1
|
Satheesh G, Dhurjati R, Huffman MD, Rosende A, Rodgers A, Prabhakaran D, Ordunez P, Jha V, Salam A. Standardized treatment protocols for hypertension: global availability, characteristics, and alignment with the hypertension guideline recommendations. J Hypertens 2024; 42:902-908. [PMID: 38108382 DOI: 10.1097/hjh.0000000000003636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
BACKGROUND Hypertension control is suboptimal globally. Implementing evidence-based, simple, standardized treatment protocols (STPs) has been instrumental in effectively and efficiently improving treatment and control of hypertension. We aimed to identify, characterize, and critically appraise hypertension STPs. METHODS We defined STP as a series of steps for the pharmacological treatment of primary hypertension, with information on target population, BP threshold for treatment initiation, target BP, specific drugs/classes/doses, and follow-up frequency. STPs for adult patients were identified from the websites of relevant health organizations, Google search, and through expert consultations (until July 2023). STPs for secondary, gestational, or malignant hypertension or those that were templates/samples were excluded. Included STPs were critically appraised using HEARTS in the Americas Checklist for hypertension management in primary care and compared with the 2021 WHO hypertension management guideline recommendations. RESULTS Fifty STPs were identified. All STPs had a stepwise treatment approach, involved guideline-recommended first-line drugs, and 98% consisted of at least four steps. Majority (54%) recommended monotherapy with calcium channel blockers as first-line treatment. Only 44% STPs recommended treatment initiation with combination therapy, and 16% recommended single-pill combinations. Most (62%) had dose-intensification as the second step. Most (74%) STPs did not provide complete dosing information. Only one STP mentioned a target time for achieving BP control. On average, STPs scored a performance of 68% on the HEARTS Checklist. CONCLUSION Several STPs are available globally; however, most of them have enormous scope for improvement through interventions aimed at alignment with the latest evidence-based guidelines and multistakeholder engagement.
Collapse
Affiliation(s)
- Gautam Satheesh
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Rupasvi Dhurjati
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Mark D Huffman
- Washington University in St. Louis, St. Louis, Missouri, USA
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Andres Rosende
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, District of Columbia, USA
| | - Anthony Rodgers
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Pedro Ordunez
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, District of Columbia, USA
| | - Vivekanand Jha
- School of Public Health, Imperial College, London, UK
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Abdul Salam
- The George Institute for Global Health, Sydney, New South Wales, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| |
Collapse
|
2
|
Ordunez P, Campbell NRC, DiPette DJ, Jaffe MG, Rosende A, Martinez R, Gamarra A, Lombardi C, Parra N, Rodriguez L, Rodriguez Y, Brettler J. HEARTS in the Americas: Targeting Health System Change to Improve Population Hypertension Control. Curr Hypertens Rep 2024; 26:141-156. [PMID: 38041725 PMCID: PMC10904446 DOI: 10.1007/s11906-023-01286-w] [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] [Accepted: 11/08/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE OF REVIEW HEARTS in the Americas is the regional adaptation of Global Hearts, the World Health Organization initiative for cardiovascular disease (CVD) prevention and control. Its overarching goal is to drive health services to change managerial and clinical practice in primary care settings to improve hypertension control and CVD risk management. This review describes the HEARTS in the Americas initiative. First, the regional epidemiological situation of CVD mortality and population hypertension control trends are summarized; then the rationale for its main intervention components: the primary care-oriented management system and the HEARTS Clinical Pathway are described. Finally, the key factors for accelerating the expansion of HEARTS are examined: medicines, team-based care, and a system for monitoring and evaluation. RECENT FINDINGS Thus far, 33 countries in Latin America and the Caribbean have committed to integrating this program across their primary healthcare network by 2025. The increase in hypertension coverage and control in primary health care settings compared with the traditional model is promising and confirms that the interventions under the HEARTS umbrella are feasible and acceptable to communities, patients, providers, decision-makers, and funders. This review highlights some cases of successful implementation. Scaling up effective treatment for hypertension and optimization of CVD risk management is a pragmatic way to accelerate the reduction of CVD mortality while strengthening primary healthcare systems to respond effectively, with quality, and equitably, to the challenge of non-communicable diseases, not only in low-middle income countries but in all communities globally.
Collapse
Affiliation(s)
- Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA.
| | - Norm R C Campbell
- Department of Medicine, Libin Cardiovascular Institute, The University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Donald J DiPette
- University of South Carolina and University of South Carolina School of Medicine, Columbia, SC, USA
| | - Marc G Jaffe
- Department of Endocrinology, The Permanente Medical Group, Kaiser San Francisco Medical Center, San Francisco, CA, USA
| | - Andres Rosende
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Ramon Martinez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Angelo Gamarra
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Cintia Lombardi
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Natalia Parra
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Libardo Rodriguez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Yenny Rodriguez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Jeffrey Brettler
- Southern California Permanente Medical Group, Department of Health Systems Science, Regional Hypertension Program, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, USA
| |
Collapse
|
3
|
Ordunez P, Campbell NRC, DiPette DJ, Jaffe MG, Rosende A, Martínez R, Gamarra A, Lombardi C, Parra N, Rodríguez L, Rodríguez Y, Brettler J. [HEARTS in the Americas: targeting health system change to improve population hypertension controlHEARTS nas Américas: impulsionar mudanças no sistema de saúde para melhorar o controle da hipertensão arterial na população]. Rev Panam Salud Publica 2024; 48:e17. [PMID: 38464870 PMCID: PMC10924616 DOI: 10.26633/rpsp.2024.17] [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: 11/08/2023] [Accepted: 12/02/2023] [Indexed: 03/12/2024] Open
Abstract
Purpose of review HEARTS in the Americas is the regional adaptation of Global Hearts, the World Health Organization initiative for cardiovascular disease (CVD) prevention and control. Its overarching goal is to drive health services to change managerial and clinical practice in primary care settings to improve hypertension control and CVD risk management. This review describes the HEARTS in the Americas initiative. First, the regional epidemiological situation of CVD mortality and population hypertension control trends are summarized; then the rationale for its main intervention components: the primary care-oriented management system and the HEARTS Clinical Pathway are described. Finally, the key factors for accelerating the expansion of HEARTS are examined: medicines, team-based care, and a system for monitoring and evaluation. Recent findings Thus far, 33 countries in Latin America and the Caribbean have committed to integrating this program across their primary healthcare network by 2025. The increase in hypertension coverage and control in primary health care settings compared with the traditional model is promising and confirms that the interventions under the HEARTS umbrella are feasible and acceptable to communities, patients, providers, decision-makers, and funders. This review highlights some cases of successful implementation. Summary Scaling up effective treatment for hypertension and optimization of CVD risk management is a pragmatic way to accelerate the reduction of CVD mortality while strengthening primary healthcare systems to respond effectively, with quality, and equitably, to the challenge of non-communicable diseases, not only in low-middle income countries but in all communities globally.
Collapse
Affiliation(s)
- Pedro Ordunez
- Departamento de Enfermedades no Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaDepartamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
| | - Norm R. C. Campbell
- Departamento de MedicinaInstituto Cardiovascular LibinUniversidad de CalgaryCalgaryAB T2N 1N4CanadáDepartamento de Medicina, Instituto Cardiovascular Libin, Universidad de Calgary, Calgary, AB T2N 1N4, Canadá.
| | - Donald J. DiPette
- Universidad de Carolina del SurFacultad de Medicina de la Universidad de Carolina del SurColumbiaEstados Unidos de AméricaUniversidad de Carolina del Sur y Facultad de Medicina de la Universidad de Carolina del Sur, Columbia, Estados Unidos de América.
| | - Marc G. Jaffe
- Departamento de EndocrinologíaThe Permanente Medical GroupCentro Médico de San Francisco de Kaiser PermanenteSan FranciscoEstados Unidos de AméricaDepartamento de Endocrinología, The Permanente Medical Group, Centro Médico de San Francisco de Kaiser Permanente, San Francisco, Estados Unidos de América.
| | - Andrés Rosende
- Departamento de Enfermedades no Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaDepartamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
| | - Ramón Martínez
- Departamento de Enfermedades no Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaDepartamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
| | - Angelo Gamarra
- Departamento de Enfermedades no Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaDepartamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
| | - Cintia Lombardi
- Departamento de Enfermedades no Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaDepartamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
| | - Natalia Parra
- Departamento de Enfermedades no Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaDepartamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
| | - Libardo Rodríguez
- Departamento de Enfermedades no Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaDepartamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
| | - Yenny Rodríguez
- Departamento de Enfermedades no Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaDepartamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
| | - Jeffrey Brettler
- Southern California Permanent Medical GroupDepartamento de Ciencias de Sistemas de SaludPrograma Regional de Hipertensión, Facultad de Medicina Bernard J. Tyson de Kaiser PermanentePasadenaEstados Unidos de AméricaSouthern California Permanent Medical Group, Departamento de Ciencias de Sistemas de Salud, Programa Regional de Hipertensión, Facultad de Medicina Bernard J. Tyson de Kaiser Permanente, Pasadena, Estados Unidos de América.
| |
Collapse
|
4
|
Gao M, Lu Y, Zhang L, Shi M, Zhou H, Zhou H, Kuang X, Li Y. Social anxiety, self-esteem and quality of life among hypertensive patients during COVID-19 local epidemic in China: A mediation analysis. Nurs Open 2024; 11:e2014. [PMID: 38268276 PMCID: PMC10697854 DOI: 10.1002/nop2.2014] [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: 11/07/2022] [Revised: 07/01/2023] [Accepted: 09/17/2023] [Indexed: 01/26/2024] Open
Abstract
OBJECTIVES To explore the mediating role of self-esteem in social anxiety and QoL during the COVID-19 local epidemic in China. DESIGN A cross-sectional survey. METHODS This study conveniently selected 344 hypertensive patients from a Grade-A tertiary hospital in Wuhu, Anhui Province, as the study population. Participants completed the demographic questionnaire, the social phobia inventory, the self-esteem scale and the 36-item short-form health survey. RESULTS Social anxiety, self-esteem and QoL were significantly correlated with each other. Social anxiety showed no direct effect on QoL (β = 0.011, p > 0.05). Social anxiety showed an indirect effect on QoL (β = -0.248, p < 0.001). Self-esteem fully mediated the association between social anxiety and QoL in hypertensive patients. PATIENT OR PUBLIC CONTRIBUTION Hypertensive patients in this study were participants during the data collection process. Nursing staff from the cardiology department at the hospital of a hospital in Wuhu City, Anhui Province assisted in the recruitment phase of the data collection process.
Collapse
Affiliation(s)
- Mengzhao Gao
- School of NursingWannan Medical CollegeWuhuChina
| | - Yidan Lu
- School of NursingWannan Medical CollegeWuhuChina
| | - Lin Zhang
- School of NursingWannan Medical CollegeWuhuChina
| | - Min Shi
- School of NursingWannan Medical CollegeWuhuChina
| | - Haoran Zhou
- School of NursingWannan Medical CollegeWuhuChina
| | - Helian Zhou
- School of NursingWannan Medical CollegeWuhuChina
| | - Xia Kuang
- Cardiovascular DepartmentFirst Affiliated Hospital of Wannan Medical CollegeWuhuChina
| | - Yuanzhen Li
- School of NursingWannan Medical CollegeWuhuChina
| |
Collapse
|