CI: 1.86–7.38] and regular quality assurance activities [RR= 1.62, 95% CI: 1.12–2.34] were also significantly associated with increased EM-Diabetes availability in 2017 only. Conclusions Overall, the health facilities in Bangladesh had insufficient essential medicines for treating diabetes. In general, the availability of EM-Diabetes declined from 2014 to 2017, except for metformin. Policymakers should consider a wide range of policy implications, focusing on the management of public facilities, rural facilities, routine user fees, and quality assurance activities to improve the availability of EM-Diabetes at health facilities in Bangladesh.
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Affiliation(s)
- Shariful Hakim
- Department of Statistics, Shahjalal University of Science & Technology, Sylhet, 3114, Bangladesh.,Chander Hat Degree College, Nilphamari, Bangladesh
| | | | - Nasar U Ahmed
- Department of Epidemiology, Florida International University, Miami, FL, USA
| | - Md Jamal Uddin
- Department of Statistics, Shahjalal University of Science & Technology, Sylhet, 3114, Bangladesh.
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Metz M, Pierre JL, Yan LD, Rouzier V, St‐Preux S, Exantus S, Preval F, Roberts N, Tymejczyk O, Malebranche R, Deschamps MM, Pape JW, McNairy ML. Hypertension continuum of care: Blood pressure screening, diagnosis, treatment, and control in a population-based cohort in Haiti. J Clin Hypertens (Greenwich) 2022; 24:246-254. [PMID: 35199944 PMCID: PMC8925011 DOI: 10.1111/jch.14399] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/30/2021] [Accepted: 11/09/2021] [Indexed: 01/13/2023]
Abstract
Cardiovascular disease (CVD) is the number one cause of death in low-income countries including Haiti, with hypertension (HTN) being the leading risk factor. This study aims to identify gaps in the HTN continuum of screening, diagnosis, treatment, and blood pressure (BP) control. Sociodemographic and clinical data were collected from a population-based sample of adults ≥18 years in Port-au-Prince (PAP) from March 2019 to April 2021. HTN was defined as systolic BP ≥ 140 mmHg, diastolic BP ≥ 90 mmHg, or use of antihypertensive medication. Screening was defined as ever having had a BP measurement; diagnosis as previously being informed of a HTN diagnosis; treatment as having taken antihypertensives in the past 2 weeks; and controlled as taking antihypertensives and having BP < 140/90 mmHg. Factors associated with attaining each step in the continuum were assessed using Poisson multivariable regressions. Among 2737 participants, 810 (29% age-standardized) had HTN, of whom 97% had been screened, 72% diagnosed, 45% treated, and 13% controlled. There were no significant differences across age groups or sex. Obesity (BMI ≥ 30) was a significant factor associated with receiving treatment compared to normal weight (BMI < 25), with a prevalence ratio (PR) of 1.5 (95% CI 1.1-2.0). Having secondary or higher education was associated with higher likelihood of controlled BP (PR 1.9 [95% CI 1.1-3.3]). In this urban Haitian population, the greatest gaps in HTN care are treatment and control. Targeted interventions are needed to improve these steps, including broader access to affordable treatment, timely distribution of medications, and patient adherence to HTN medication.
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Affiliation(s)
- Miranda Metz
- Center for Global HealthDepartment of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Jean Lookens Pierre
- GHESKIOHaitian Group for the Study of Kaposi's Sarcoma and Opportunistic InfectionsPort‐au‐PrinceHaiti
| | - Lily Du Yan
- Center for Global HealthDepartment of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
- Division of General Internal MedicineDepartment of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Vanessa Rouzier
- GHESKIOHaitian Group for the Study of Kaposi's Sarcoma and Opportunistic InfectionsPort‐au‐PrinceHaiti
- Division of General Internal MedicineDepartment of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Stephano St‐Preux
- GHESKIOHaitian Group for the Study of Kaposi's Sarcoma and Opportunistic InfectionsPort‐au‐PrinceHaiti
| | - Serfine Exantus
- GHESKIOHaitian Group for the Study of Kaposi's Sarcoma and Opportunistic InfectionsPort‐au‐PrinceHaiti
| | - Fabyola Preval
- GHESKIOHaitian Group for the Study of Kaposi's Sarcoma and Opportunistic InfectionsPort‐au‐PrinceHaiti
| | - Nicholas Roberts
- Center for Global HealthDepartment of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Olga Tymejczyk
- City University of New York Institute for Implementation Science in Population HealthNew YorkNew YorkUSA
| | | | - Marie Marcelle Deschamps
- GHESKIOHaitian Group for the Study of Kaposi's Sarcoma and Opportunistic InfectionsPort‐au‐PrinceHaiti
| | - Jean W. Pape
- GHESKIOHaitian Group for the Study of Kaposi's Sarcoma and Opportunistic InfectionsPort‐au‐PrinceHaiti
| | - Margaret L. McNairy
- Center for Global HealthDepartment of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
- Division of General Internal MedicineDepartment of MedicineWeill Cornell MedicineNew YorkNew YorkUSA
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Dai S, Xiao X, Xu C, Jiao Y, Qin Z, Meng J, Zuo H, Zeng P, Tang D, Wu X, Nima Q, Quzong D, Zhao X. Association of Dietary Approaches to Stop Hypertension diet and Mediterranean diet with blood pressure in less-developed ethnic minority regions. Public Health Nutr 2022; 25:1-29. [PMID: 35029141 PMCID: PMC9991676 DOI: 10.1017/s1368980022000106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We aimed to investigate the association of Dietary Approaches to Stop Hypertension (DASH)-style diet and Mediterranean-style diet with blood pressure in less-developed ethnic minority regions (LMERs). DESIGN Cross-sectional study. SETTING Dietary intakes were assessed by a validated food frequency questionnaire. Dietary quality was assessed by the DASH-style diet score and the alternative Mediterranean-style diet (aMED) score. The association between dietary quality and blood pressure was evaluated using multivariate linear regression model. We further examined those associations in subgroups of blood pressure level. PARTICIPANTS A total of 81433 adults from the China Multi-Ethnic Cohort (CMEC) study were included in this study. RESULTS In the overall population, compared with the lowest quintile, the highest quintile of DASH-style diet score was negatively associated with systolic BP (coefficient: -2.78, 95% CI: -3.15 to -2.41; P-trend<0.001), while the highest quintile of aMED score had a weaker negative association with systolic BP (coefficient: -1.43, 95% CI: -1.81 to -1.05; P-trend<0.001). Both dietary indices also showed a weaker effect on diastolic BP (coefficient for DASH-style diet: -1.06, 95% CI: -1.30 to -0.82; coefficient for aMED: -0.43, 95% CI: -0.68 to -0.19). In the subgroup analysis, both dietary indices showed a stronger beneficial effect on systolic BP in the hypertension group than in either of the other subgroups. CONCLUSION Our results indicated that the healthy diet originating from Western developed countries can also have beneficial effects on blood pressure in LEMRs. DASH-style diet may be a more appropriate recommendation than aMED as part of a dietary strategy to control blood pressure, especially in hypertensive patients.
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Affiliation(s)
- Suyao Dai
- West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Renmin South Road, Chengdu, Sichuan610041, China
| | - Xiong Xiao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Renmin South Road, Chengdu, Sichuan610041, China
| | - Chuanzhi Xu
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Yan Jiao
- Chongqing Municipal Centre for Disease Control and Prevention, Chongqing, China
| | - Zixiu Qin
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, Guizhou, China
| | - Jiantong Meng
- Chengdu Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Haojiang Zuo
- West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Renmin South Road, Chengdu, Sichuan610041, China
| | - Peibin Zeng
- West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Renmin South Road, Chengdu, Sichuan610041, China
| | - Dan Tang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Renmin South Road, Chengdu, Sichuan610041, China
| | - Xinyu Wu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Renmin South Road, Chengdu, Sichuan610041, China
| | - Qucuo Nima
- Tibet Centre for Disease Control and Prevention CN, No. 21, Linkuo North Road, Chengguan District, Lhasa, Tibet Autonomous Region850000, China
| | - Deji Quzong
- Tibet University, No.10, East Tibet University Road, Lhasa, Tibet Autonomous Region850000, China
| | - Xing Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Renmin South Road, Chengdu, Sichuan610041, China
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Cavagna P, Takombe JL, Damorou JM, Kouam Kouam C, Diop IB, Ikama SM, Kramoh KE, Ali Toure I, Balde D, Dzudie A, Ferreira B, Houenassi M, Kane A, Kimbally-Kaki SG, Kingue S, Limbole E, Mfeukeu Kuate L, Mipinda JB, N'Guetta R, Nhavoto C, Sidy Ali A, Gaye B, Tajeu GS, Macquart De Terline D, Perier MC, Azizi M, Jouven X, Antignac M. Blood pressure-lowering medicines implemented in 12 African countries: the cross-sectional multination EIGHT study. BMJ Open 2021; 11:e049632. [PMID: 34857562 PMCID: PMC8640662 DOI: 10.1136/bmjopen-2021-049632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE In Africa, the number of patients with hypertension is expected to reach 216.8 million by 2030. Large-scale data on antihypertensive medications used in Sub-Saharan Africa (SSA) are scarce.Here, we describe antihypertensive drug strategies and identify treatment factors associated with blood pressure (BP) control in 12 Sub-Saharan countries. SETTING Outpatient consultations for hypertension in urban tertiary cardiology centres of 29 hospitals from 17 cities across 12 SSA countries between January 2014 and November 2015. PARTICIPANTS Patients ≥18 years of age with hypertension were enrolled at any visit during outpatient consultations in the cardiology departments MAIN OUTCOME MEASURE: We collected BP levels, demographic characteristics and antihypertensive treatment use (including traditional medicine) of patients with hypertension attending outpatient visits. BP control was defined as seated office BP <140/90 mm Hg. We used logistic regression with a random effect on countries to assess factors of BP control. RESULTS Overall, 2198 hypertensive patients were included and a total of 96.6% (n=2123) were on antihypertensive medications. Among treated patients, 653 (30.8%) patients received a monotherapy by calcium channel blocker (n=324, 49.6%), renin-angiotensin system blocker (RAS) (n=126, 19.3%) or diuretic (n=122, 18.7%). Two-drug strategies were prescribed in 927 (43.6%) patients including mainly diuretics and RAS (n=327, 42% of two-drug strategies). Prescriptions of three-drugs or more were used in 543 (25.6%) patients. Overall, among treated patients, 1630 (76.7%) had uncontrolled BP, of whom 462 (28.3%) had BP levels ≥180/110 mm Hg, mainly in those on monotherapy. After adjustment for sociodemographic factors, the use of traditional medicine was the only factor significantly associated with uncontrolled BP (OR 1.72 (1.19 to 2.49) p<0.01). CONCLUSION Our study provided large-scale data on antihypertensive prescriptions in the African continent. Among patients declared adherent to drugs, poor BP control was significantly associated with the use of traditional medicine.
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Affiliation(s)
- Pauline Cavagna
- Department of Pharmacy, St Antoine Hospital, AP-HP Sorbonne Université, Paris, France
- Université de Paris, PARCC, INSERM, F-75015 Paris, France, Paris, France
| | - Jean Laurent Takombe
- Department of Internal Medicine, General Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | | | | | - Stephane Méo Ikama
- Cardiology, National University Hospital of Brazzaville, Marien NGOUABI University, Brazzaville, Congo
| | - Kouadio Euloge Kramoh
- Cardiology, Institute of Cardiology of Abidjan (Côte d'Ivoire), BPV 206, abidjan, Côte d'Ivoire
| | - Ibrahim Ali Toure
- Internal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niamey, Niger
| | - Dadhi Balde
- Cardiology, University Hospital of Conakry, Conakry, Guinea
| | - Anastase Dzudie
- Cardiac Intensive Care & Cardiac Pacing Unit, Douala General Hospital, Douala, Cameroon
| | | | - Martin Houenassi
- National University Hospital of Hubert K. MAGA (CNHU-HKM), Cotonou, Benin
| | - Adama Kane
- Cardiology, St Louis Hospital, Dakar, Senegal
| | - Suzy Gisele Kimbally-Kaki
- Cardiology, National University Hospital of Brazzaville, Marien NGOUABI University, Brazzaville, Congo
| | - Samuel Kingue
- University of Yaoundé, Ministry of Public Health, Yaoundé, Cameroon
| | - Emmanuel Limbole
- Cardiology, University of Medicine of Kinshasa, Kinshasa, Democratic Republic of the Congo
- Department of Internal Medicine of la Gombe (CMCG), Department of Internal Medicine, Ngaliema Hospital, Kinshasa, Democratic Republic of the Congo
| | | | | | - Roland N'Guetta
- Cardiology, Institute of Cardiology of Abidjan (Côte d'Ivoire), BPV 206, abidjan, Côte d'Ivoire
| | | | | | - Bamba Gaye
- Université de Paris, PARCC, INSERM, F-75015 Paris, France, Paris, France
| | - Gabriel S Tajeu
- Department of Health Services Administration Cardiology Clinics and Policy, Temple University, Philadelphia, Pennsylvania, USA
| | - Diane Macquart De Terline
- Department of Pharmacy, St Antoine Hospital, AP-HP Sorbonne Université, Paris, France
- Université de Paris, PARCC, INSERM, F-75015 Paris, France, Paris, France
| | | | - Michel Azizi
- Hypertension Unit, European Georges Pompidou Hospital, AP-HP Centre, Paris, France
- INSERM, Centre d'Investigation Clinique 1418, Paris, France
- Cardiovascular epidemiology department, University of Paris, Paris, France
| | - Xavier Jouven
- Université de Paris, PARCC, INSERM, F-75015 Paris, France, Paris, France
- Cardiovascular epidemiology department, University of Paris, Paris, France
- Cardiology, European Georges Pompidou Hospital, AP-HP Centre, Paris, France
| | - Marie Antignac
- Department of Pharmacy, St Antoine Hospital, AP-HP Sorbonne Université, Paris, France
- Université de Paris, PARCC, INSERM, F-75015 Paris, France, Paris, France
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41
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Balouchi A, Rafsanjani MHAP, Al-Mutawaa K, Naderifar M, Rafiemanesh H, Ebadi A, Ghezeljeh TN, Shahraki-Mohammadi A, Al-Mawali A. Hypertension and pre-hypertension in Middle East and North Africa (MENA): A meta-analysis of prevalence, awareness, treatment, and control. Curr Probl Cardiol 2021; 47:101069. [PMID: 34843808 DOI: 10.1016/j.cpcardiol.2021.101069] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/11/2021] [Accepted: 11/21/2021] [Indexed: 01/03/2023]
Abstract
Hypertension (HTN) is one of the most important public health challenges, especially in developing countries. Despite individual studies, information on the exact prevalence of prehypertension (pre-HTN) and HTN in the Middle East and North Africa (MENA) is lacking. This meta-analysis was conducted to evaluate prevalence of pre-HTN and HTN, awareness, treatment, and control in the MENA region. PubMed, Web of Science, and Scopus databases were searched from inception to April 30, 2021. Keywords included hypertension, pre-hypertension, awareness, treatment, and control. The quality of the included studies was evaluated using the Hoy scale. A random-effects model was evaluated based on overall HTN. The heterogeneity of the preliminary studies was evaluated using the I2 test. A total of 147 studies involving 1,312,244 participants were included in the meta-analysis. Based on the results of the random-effects method (95% CI), the Prevalence of pre-HTN and HTN were 30.6% (95% CI: 25.2, 36.0%; I2 = 99.9%), and 26.2% (95% CI: 24.6, 27.9%; I2 = 99.8%), respectively. The prevalence of HTN awareness was 51.3% (95% CI: 47.7, 54.8; I2 = 99.0%). The prevalence of HTN treatment was 47.0% (95% CI: 34.8, 59.2; I2 = 99.9%). The prevalence of HTN control among treated patients was 43.1% (95% CI: 38.3, 47.9; I2 = 99.3%). Considering the high prevalence of HTN, very low awareness, and poor HTN control in the region, more attention should be paid to preventive programs for HTN reduction.
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Affiliation(s)
- Abbas Balouchi
- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | | | - Kholoud Al-Mutawaa
- Senior consultant community Medicine, Head of Non-communicable Disease Department, Ministry of Public Health, Doha, Qatar
| | - Mahin Naderifar
- Department of Nursing, Zabol University of Medical Sciences, Zabol, Iran
| | | | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Tahereh Najafi Ghezeljeh
- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Azita Shahraki-Mohammadi
- Assistant Professor of Medical Library and Information Sciences, Department of medical library and information sciences, Paramedical school, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Adhra Al-Mawali
- Director/Centre of Studies & Research, Ministry of Health, Oman.
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Riddell MA, Mini GK, Joshi R, Thrift AG, Guggilla RK, Evans RG, Thankappan KR, Chalmers K, Chow CK, Mahal AS, Kalyanram K, Kartik K, Suresh O, Thomas N, Maulik PK, Srikanth VK, Arabshahi S, Varma RP, D'Esposito F, Oldenburg B. ASHA-Led Community-Based Groups to Support Control of Hypertension in Rural India Are Feasible and Potentially Scalable. Front Med (Lausanne) 2021; 8:771822. [PMID: 34881267 PMCID: PMC8645590 DOI: 10.3389/fmed.2021.771822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/27/2021] [Indexed: 12/14/2022] Open
Abstract
Background: To improve the control of hypertension in low- and middle-income countries, we trialed a community-based group program co-designed with local policy makers to fit within the framework of India's health system. Trained accredited social health activists (ASHAs), delivered the program, in three economically and developmentally diverse settings in rural India. We evaluated the program's implementation and scalability. Methods: Our mixed methods process evaluation was guided by the United Kingdom Medical Research Council guidelines for complex interventions. Meeting attendance reports, as well as blood pressure and weight measures of attendees and adherence to meeting content and use of meeting tools were used to evaluate the implementation process. Thematic analysis of separate focus group discussions with participants and ASHAs as well as meeting reports and participant evaluation were used to investigate the mechanisms of impact. Results: Fifteen ASHAs led 32 community-based groups in three rural settings in the states of Kerala and Andhra Pradesh, Southern India. Overall, the fidelity of intervention delivery was high. Six meetings were delivered over a 3-month period to each of the intervention groups. The mean number of meetings attended by participants at each site varied significantly, with participants in Rishi Valley attending fewer meetings [mean (SD) = 2.83 (1.68)] than participants in West Godavari (Tukeys test, p = 0.009) and Trivandrum (Tukeys test, p < 0.001) and participants in West Godavari [mean (SD) = 3.48 (1.72)] attending significantly fewer meetings than participants in Trivandrum [mean (SD) = 4.29 (1.76), Tukeys test, p < 0.001]. Culturally appropriate intervention resources and the training of ASHAs, and supportive supervision of them during the program were critical enablers to program implementation. Although highly motivated during the implementation of the program ASHA reported historical issues with timely remuneration and lack of supportive supervision. Conclusions: Culturally appropriate community-based group programs run by trained and supported ASHAs are a successful and potentially scalable model for improving the control of hypertension in rural India. However, consideration of issues related to unreliable/insufficient remuneration for ASHAs, supportive supervision and their formal role in the wider health workforce in India will be important to address in future program scale up. Trial Registration: Clinical Trial Registry of India [CTRI/2016/02/006678, Registered prospectively].
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Affiliation(s)
- Michaela A. Riddell
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - G. K. Mini
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
- Global Institute of Public Health, Ananthapuri Hospitals and Research Institute, Trivandrum, India
| | - Rohina Joshi
- George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- George Institute for Global Health, New Delhi, India
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Amanda G. Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Rama K. Guggilla
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Białystok, Białystok, Poland
| | - Roger G. Evans
- Cardiovascular Disease Program, Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia
| | - Kavumpurathu R. Thankappan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
- Department of Public Health & Community Medicine, Central University of Kerala, Kasaragod, India
| | - Kate Chalmers
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Clara K. Chow
- George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Ajay S. Mahal
- School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | | | | | - Oduru Suresh
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Rishi Valley Rural Health Centre, Chittoor, India
| | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | - Pallab K. Maulik
- George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- George Institute for Global Health, New Delhi, India
| | - Velandai K. Srikanth
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC, Australia
| | - Simin Arabshahi
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Ravi P. Varma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Fabrizio D'Esposito
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute and Larobe University, Melbourne, VIC, Australia
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43
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Clark SN, Bennett JE, Arku RE, Hill AG, Fink G, Adanu RM, Biritwum RB, Darko R, Bawah A, Duda RB, Ezzati M. Small area variations and factors associated with blood pressure and body-mass index in adult women in Accra, Ghana: Bayesian spatial analysis of a representative population survey and census data. PLoS Med 2021; 18:e1003850. [PMID: 34762663 PMCID: PMC8584976 DOI: 10.1371/journal.pmed.1003850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Body-mass index (BMI) and blood pressure (BP) levels are rising in sub-Saharan African cities, particularly among women. However, there is very limited information on how much they vary within cities, which could inform targeted and equitable health policies. Our study aimed to analyse spatial variations in BMI and BP for adult women at the small area level in the city of Accra, Ghana. METHODS AND FINDINGS We combined a representative survey of adult women's health in Accra, Ghana (2008 to 2009) with a 10% random sample of the national census (2010). We applied a hierarchical model with a spatial term to estimate the associations of BMI and systolic blood pressure (SBP) and diastolic blood pressure (DBP) with demographic, socioeconomic, behavioural, and environmental factors. We then used the model to estimate BMI and BP for all women in the census in Accra and calculated mean BMI, SBP, and DBP for each enumeration area (EA). BMI and/or BP were positively associated with age, ethnicity (Ga), being currently married, and religion (Muslim) as their 95% credible intervals (95% CrIs) did not include zero, while BP was also negatively associated with literacy and physical activity. BMI and BP had opposite associations with socioeconomic status (SES) and alcohol consumption. In 2010, 26% of women aged 18 and older had obesity (BMI ≥ 30 kg/m2), and 21% had uncontrolled hypertension (SBP ≥ 140 and/or DBP ≥ 90 mm Hg). The differences in mean BMI and BP between EAs at the 10th and 90th percentiles were 2.7 kg/m2 (BMI) and in BP 7.9 mm Hg (SBP) and 4.8 mm Hg (DBP). BMI was generally higher in the more affluent eastern parts of Accra, and BP was higher in the western part of the city. A limitation of our study was that the 2010 census dataset used for predicting small area variations is potentially outdated; the results should be updated when the next census data are available, to the contemporary population, and changes over time should be evaluated. CONCLUSIONS We observed that variation of BMI and BP across neighbourhoods within Accra was almost as large as variation across countries among women globally. Localised measures are needed to address this unequal public health challenge in Accra.
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Affiliation(s)
- Sierra N. Clark
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
- MRC Centre for Environment and Health, Imperial College London, United Kingdom
| | - James E. Bennett
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
- MRC Centre for Environment and Health, Imperial College London, United Kingdom
| | - Raphael E. Arku
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts, United States of America
| | - Allan G. Hill
- Department of Social Statistics and Demography, University of Southampton, Southampton, United Kingdom
| | - Günther Fink
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland
| | - Richard M. Adanu
- Department of Population, Family, and Reproductive Health, University of Ghana, Accra, Ghana
| | | | - Rudolph Darko
- School of Medicine, University of Ghana, Accra, Ghana
| | - Ayaga Bawah
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
| | - Rosemary B. Duda
- Harvard Medical School, Harvard University, Boston, Massachusetts, United States of America
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
- MRC Centre for Environment and Health, Imperial College London, United Kingdom
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, United Kingdom
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44
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Harrison MA, Marfo AFA, Opare-Addo MNA, Ankrah DNA, Acheampong F, Nelson F, Buabeng KO. Anti-hypertensive medication access and affordability and their association with blood pressure control at a teaching hospital in Ghana. Pan Afr Med J 2021; 39:184. [PMID: 34584609 PMCID: PMC8449564 DOI: 10.11604/pamj.2021.39.184.27977] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/25/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction many hypertensive patients require two or more anti-hypertensive drugs, but in low- and middle-income countries there may be challenges with medication access or affordability. The objective of this study was to determine accessibility and affordability of anti-hypertensive medicines and their association with blood pressure (BP) control among hypertensive patients attending the Korle-Bu teaching hospital (KBTH) polyclinic. Methods a cross-sectional study was conducted among 310 systematically sampled hypertensive patients attending the KBTH Polyclinic in Ghana. A structured questionnaire was used to obtain data on patient demographics and clinical characteristics, prices, availability and mode of payment of generic anti-hypertensive medicines. Results fifty-nine patients (19.4%) made out-of-pocket payments. At the private pharmacy and hospital, 123 (40.5%) and 77 patients (25.3%) respectively could not afford four anti-hypertensive medicines. Medicines availability at KBTH was 60%. Continuous access to BP drugs at KBTH was 14.8%. Overall access was 74.9% (SD ± 41.3). Out-of-pocket affordability of the medicines was positively correlated with BP control (R=0.12, p=0.037). Obtaining medicines via health insurance only was more likely to result in BP control than making any out-of-pocket payments (OR= 2.185; 95% CI, 1.215 - 3.927). Access at KBTH was more likely to result in BP control (OR=1.642; 95% C.I, 0.843 - 3.201). Conclusion there were access challenges although most patients obtained BP medication free. Out-of-pocket affordability is a challenge for some hypertensive patients. Access to affordable BP medication can improve BP control. These findings provide an impetus for urgently evaluating access to affordable anti-hypertensive medicines in other hospitals in Ghana.
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Affiliation(s)
- Mark Amankwa Harrison
- Pharmacy Department, Korle Bu Teaching Hospital, Accra, Ghana.,Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Afia Frimpomaa Asare Marfo
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Mercy Naa Aduele Opare-Addo
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | - Frempomaa Nelson
- Pharmacy Department, Korle Bu Teaching Hospital, Accra, Ghana.,Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kwame Ohene Buabeng
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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45
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Jaffar S, Ramaiya K, Karekezi C, Sewankambo N. Controlling diabetes and hypertension in sub-Saharan Africa: lessons from HIV programmes. Lancet 2021; 398:1111-1113. [PMID: 34506744 DOI: 10.1016/s0140-6736(21)01731-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/23/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Shabbar Jaffar
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK.
| | - Kaushik Ramaiya
- Shree Hindu Mandal Hospital, Dar es Salaam, Tanzania; Tanzania Non-Communicable Diseases Alliance, Dar es Salaam, Tanzania
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Cavagna P, Ikama MS, Kramoh KE, Takombe JL, Diop IB, Toure IA, Balde DM, Dzudie A, Ferreira B, Houenassi MD, Hounkponou M, Kane A, Kimbally-Kaki SG, Kingue S, Kouam CK, Limbole E, Kuate LM, Mipinda JB, N’guetta R, Nhavoto C, Damorou JM, Ali AS, Gaye B, Tajeu GS, de Terline DM, Perier MC, Azizi M, Jouven X, Antignac M. Antihypertensive strategies and hypertension control in Sub-Saharan Africa. Eur J Prev Cardiol 2021; 28:e21-e25. [PMID: 32635766 PMCID: PMC8903050 DOI: 10.1177/2047487320937492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Pauline Cavagna
- Department of Pharmacy, St Antoine Hospital, AP-HP Sorbonne Université, Paris, France
- Paris Cardiovascular Research Centre, INSERM U970, Paris, France
| | - Méo Stéphane Ikama
- Cardiology Department, National University Hospital of Brazzaville, Marien NGOUABI University, Brazzaville, Congo
| | | | - Jean Laurent Takombe
- Department of Internal Medicine of la Gombe (CMCG), Ngaliema Hospital, Kinshasa, Democratic Republic of the Congo
| | | | - Ibrahim Ali Toure
- Internal Medicine and Cardiology Department, University Hospital of Lamorde, Niamey University, Niger
| | - Dadhi M Balde
- Department of Cardiology, University Hospital of Conakry, Guinea
| | - Anastase Dzudie
- Cardiac Intensive Care & Cardiac Pacing Unit, Douala General Hospital, Cameroon
| | | | - Martin D Houenassi
- National University Hospital of Hubert K. MAGA (CNHU-HKM), Cotonou, Benin
| | | | - Adama Kane
- Cardiology Department, University Hospital of Aristide Le Dantec, Dakar, Senegal
| | - Suzy G Kimbally-Kaki
- Cardiology Department, National University Hospital of Brazzaville, Marien NGOUABI University, Brazzaville, Congo
| | - Samuel Kingue
- University of Yaoundé, Ministry of Public Health, Cameroon
| | | | - Emmanuel Limbole
- Department of Internal Medicine of la Gombe (CMCG), Ngaliema Hospital, Kinshasa, Democratic Republic of the Congo
- Cardiology Department, University of Medicine of Kinshasa, Democratic Republic of the Congo
| | - Liliane Mfeukeu Kuate
- Internal Medicine Department, Regional Hospital, Bafoussam, Cameroon
- Cardiology Department, Central Hospital of Yaoundé, Cameroon
| | | | - Roland N’guetta
- Institute of Cardiology of Abidjan (Côte d’Ivoire), Côte d’Ivoire
| | | | | | | | - Bamba Gaye
- Paris Cardiovascular Research Centre, INSERM U970, Paris, France
| | - Gabriel S Tajeu
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA, USA
| | - Diane Macquart de Terline
- Department of Pharmacy, St Antoine Hospital, AP-HP Sorbonne Université, Paris, France
- Paris Cardiovascular Research Centre, INSERM U970, Paris, France
- Cardiovascular Epidemiology Department, University of Paris, France
| | | | - Michel Azizi
- Cardiovascular Epidemiology Department, University of Paris, France
- Hypertension Unit, European Georges Pompidou Hospital, AP-HP, Paris, France
- Institut National de la Santé et de la Recherche Médicale, Centre d’Investigation Clinique 1418, Paris, France
| | - Xavier Jouven
- Cardiovascular Epidemiology Department, University of Paris, France
- Cardiology Department, European Georges Pompidou Hospital, AP-HP Centre, Paris, France
| | - Marie Antignac
- Department of Pharmacy, St Antoine Hospital, AP-HP Sorbonne Université, Paris, France
- Paris Cardiovascular Research Centre, INSERM U970, Paris, France
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47
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Chow CK, Atkins ER, Hillis GS, Nelson MR, Reid CM, Schlaich MP, Hay P, Rogers K, Billot L, Burke M, Chalmers J, Neal B, Patel A, Usherwood T, Webster R, Rodgers A. Initial treatment with a single pill containing quadruple combination of quarter doses of blood pressure medicines versus standard dose monotherapy in patients with hypertension (QUARTET): a phase 3, randomised, double-blind, active-controlled trial. Lancet 2021; 398:1043-1052. [PMID: 34469767 DOI: 10.1016/s0140-6736(21)01922-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/06/2021] [Accepted: 08/11/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Treatment inertia is a recognised barrier to blood pressure control, and simpler, more effective treatment strategies are needed. We hypothesised that a hypertension management strategy starting with a single pill containing ultra-low-dose quadruple combination therapy would be more effective than a strategy of starting with monotherapy. METHODS QUARTET was a multicentre, double-blind, parallel-group, randomised, phase 3 trial among Australian adults (≥18 years) with hypertension, who were untreated or receiving monotherapy. Participants were randomly assigned to either treatment, that started with the quadpill (containing irbesartan at 37·5 mg, amlodipine at 1·25 mg, indapamide at 0·625 mg, and bisoprolol at 2·5 mg) or an indistinguishable monotherapy control (irbesartan 150 mg). If blood pressure was not at target, additional medications could be added in both groups, starting with amlodipine at 5 mg. Participants were randomly assigned using an online central randomisation service. There was a 1:1 allocation, stratified by site. Allocation was masked to all participants and study team members (including investigators and those assessing outcomes) except the manufacturer of the investigational product and one unmasked statistician. The primary outcome was difference in unattended office systolic blood pressure at 12 weeks. Secondary outcomes included blood pressure control (standard office blood pressure <140/90 mm Hg), safety, and tolerability. A subgroup continued randomly assigned allocation to 12 months to assess long-term effects. Analyses were per intention to treat. This trial was prospectively registered with the Australian New Zealand Clinical Trials Registry, ACTRN12616001144404, and is now complete. FINDINGS From June 8, 2017, to Aug 31, 2020, 591 participants were recruited, with 743 assessed for eligibility, 152 ineligible or declined, 300 participants randomly assigned to intervention of initial quadpill treatment, and 291 to control of initial standard dose monotherapy treatment. The mean age of the 591 participants was 59 years (SD 12); 356 (60%) were male and 235 (40%) were female; 483 (82%) were White, 70 (12%) were Asian, and 38 (6%) reported as other ethnicity; and baseline mean unattended office blood pressure was 141 mm Hg (SD 13)/85 mm Hg (SD 10). By 12 weeks, 44 (15%) of 300 participants had additional blood pressure medications in the intervention group compared with 115 (40%) of 291 participants in the control group. Systolic blood pressure was lower by 6·9 mm Hg (95% CI 4·9-8·9; p<0·0001) and blood pressure control rates were higher in the intervention group (76%) versus control group (58%; relative risk [RR] 1·30, 95% CI 1·15-1·47; p<0·0001). There was no difference in adverse event-related treatment withdrawals at 12 weeks (intervention 4·0% vs control 2·4%; p=0·27). Among the 417 patients who continued, uptitration occurred more frequently among control participants than intervention participants (p<0·0001). However, at 52 weeks mean unattended systolic blood pressure remained lower by 7·7 mm Hg (95% CI 5·2-10·3) and blood pressure control rates higher in the intervention group (81%) versus control group (62%; RR 1·32, 95% CI 1·16-1·50). In all randomly assigned participants up to 12 weeks, there were seven (3%) serious adverse events in the intervention group and three (1%) serious adverse events in the control group. INTERPRETATION A strategy with early treatment of a fixed-dose quadruple quarter-dose combination achieved and maintained greater blood pressure lowering compared with the common strategy of starting monotherapy. This trial demonstrated the efficacy, tolerability, and simplicity of a quadpill-based strategy. FUNDING National Health and Medical Research Council, Australia.
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Affiliation(s)
- Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - Emily R Atkins
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | - Graham S Hillis
- Royal Perth Hospital and Medical School, University of Western Australia, Perth, WA, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Christopher M Reid
- School of Public Health & Preventive Medicine Monash University, Melbourne, VIC, Australia; School of Population Health, Curtin University, Perth, WA, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, Royal Perth Hospital Research Foundation, Medical School, University of Western Australia, Perth, WA, Australia
| | - Peter Hay
- Castle Hill Medical Centre, Sydney, NSW, Australia
| | - Kris Rogers
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia; Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Laurent Billot
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | - Michael Burke
- School of Medicine, Western Sydney University, Sydney, Australia
| | - John Chalmers
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | - Bruce Neal
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia; School of Public Health, Imperial College London, London, UK
| | - Anushka Patel
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | - Tim Usherwood
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | - Ruth Webster
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia; Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Anthony Rodgers
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
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Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet 2021; 398:957-980. [PMID: 34450083 PMCID: PMC8446938 DOI: 10.1016/s0140-6736(21)01330-1] [Citation(s) in RCA: 1076] [Impact Index Per Article: 358.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. METHODS We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. FINDINGS The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. INTERPRETATION Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. FUNDING WHO.
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49
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Nguyen TN, Chow CK. Global and national high blood pressure burden and control. Lancet 2021; 398:932-933. [PMID: 34450082 DOI: 10.1016/s0140-6736(21)01688-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/14/2021] [Indexed: 12/21/2022]
Affiliation(s)
- Tu N Nguyen
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2145, Australia
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2145, Australia; Department of Cardiology, Westmead Hospital, Sydney, NSW 2145, Australia.
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Tan HJ, Ling WC, Chua AL, Lee SK. Oral epigallocatechin gallate reduces intestinal nadolol absorption via modulation of Oatp1a5 and Oct1 transcriptional levels in spontaneously hypertensive rats. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2021; 90:153623. [PMID: 34303263 DOI: 10.1016/j.phymed.2021.153623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 04/27/2021] [Accepted: 06/06/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Concurrent use of epigallocatechin-3-gallate (EGCG) and medication may lead to botanical-drug interactions, subsequently therapeutic failure or drug toxicity. It has been reported that EGCG reduces plasma nadolol bioavailability in normotensive models. Nevertheless, evidence on the effects of EGCG on hypertensive model, and the possible underlying mechanism have not been elucidated. OBJECTIVES This study aims (i) to investigate the effects of EGCG on nadolol pharmacokinetics (maximum plasma concentration, time to achieve maximum concentration, area under the time-plasma concentration curve, plasma half-life and total clearance) and subsequently its impact on blood pressure control; and (ii) to identify transcriptional regulatory roles of EGCG on the nadolol intestinal and hepatic drug-transporters in SHR. METHODS Male SHR were pre-treated with a daily dose of EGCG (10 mg/kg body weight, i.g.) for 13 days. On day-14, a single dose of nadolol (10 mg/kg body weight) was given to the rats 30 min after the last dose of EGCG administration. Systolic blood pressure (SBP) was measured at 6-h and 22-h post-nadolol administration. Plasma and urinary nadolol concentrations were quantified using high-performance liquid chromatography, and pharmacokinetic parameters were analyzed by using non-compartmental analysis. Hepatic and ileal Oatp1a5, P-gp, and Oct1 mRNA expressions were determined by real-time PCR. RESULTS SBP of SHR pre-treated with EGCG and received nadolol was significantly higher than those which were not pre-treated with EGCG but received nadolol. Pre-treatment of EGCG resulted in a marked reduction of plasma nadolol maximum concentration (Cmax) and area under the time-plasma concentration curve (AUC) by 53% and 51% compared to its control. The 14-day treatment with oral EGCG led to a significant downregulation of mRNA levels of ileal Oatp1a5, P-gp, and Oct1 genes by 4.03-, 8.01- and 4.03-fold; and hepatic P-gp, and Oct1 genes by 2.61- and 2.66-fold. CONCLUSION These data concluded that exposure to EGCG could lead to reduced nadolol bioavailability and therefore, uncontrolled raised blood pressure and higher risks of cardiovascular events. Our data suggest that the reduced nadolol bioavailability is associated with the downregulation of ileal Oatp1a5 and Oct1 mRNA levels that subsequently lead to poor absorption of nadolol to the systemic circulation.
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Affiliation(s)
- Hong-Jie Tan
- Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, 43000 Kajang, Bandar Sungai Long, Selangor, Malaysia
| | - Wei-Chih Ling
- Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, 43000 Kajang, Bandar Sungai Long, Selangor, Malaysia
| | - Ang-Lim Chua
- Faculty of Medicine, Universiti Teknologi Malaysia, Sungai Buloh, Selangor, Malaysia
| | - Siew-Keah Lee
- Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, 43000 Kajang, Bandar Sungai Long, Selangor, Malaysia.
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