Hypertension care cascades and reducing inequities in cardiovascular disease in low- and middle-income countries

Stein D.T. Reitsma M.B. Geldsetzer P. Agoudavi K. Aryal K.K. Bahendeka S. Brant L.C.C. Farzadfar F. Gurung M.S. Guwatudde D. Houehanou Y.C.N. Malta D.C. Martins J.S. Saeedi Moghaddam S. Mwangi K.J. Norov B. Sturua L. Zhumadilov Z. Bärnighausen T. Davies J.I. Flood D. Marcus M.E. Theilmann M. Vollmer S. Manne-Goehler J. Atun R. Sudharsanan N. Verguet S.
February 2024 Nature Research

Nature Medicine
2024 #30 Issue 2 414 - 423 pp.

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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Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
Department of Health Policy, Stanford School of Medicine, Stanford University, Stanford, CA, United States
Division of Primary Care and Population Health, Stanford University, Stanford, CA, United States
Chan Zuckerberg Biohub, San Francisco, CA, United States
Noncommunicable Disease Program, Ministry of Health, Lomé, Togo
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
MKPGMS-Uganda Martyrs University, Kampala, Uganda
St. Francis Hospital, Nsambya, Kampala, Uganda
Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
Policy and Planning Division, Ministry of Health, Thimphu, Bhutan
Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
National School of Public Health, University of Parakou, Parakou, Benin
Department Maternal Child and Public Health, Nursing School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
Faculty of Medicine and Health Sciences, Universidade Nacional Timor Lorosa’e, Díli, Timor-Leste
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
World Health Organization, Pretoria, South Africa
Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
Nutrition Department, National Center for Public Health, Ulaanbaatar, Mongolia
National Center for Disease Control and Public Health, Tbilisi, Georgia
Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
School of Medicine, Nazarbayev University, Astana, Kazakhstan
Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
Harvard Center for Population and Development Studies, Cambridge, MA, United States
Africa Health Research Institute, KwaZulu-Natal, South Africa
Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa
Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
Center for Indigenous Health Research, Wuqu’ Kawoq, Tecpán, Guatemala
Brigham and Women’s Hospital, Boston, MA, United States
Harvard Medical School, Boston, MA, United States
Professorship of Behavioral Science for Disease Prevention and Health Care, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
Department of Economics & Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA, United States
Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, United States

Department of Global Health and Population
Department of Health Policy
Division of Primary Care and Population Health
Chan Zuckerberg Biohub
Noncommunicable Disease Program
Bergen Centre for Ethics and Priority Setting in Health
Public Health Promotion and Development Organization
MKPGMS-Uganda Martyrs University
St. Francis Hospital
Faculty of Medicine
Non-Communicable Diseases Research Center
Policy and Planning Division
Department of Epidemiology and Biostatistics
National School of Public Health
Department Maternal Child and Public Health
Faculty of Medicine and Health Sciences
Endocrinology and Metabolism Research Center
Kiel Institute for the World Economy
World Health Organization
Division of Non-Communicable Diseases
Nutrition Department
National Center for Disease Control and Public Health
Petre Shotadze Tbilisi Medical Academy
School of Medicine
Heidelberg Institute of Global Health
Harvard Center for Population and Development Studies
Africa Health Research Institute
Institute of Applied Health Research
Department of Global Health
Department of Internal Medicine
Center for Indigenous Health Research
Brigham and Women’s Hospital
Harvard Medical School
Professorship of Behavioral Science for Disease Prevention and Health Care
Department of Economics & Centre for Modern Indian Studies
Division of Infectious Diseases
Medical Practice Evaluation Center
Department of Global Health and Social Medicine

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