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Aramrat P, Aramrat C, Kim TT, Husain MJ, Basu S, Dabak S, Isaranuwatchai W, Wiwatkunupakarn N, Sukonthasarn A, Angkurawaranon C, Kostova D, Moran AE. Costs of the HEARTS hypertension program in primary care in Lampang province, Thailand. BMC PRIMARY CARE 2025; 26:120. [PMID: 40269749 PMCID: PMC12016098 DOI: 10.1186/s12875-025-02824-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/07/2025] [Indexed: 04/25/2025]
Abstract
BACKGROUND In 2020, a pilot program for hypertension control was initiated in primary care facilities in Lampang Province, Thailand. The program followed the framework of the HEARTS program for standardized hypertension treatment, but the financial costs of the program are not well understood. This study evaluates the costs of the HEARTS approach compared to usual care to inform future scale-up efforts of the program. METHODS Cost data were collected and analyzed using the HEARTS costing tool, a Microsoft Excel-based tool that supports activity-based costing of the HEARTS program from the health system perspective. Three scenarios were considered: usual care, the HEARTS regimen using standardized hypertension treatment with single-agent pills, and a sub-scenario of the HEARTS regimen using single-pill dual-drug combination pills. Costs are estimated as annual costs from the health system perspective in all Lampang primary care facilities. RESULTS For the usual care scenario, the HEARTS single-pill scenario, and the HEARTS combination-pill sub-scenario, the average annual medication cost per treated patient was USD 14.0 (THB 485), USD 13.8 (THB 479), and USD 14.3 (THB 497), respectively. Total program cost per primary care user was USD 13.6 (THB 472.7), THB USD 14.3 (494.5), and USD 14.4 (THB 499.9) across the three scenarios, respectively. The largest program cost driver (45-47% across the examined scenarios) was attributed to a comprehensive package of laboratory tests applied to all hypertension patients. Hypothetically, reducing test coverage from all hypertension patients (27% of primary care users) to 15% of primary care users (corresponding to the proportion of patients aged 65+) would reduce program cost per user from USD 14.3 to USD 12.0 in the HEARTS combination-pill scenario. CONCLUSIONS Compared to usual care, HEARTS implementation costs include additional costs for staff training, which are balanced by lower medication expenditures using the HEARTS standardized regimen with single-agent pills. The HEARTS regimen using dual-drug combination pills was estimated to be slightly more costly due to the higher price of combination pills. Optimizing coverage of diagnostic tests and lowering the purchasing prices of combination-pill medicines are key areas for cost reduction in future scale-up efforts.
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Affiliation(s)
- Piyachon Aramrat
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Si Phum, Muang , 50200, Chiang Mai, Thailand
| | - Chanchanok Aramrat
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Si Phum, Muang , 50200, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Center, Chiang Mai University, Chiang Mai, Thailand
| | - Thomas Taeksung Kim
- Global Health Center, Centers for Diseases Control and Prevention, Atlanta, United States of America
| | - Muhammad Jami Husain
- Global Health Center, Centers for Diseases Control and Prevention, Atlanta, United States of America
| | - Soumava Basu
- Global Health Center, Centers for Diseases Control and Prevention, Atlanta, United States of America
| | - Saudamini Dabak
- Health Intervention and Technology Assessment Program, Ministry of Public Health of Thailand, Bangkok, Thailand
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program, Ministry of Public Health of Thailand, Bangkok, Thailand
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
| | - Nutchar Wiwatkunupakarn
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Si Phum, Muang , 50200, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Center, Chiang Mai University, Chiang Mai, Thailand
| | | | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Si Phum, Muang , 50200, Chiang Mai, Thailand.
- Global Health and Chronic Conditions Research Center, Chiang Mai University, Chiang Mai, Thailand.
| | - Deliana Kostova
- Global Health Center, Centers for Diseases Control and Prevention, Atlanta, United States of America
| | - Andrew E Moran
- Resolve to Save Lives, New York, United States of America
- Columbia University Irving Medical Center, New York, United States of America
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Shrestha A, Yang L, Demissie GD, Dhital R, Panniyammakal J, Parasuraman G, Gupta S, Karmacharya B, Thankappan KR, Oldenburg B, Haregu T. Scaling up structured lifestyle interventions to improve the management of cardiometabolic diseases in low-income and middle-income countries: a systematic review of strategies, methods and outcomes. BMJ PUBLIC HEALTH 2025; 3:e001371. [PMID: 40051537 PMCID: PMC11883891 DOI: 10.1136/bmjph-2024-001371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 01/29/2025] [Indexed: 03/09/2025]
Abstract
Introduction Cardiometabolic diseases (CMDs), the leading causes of death in low-income and middle-income countries (LMICs), are proven to be mitigated through structured lifestyle interventions (SLIs-dietary changes, physical activity, tobacco cessation and alcohol intake), but the challenge lies in scaling them up in LMICs. Therefore, we undertook a systematic review to identify the strategies, methods and outcomes used in scaling up SLI programmes to improve cardiometabolic outcomes in LMICs. Methods We searched studies implementing scale-up strategies (delivery approaches enhancing an intervention's adoption, implementation and sustainability), methods (theories, models and frameworks) and present outcomes (feasibility, fidelity, etc) following the Proctor E framework. We searched six databases to identify studies published in English with no time restriction, guided by the Setting, Perspective, Intervention, Comparison and Evaluation framework. Quality assessment was performed using the Cochrane risk-of-bias, National Institutes of Health and Joanna Briggs Institute tools. Given the heterogeneity of the outcome measures, we conducted a narrative synthesis of the extracted information. Results Out of the 26 studies included, 18 (69%) adapted SLI interventions to suit local contexts. Strategies such as system integration, strengthening facility services and training led to up to 100% attendance of participants. Notably, only four studies (15%) used theories, models and frameworks for the full scale-up process, which is crucial for large-scale implementation in resource-limited settings. 15 (58%) studies reported the feasibility of scale-up, whereas 7 (27%) reported no significant differences in lifestyle behaviours or CMD biomarkers. Conclusions Early community and local stakeholders' engagement is crucial for codeveloping strategies for the scale-up of SLIs. Conducting readiness assessments and system integration are all essential considerations for improving scale-up outcomes. Additionally, we strongly recommend using suitable frameworks to guide the scale-up of SLIs to maximise the benefit for the population.
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Affiliation(s)
- Abha Shrestha
- La Trobe University, Melbourne, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Lu Yang
- La Trobe University, Melbourne, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Getu Debalkie Demissie
- La Trobe University, Melbourne, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Rolina Dhital
- Health Action and Research Pvt Ltd, Kathmandu, Nepal
| | - Jeemon Panniyammakal
- La Trobe University, Melbourne, Victoria, Australia
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Ganeshkumar Parasuraman
- Indian Council of Medical Research, Chennai, India
- National Institute of Epidemiology, Chennai, India
| | | | | | | | - Brian Oldenburg
- La Trobe University, Melbourne, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Tilahun Haregu
- La Trobe University, Melbourne, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Turkson-Ocran RAN, Ogungbe O, Botchway M, Baptiste DL, Owusu B, Ajibewa T, Chen Y, Gbaba S, Kwapong FL, Aidoo EL, Nmezi NA, Cluett JL, Commodore-Mensah Y, Juraschek SP. Hypertension Management to Reduce Racial/Ethnic Disparities: Clinical and Community-Based Interventions. CURRENT CARDIOVASCULAR RISK REPORTS 2024; 18:239-258. [PMID: 40271110 PMCID: PMC12014200 DOI: 10.1007/s12170-024-00750-9] [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] [Accepted: 09/23/2024] [Indexed: 04/25/2025]
Abstract
Purpose of the Review Hypertension remains a major public health concern globally and in the United States with significant racial/ethnic disparities in prevalence, treatment, and control. Despite effective treatments, undiagnosed or uncontrolled hypertension persists, leading to an increased risk of cardiovascular disease and substantial healthcare costs. Addressing hypertension disparities requires a comprehensive approach, integrating clinical interventions with community-based strategies. This review examines the current landscape of clinic-and community-based interventions designed to improve hypertension management and reduce disparities. Recent Findings Clinic-based approaches highlighted include implementing evidence-based guidelines, using treatment algorithms, promoting self-management, integrating digital health technologies, and incorporating team-based care approaches. Community interventions discussed involve lifestyle modification programs, faith-based initiatives, trusted community spaces, culturally-tailored health education, engaging community health workers, and collaborative care models linking clinics and communities. This review stresses the importance of addressing SDoH, fostering community engagement, and delivering culturally competent care. Strengthening clinic-community linkages, evaluating long-term effectiveness and cost-effectiveness, leveraging technology and innovation, and addressing gaps in research for underrepresented groups are key priorities for advancing health equity in hypertension management. Summary To effectively close the widening gap in hypertension disparities, collaborative multi-level efforts integrating clinical excellence and community empowerment are essential to mitigate the disproportionate burden of hypertension among racial/ethnic minority populations.
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Affiliation(s)
| | - Oluwabunmi Ogungbe
- Johns Hopkins School of Nursing; Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health; Baltimore, MD
| | | | | | - Brenda Owusu
- University of Miami School of Nursing & Health Studies, Coral Gables, Florida
| | | | - Yuling Chen
- Johns Hopkins School of Nursing; Baltimore, MD
| | | | | | | | | | - Jennifer L Cluett
- Beth Israel Deaconess Medical Center; Boston, MA
- Harvard Medical School; Boston, MA
| | - Yvonne Commodore-Mensah
- Johns Hopkins School of Nursing; Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health; Baltimore, MD
| | - Stephen P Juraschek
- Beth Israel Deaconess Medical Center; Boston, MA
- Harvard Medical School; Boston, MA
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Hernández Véliz D, Valdés González Y, Armas Rojas NB, De la Noval García R, Ringrose J, Padwal R. Validation of combiomed hipermax-BF model A7101 automatic oscillometric upper-arm sphygmomanometer in general population: AAMI/ESH/ISO universal standard (ISO 81060-2:2018/Amd 1:2020). J Hum Hypertens 2024; 38:779-785. [PMID: 39182003 DOI: 10.1038/s41371-024-00948-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 08/11/2024] [Accepted: 08/19/2024] [Indexed: 08/27/2024]
Abstract
This study evaluates the accuracy of the Hipermax-BF model A7101 (Combiomed, Havana, Cuba) automatic oscillometric upper-arm sphygmomanometer for office and home use in general population as part of the HEARTS in the Americas initiative. The research was developed according to the Universal Standard AAMI/ESH/ISO ISO 81060-2:2018/Amd 1:2020. The subjects were recruited according to the requirements of age, gender, blood pressure values and upper-arm circumference. The same upper-arm sequential blood pressure measurement method was used. For measurements with the device under test, the 2-piece cuff from 22-44 cm limb circumference range was used. 92 subjects were recruited and 85 were analyzed. Mean age was 44.8 ± 14.7 years, mean upper-arm circumference was 32.3 ± 6.2, and 56.5% were female. For Validation Criterion 1, the mean value ± standard deviation of the differences in readings between the device under test and the reference device was 1.2 ± 4.9/0.8 ± 4.9 mmHg (systolic/diastolic). For both pressures, in criterion 1 the standard requires a mean value of the differences ≤ ± 5 mmHg and a standard deviation ≤ ± 8 mmHg. For Validation Criterion 2, the standard deviation of the mean blood pressure differences per subject was 4.2/4.2 mmHg (systolic/diastolic). According to Table 1 of criterion 2, for the mean values of 1.2/0.8 mmHg (systolic/diastolic), the maximum allowable standard deviation had to be < 6.84 for systolic and < 6.89 for diastolic pressure. The Combiomed Hipermax-BF A7101 automatic sphygmomanometer meets the requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018/Amd 1:2020) in the general population.
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Affiliation(s)
- Damaris Hernández Véliz
- Institute of Cardiology and Cardiovascular Surgery, 17th street 702 between A and Paseo Avenue, Havana, 10400, Cuba
| | | | - Nurys Bárbara Armas Rojas
- Institute of Cardiology and Cardiovascular Surgery, 17th street 702 between A and Paseo Avenue, Havana, 10400, Cuba
| | - Reinaldo De la Noval García
- Institute of Cardiology and Cardiovascular Surgery, 17th street 702 between A and Paseo Avenue, Havana, 10400, Cuba
| | | | - Raj Padwal
- University of Alberta, Edmonton, AB, Canada
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Jaswal N, Goel S, Upadhyay K, Pathni AK, Bera OP, Shah V. Factors affecting patient retention to hypertension treatment in a North Indian State: A mixed-method study. J Clin Hypertens (Greenwich) 2024; 26:1073-1081. [PMID: 39022879 PMCID: PMC11488296 DOI: 10.1111/jch.14866] [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: 12/12/2023] [Revised: 06/12/2024] [Accepted: 06/18/2024] [Indexed: 07/20/2024]
Abstract
Hypertension is a global health challenge, especially in low-to-middle-income countries, where awareness and control are suboptimal. Despite available treatments, poor medication adherence hampers blood pressure control, leading to adverse outcomes and increased costs. In response, the GOI has initiated national action plans to address noncommunicable diseases, including hypertension. The study aimed to analyze patient retention rates in hypertension treatment across healthcare levels and understand providers' and patients' perspectives on control factors. Using a mixed-method concurrent design in a North Indian district, retrospective data collection covered hypertensive patients registered from January 2020 to July 2020, followed for a year (August 2020-July 2021). Quantitative data included socio-demographic characteristics and patient follow-up rates. Qualitative data comprised focus group discussions (FGD) and in-depth interviews (IDI) with healthcare providers (HCPs) and patients. Findings identified challenges in patient retention and medication adherence, notably among females and at higher-level healthcare facilities, leading to substantial loss of follow-up. Only 63% of hypertensive outpatients maintained controlled blood pressure in the past year. Male patients exhibited more consistent attendance than females. Despite sufficient HCP knowledge, patient retention was better at Health and Wellness Centers (HWCs) levels, while blood pressure control was poorer at higher facilities. Barriers such as medication side effects, pill burden, and limited healthcare access hindered hypertension control, highlighting the need for improved primary care services, including extended clinic hours and diagnostic facilities. Improving hypertension control requires addressing medication adherence and healthcare access barriers. Strengthening primary care services and implementing patient-centered interventions are crucial steps.
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Affiliation(s)
| | - Sonu Goel
- Department of Community Medicine and School of Public HealthPost Graduate Institute of Medical Education and ResearchChandigarhIndia
| | - Kritika Upadhyay
- Department of Community Medicine and School of Public HealthPost Graduate Institute of Medical Education and ResearchChandigarhIndia
| | | | | | - Vandana Shah
- Global Health Advocacy Incubator (GHAI)Washington, D.C.USA
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Deaver JE, Uchuya GM, Cohen WR, Foote JA. A retrospective cohort study of a community-based primary care program's effects on pharmacotherapy quality in low-income Peruvians with type 2 diabetes and hypertension. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003512. [PMID: 39173046 PMCID: PMC11341050 DOI: 10.1371/journal.pgph.0003512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 06/30/2024] [Indexed: 08/24/2024]
Abstract
Little is known about the effects of the Chronic Care Model (CCM) and community health workers (CHWs) on pharmacotherapy of type 2 diabetes and hypertension in resource-poor settings. This retrospective cohort implementation study evaluated the effects of a community-based program consisting of CCM, CHWs, guidelines-based treatment protocols, and inexpensive freely accessible medications on type 2 diabetes and hypertension pharmacotherapy quality. A door-to-door household survey identified 856 adults 35 years of age and older living in a low-income Peruvian community, of whom 83% participated in screening for diabetes and hypertension. Patients with confirmed type 2 diabetes and/or hypertension participated in the program's weekly to monthly visits for < = 27 months. The program was implemented as two care periods employed sequentially. During home care, CHWs made weekly home visits and a physician made treatment decisions remotely. During subsequent clinic care, a physician attended patients in a centralized clinic. The study compared the effects of program (pre- versus post-) (N = 262 observations), and home versus clinic care periods (N = 211 observations) on standards of treatment with hypoglycemic and antihypertensive agents, angiotensin converting enzyme inhibitors, and low-dose aspirin. During the program, 80% and 50% achieved hypoglycemic and antihypertensive standards, respectively, compared to 35% and 8% prior to the program, RRs 2.29 (1.72-3.04, p <0.001) and 6.64 (3.17-13.9, p<0.001). Achievement of treatment standards was not improved by clinic compared to home care (RRs 1.0 +/- 0.08). In both care periods, longer retention in care (>50% of allowable time) was associated with achievement of all treatment standards. 85% compared to 56% achieved the hypoglycemic treatment standard with longer and shorter retention, respectively, RR 1.52 (1.13-2.06, p<0.001); 56% compared to 27% achieved the antihypertensive standard, RR 2.11 (1.29-3.45, p<0.001). In a dose-dependent manner, the community-based program was associated with improved guidelines-based pharmacotherapy of type 2 diabetes and hypertension.
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Affiliation(s)
| | | | - Wayne R. Cohen
- College of Medicine, University of Arizona, Tucson, Arizona, United States of America
| | - Janet A. Foote
- College of Public Health, University of Arizona, Tucson, Arizona, United States of America
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Chavan TA, Kaviprawin M, Sakthivel M, Kishore N, Jogewar P, Gill SS, Kunwar A, Durgad K, Wankhede AB, Bharadwaj V, Khedkar SN, Sarode L, Das B, Bangar SD, Venkatasamy V, Gupta A, Kriina M, Krishna A, Pathni AK, Sahoo SK, Parasuraman G, Shivashankar R, Pragya P, Sharma M, Kaur P. India Hypertension Control Initiative: decentralization of hypertension care to health wellness centres in Punjab and Maharashtra, India, 2018-2022. BMC Health Serv Res 2024; 24:884. [PMID: 39095821 PMCID: PMC11297667 DOI: 10.1186/s12913-024-11354-9] [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: 04/25/2024] [Accepted: 07/24/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION The India Hypertension Control Initiative (IHCI) emphasizes decentralized patient-centric care to boost hypertension control in public healthcare facilities. We documented the decentralization process, enrolment pattern by facility type, and treatment outcomes in nine districts of Punjab and Maharashtra states, India, from 2018-2022. METHODS We detailed the shift in hypertension care from higher facilities to Health and Wellness Centres (HWCs) using the World Health Organization (WHO) health system pillar framework. We reviewed hypertension treatment records in 4,045 public facilities from nine districts in the two states, focusing on indicators including registration numbers, the proportion of controlled, uncontrolled blood pressure (BP), and missed visits among those under care. RESULTS The decentralization process involved training, treatment protocol provision, supervision, and monitoring. Among 394,038 individuals registered with hypertension from 2018-2021, 69% were under care in 2022. Nearly half of those under care (129,720/273,355) received treatment from HWCs in 2022. Care of hypertensive individuals from district hospitals (14%), community health centres (20%), and primary health centres (24%) were decentralized to HWCs. Overall BP control rose from 20% (4,004/20,347) in 2019 to 58% (157,595/273,355) in 2022, while missed visits decreased from 61% (12,394/20,347) in 2019 to 26% (70,894/273,355) in 2022. This trend was consistent in both states. HWCs exhibited the highest BP control and the lowest missed visits throughout the study period compared to other facility types. CONCLUSION We documented an increase in decentralized access to hypertension treatment and improved treatment outcomes over four years. We recommend operationalizing hypertension care at HWCs to other districts in India to improve BP control.
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Affiliation(s)
- Tejpalsinh A Chavan
- Division of Noncommunicable Diseases (NCD), Indian Council of Medical Research (ICMR) - National Institute of Epidemiology (NIE), Chennai, India.
- India Hypertension Control Initiative (IHCI) Project, District NCD Cell, World Health Organization (WHO), Pune, India.
| | - Mogan Kaviprawin
- Division of Noncommunicable Diseases (NCD), Indian Council of Medical Research (ICMR) - National Institute of Epidemiology (NIE), Chennai, India
| | - Manikandanesan Sakthivel
- Division of Noncommunicable Diseases (NCD), Indian Council of Medical Research (ICMR) - National Institute of Epidemiology (NIE), Chennai, India
| | - Navneet Kishore
- Division of Noncommunicable Diseases (NCD), Indian Council of Medical Research (ICMR) - National Institute of Epidemiology (NIE), Chennai, India
- IHCI Project, State NCD Cell, WHO, Chandigarh, Punjab, India
| | - Padmaja Jogewar
- State NCD Cell, Directorate of Health Services, Government of Maharashtra, Mumbai, India
| | - Sandeep Singh Gill
- State NCD Cell, Department of Health and Family Welfare, Government of Punjab, Chandigarh, India
| | - Abhishek Kunwar
- Department of Noncommunicable Diseases, WHO Country Office, New Delhi, India
| | - Kiran Durgad
- Department of Noncommunicable Diseases, WHO Country Office, New Delhi, India
| | - Amol B Wankhede
- IHCI Project, State NCD Cell, WHO, Mumbai, Maharashtra, India
| | | | - Suhas N Khedkar
- IHCI Project, District NCD Cell, WHO, Satara, Maharashtra, India
| | - Lalit Sarode
- IHCI Project, District NCD Cell, WHO, Wardha, Maharashtra, India
| | - Bidisha Das
- IHCI Project, District NCD Cell, WHO, Bhatinda, Punjab, India
| | | | - Vettrichelvan Venkatasamy
- Division of Noncommunicable Diseases (NCD), Indian Council of Medical Research (ICMR) - National Institute of Epidemiology (NIE), Chennai, India
| | - Ashu Gupta
- State NCD Cell, Department of Health and Family Welfare, Government of Punjab, Chandigarh, India
| | - Mosoniro Kriina
- Division of Noncommunicable Diseases (NCD), Indian Council of Medical Research (ICMR) - National Institute of Epidemiology (NIE), Chennai, India
| | | | | | | | - Ganeshkumar Parasuraman
- Division of Noncommunicable Diseases (NCD), Indian Council of Medical Research (ICMR) - National Institute of Epidemiology (NIE), Chennai, India
| | | | | | | | - Prabhdeep Kaur
- Division of Noncommunicable Diseases (NCD), Indian Council of Medical Research (ICMR) - National Institute of Epidemiology (NIE), Chennai, India
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Durán M, Ugel E, Ojeda-Cáceres H, Bonelli A, Saglimbeni M, Rodríguez Araque E, González Galasso C, Yñiguez A, González C, Ramos D, Rivera E. [Evaluation of Implementation of the HEARTS Initiative in a Rural Community in Venezuela, 2023Avaliação da implementação da iniciativa HEARTS em uma comunidade rural da Venezuela, 2023]. Rev Panam Salud Publica 2024; 48:e53. [PMID: 39044774 PMCID: PMC11265309 DOI: 10.26633/rpsp.2024.53] [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: 02/24/2024] [Accepted: 04/03/2024] [Indexed: 07/25/2024] Open
Abstract
Objective To evaluate the implementation of HEARTS strategies in a community in the Bolivarian Republic of Venezuela. Methods Quasi-experimental study evaluating the cascade of care, driving factors, and maturity and performance indicators four months after implementation of the HEARTS initiative in 52 patients with high blood pressure (BP) in the community of La Marroquina. The data were processed using SPSS® Statistics, version 25.0. Student's t-distribution and chi-square tests were applied to determine statistical significance. Results Fifty patients, 63.5% of them with a low educational level and low or very low socioeconomic status, completed the four-month monitoring period. At baseline, 11.5% had controlled BP and 40.4% initiated monotherapy. By the fourth month, 100% of patients with high BP had been diagnosed, 92% had received treatment, and 52% had achieved control of their BP. Seventy-two percent were receiving combined therapy. Seventy percent of the hypertensive individuals maintained blood pressure levels <140/90 mmHg. The maturity index score was 4 of 5, and the performance index was classified as incipient. Conclusion This work shows that, in a short time, a good maturity index was achieved through the implementation, by medical and supervised non-medical personnel, of a standardized protocol for diagnosis, treatment, and monitoring of high blood pressure in a rural population. Rates of diagnosis, treatment, and BP control improved, with incipient performance results. Sustaining this initiative will have a major impact on the health of this population. Its implementation as a national public health policy is recommended.
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Affiliation(s)
- Maritza Durán
- Sociedad Venezolana de Medicina InternaRepública Bolivariana de VenezuelaSociedad Venezolana de Medicina Interna, República Bolivariana de Venezuela.
| | - Eunice Ugel
- Fundación para la Investigación Clínicaen Salud Pública y EpidemiológicaRepública Bolivariana de VenezuelaFundación para la Investigación Clínica, en Salud Pública y Epidemiológica, República Bolivariana de Venezuela
| | - Héctor Ojeda-Cáceres
- Organización Panamericana de la SaludCaracasRepública Bolivariana de VenezuelaOrganización Panamericana de la Salud, Caracas, República Bolivariana de Venezuela.
| | - Andrea Bonelli
- Universidad Central de VenezuelaCaracasRepública Bolivariana de VenezuelaUniversidad Central de Venezuela, Caracas, República Bolivariana de Venezuela.
| | - Manuela Saglimbeni
- Proyecto Mayú Universidad Central de VenezuelaCaracasRepública Bolivariana de VenezuelaProyecto Mayú Universidad Central de Venezuela, Caracas, República Bolivariana de Venezuela.
| | - Elio Rodríguez Araque
- Proyecto Mayú Universidad Central de VenezuelaCaracasRepública Bolivariana de VenezuelaProyecto Mayú Universidad Central de Venezuela, Caracas, República Bolivariana de Venezuela.
| | - Corina González Galasso
- Proyecto Mayú Universidad Central de VenezuelaCaracasRepública Bolivariana de VenezuelaProyecto Mayú Universidad Central de Venezuela, Caracas, República Bolivariana de Venezuela.
| | - Alejandra Yñiguez
- Proyecto Mayú Universidad Central de VenezuelaCaracasRepública Bolivariana de VenezuelaProyecto Mayú Universidad Central de Venezuela, Caracas, República Bolivariana de Venezuela.
| | - César González
- Proyecto Mayú Universidad Central de VenezuelaCaracasRepública Bolivariana de VenezuelaProyecto Mayú Universidad Central de Venezuela, Caracas, República Bolivariana de Venezuela.
| | - Diego Ramos
- Proyecto Mayú Universidad Central de VenezuelaCaracasRepública Bolivariana de VenezuelaProyecto Mayú Universidad Central de Venezuela, Caracas, República Bolivariana de Venezuela.
| | - Edgar Rivera
- Organización Panamericana de la SaludCaracasRepública Bolivariana de VenezuelaOrganización Panamericana de la Salud, Caracas, República Bolivariana de Venezuela.
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Mengesha EW, Tesfaye TD, Boltena MT, Birhanu Z, Sudhakar M, Hassen K, Kedir K, Mesfin F, Hailemeskel E, Dereje M, Hailegebrel EA, Howe R, Abebe F, Tadesse Y, Girma E, Wadilo F, Lake EA, Guta MT, Damtew B, Debebe A, Tariku Z, Amdisa D, Hiko D, Worku A, G/michael M, Abraha YG, Ababulgu SA, Fentahun N. Effectiveness of community-based interventions for prevention and control of hypertension in sub-Saharan Africa: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003459. [PMID: 39012878 PMCID: PMC11251591 DOI: 10.1371/journal.pgph.0003459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 06/05/2024] [Indexed: 07/18/2024]
Abstract
Hypertension poses a significant public health challenge in sub-Saharan Africa due to various risk factors. Community-based intervention for prevention and control of hypertension is an effective strategy to minimize the negative health outcomes. However, comprehensive systematic review evidence to inform effective community-based interventions for prevention and control of hypertension in low resource settings is lacking. This study aimed to synthesize the effectiveness of community-based interventions on prevention and control of hypertension in sub-Saharan Africa. A comprehensive search for studies was carried out on PubMed, CINAHL, Web of Science Core Collection, Embase, Scopus, and Google scholar databases. The result of the review was reported according to PRISMA guidelines. Studies published in English language were included. Two independent reviewers conducted critical appraisal of included studies and extracted the data using predefined excel sheet. Experimental, quasi experimental, cohort and analytical cross-sectional studies conducted on adults who have received community-based interventions for prevention and controls of hypertension in sub-Saharan Africa were included. In this systematic review, a total of eight studies were included, comprising of two interventional studies, two quasi-experimental studies, three cohort studies, and one comparative cross-sectional study. The interventions included health education, health promotion, home-based screening and diagnosis, as well as referral and treatment of hypertensive patients. The sample sizes ranged from 236 to 13,412 in the intervention group and 346 to 6,398 in the control group. This systematic review shows the effect of community-based interventions on reduction of systolic and diastolic blood pressure. However, the existing evidence is inconsistence and not strong enough to synthesize the effect of community-based interventions for the prevention and control of hypertension in sub-Saharan Africa. Hence, further primary studies need on the effect of community-based interventions for the prevention and control of hypertension in sub-Saharan Africa. Systematic review registration number: PROSPERO CRD42022342823.
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Affiliation(s)
| | | | - Minyahil Tadesse Boltena
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia
- Ethiopian-Evidence Based Health Care and Development Centre, A JBI Centre of Excellence, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Zewdie Birhanu
- Public Health Faculty, Institute of Health, Jimma University, Jimma, Ethiopia
- Ethiopian-Evidence Based Health Care and Development Centre, A JBI Centre of Excellence, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Morankar Sudhakar
- Public Health Faculty, Institute of Health, Jimma University, Jimma, Ethiopia
- Ethiopian-Evidence Based Health Care and Development Centre, A JBI Centre of Excellence, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Kalkidan Hassen
- Public Health Faculty, Institute of Health, Jimma University, Jimma, Ethiopia
- Ethiopian-Evidence Based Health Care and Development Centre, A JBI Centre of Excellence, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Kiya Kedir
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia
| | - Firaol Mesfin
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia
| | | | - Melat Dereje
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia
| | | | - Rawleigh Howe
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia
| | - Finina Abebe
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Ethiopian Health Education and Promotion Professionals Association, Addis Ababa, Ethiopia
| | - Yordanos Tadesse
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eshetu Girma
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Ethiopian Health Education and Promotion Professionals Association, Addis Ababa, Ethiopia
| | - Fisseha Wadilo
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia
| | - Eyasu Alem Lake
- College of Health Sciences and Medicine, Wolayita Sodo University, Sodo, Ethiopia
| | - Mistire Teshome Guta
- College of Health Sciences and Medicine, Wolayita Sodo University, Sodo, Ethiopia
| | - Bereket Damtew
- College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Adisalem Debebe
- College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Zerihun Tariku
- College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Demuma Amdisa
- Public Health Faculty, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Desta Hiko
- Public Health Faculty, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Addisu Worku
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Yoseph Gebreyohannes Abraha
- Knowledge Translation Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Ethiopian Knowledge Translation Centre for Health, The Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Sabit Ababor Ababulgu
- Knowledge Translation Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Ethiopian Knowledge Translation Centre for Health, The Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Netsanet Fentahun
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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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: 16] [Impact Index Per Article: 16.0] [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.
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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
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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.
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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.
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12
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Anand V. Team-Based Approach in Hypertension Management: A Quality Improvement Project. J Nurs Care Qual 2024; 39:76-83. [PMID: 37267122 PMCID: PMC10655909 DOI: 10.1097/ncq.0000000000000726] [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: 05/15/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND/LOCAL PROBLEM Hypertension is a major risk factor for heart diseases and stroke among Americans; only 25% have this under control nationwide. METHODS This quality improvement project evaluated the outcomes of team-based care in hypertension control by registered nurses and certified nurse practitioners in a primary care setting. Pre/post-data analysis of blood pressure (BP) control, and BP knowledge, was done. INTERVENTION The team provided education and counseling based on knowledge assessment during visits and used unattended automated blood pressure measurement (uAOBPM) techniques to measure BP. RESULTS There was a significant reduction in systolic and diastolic BP control ( P < .001). There was a statistically significant increase in disease knowledge score pre- and postintervention ( P < .001). CONCLUSION The team-based care approach improved patients' BP control and knowledge of the disease. The uAOBPM technique could be incorporated into clinical settings for accurate BP measurements.
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13
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Nsour MA, Khader Y, Al-Hadeethi OA, Kufoof L. Adaptation, implementation, and evaluation of the HEARTS technical package in primary health care settings in Jordan to improve the management of hypertension: a pilot study. J Hum Hypertens 2023; 37:950-956. [PMID: 36494515 DOI: 10.1038/s41371-022-00792-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022]
Abstract
The majority of patients with hypertension in Jordan have uncontrolled blood pressure. This study aimed to adapt and implement the hypertension management protocol (a module in the HEARTS technical package) in health care centers in Jordan and evaluate its effectiveness on hypertension management and control. The hypertension management protocol was adapted and implemented in six health centers followed by training of the healthcare staff on the adapted protocol. Patients above 18 years old who attended health centers during the study period were recruited consecutively. The blood pressure of 852 patients was monitored over 4 months, using an individual patient treatment card. At the baseline visit, the proportion of patients with uncontrolled blood pressure was 71.5%. After 4 months of the implementation of the protocol, the proportion of patients with uncontrolled blood pressure decreased to 29.1%. Of all studied characteristics, age was the only significant predictor of achieving blood pressure control. Patients aged ≤50 had a higher rate of controlled blood pressure readings after 4 months of implementation of the protocol compared to patients older than 60 years (OR = 1.98, 95% CI: 1.07, 3.67; P value = 0.028). In conclusion, the implementation of the HEARTS hypertension management protocol has successfully achieved better control of the blood pressure of the enrolled patients after 4 months of implementation. To achieve better control of hypertension in the general population, integrating evidence-based strategies for hypertension control that are listed in the HEART technical package into routine care is strongly recommended.
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Affiliation(s)
- Mohannad Al Nsour
- Global Health Development|Eastern Mediterranean Public Health Network (GHD|EMPHNET), Amman, Jordan
| | - Yousef Khader
- Global Health Development|Eastern Mediterranean Public Health Network (GHD|EMPHNET), Amman, Jordan.
- Jordan University of Science and Technology, Irbid, Jordan.
| | - Omar Alaa Al-Hadeethi
- Global Health Development|Eastern Mediterranean Public Health Network (GHD|EMPHNET), Amman, Jordan
| | - Lara Kufoof
- Global Health Development|Eastern Mediterranean Public Health Network (GHD|EMPHNET), Amman, Jordan
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Whelton PK, Flack JM, Jennings G, Schutte A, Wang J, Touyz RM. Editors' Commentary on the 2023 ESH Management of Arterial Hypertension Guidelines. Hypertension 2023; 80:1795-1799. [PMID: 37354199 PMCID: PMC10527435 DOI: 10.1161/hypertensionaha.123.21592] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 06/26/2023]
Abstract
Clinical practice guidelines are ideally suited to the provision of advice on the prevention, diagnosis, evaluation, and management of high blood pressure (BP). The recently published European Society of Hypertension (ESH) 2023 ESH Guidelines for the management of arterial hypertension is the latest in a long series of high BP clinical practice guidelines. It closely resembles the 2018 European Society of Cardiology/ESH guidelines, with incremental rather than major changes. Although the ESH guidelines are primarily written for European clinicians and public health workers, there is a high degree of concordance between its recommendations and those in the other major BP guidelines. Despite the large number of national and international BP guidelines around the world, general population surveys demonstrate that BP guidelines are not being well implemented in any part of the world. The level of BP, which is the basis for diagnosis and management, continues to be poorly measured in routine clinical practice and control of hypertension remains suboptimal, even to a conservative BP target such as a systolic/diastolic BP <140/90 mm Hg. BP guidelines need to focus much more on implementation of recommendations for accurate diagnosis and strategies for improved control in those being treated for hypertension. An evolving body of implementation science can assist in meeting this goal. Given the enormous health, social, and financial burden of high BP, better diagnosis and management should be an imperative for clinicians, government, and others responsible for the provision of health care services. Hopefully, the 2023 ESH will help enable this.
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Affiliation(s)
- Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.)
| | - John M Flack
- Hypertension Section, Division of General Medicine, Department of Medicine, Southern Illinois University, Springfield (J.M.F.)
| | - Garry Jennings
- Sydney Health Partners, University of Sydney and National Heart Foundation, New South Wales, Australia (G.J.)
| | - Alta Schutte
- School of Population Health, University of New South Wales, The George Institute for Global Health, Sydney, Australia (A.S.)
| | - Jiguang Wang
- Shanghai Institute of Hypertension, Shanghai Jiao Tong University School of Medicine, China (J.W.)
| | - Rhian M Touyz
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada (R.M.T.)
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Hong G, Hansen B, Gulati M. The delusion of measuring blood pressure. THE BRITISH JOURNAL OF CARDIOLOGY 2023; 30:23. [PMID: 39144092 PMCID: PMC11321459 DOI: 10.5837/bjc.2023.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Affiliation(s)
| | - Breanna Hansen
- Internal Medicine Resident Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Martha Gulati
- Professor of Cardiology and Director, Preventive Cardiology Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd-AHSP, A3100, Los Angeles, CA 90048, USA
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16
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Khan T, Moran AE, Perel P, Whelton PK, Brainin M, Feigin V, Kostova D, Richter P, Ordunez P, Hennis A, Lackland DT, Slama S, Pineiro D, Martins S, Williams B, Hofstra L, Garg R, Mikkelsen B. The HEARTS partner forum-supporting implementation of HEARTS to treat and control hypertension. Front Public Health 2023; 11:1146441. [PMID: 37554732 PMCID: PMC10405076 DOI: 10.3389/fpubh.2023.1146441] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/03/2023] [Indexed: 08/10/2023] Open
Abstract
Cardiovascular diseases (CVD), principally ischemic heart disease (IHD) and stroke, are the leading causes of death (18. 6 million deaths annually) and disability (393 million disability-adjusted life-years lost annually), worldwide. High blood pressure is the most important preventable risk factor for CVD and deaths, worldwide (10.8 million deaths annually). In 2016, the World Health Organization (WHO) and the United States Centers for Disease Control (CDC) launched the Global Hearts initiative to support governments in their quest to prevent and control CVD. HEARTS is the core technical package of the initiative and takes a public health approach to treating hypertension and other CVD risk factors at the primary health care level. The HEARTS Partner Forum, led by WHO, brings together the following 11 partner organizations: American Heart Association (AHA), Center for Chronic Disease Control (CCDC), International Society of Hypertension (ISH), International Society of Nephrology (ISN), Pan American Health Organization (PAHO), Resolve to Save Lives (RTSL), US CDC, World Hypertension League (WHL), World Heart Federation (WHF) and World Stroke Organization (WSO). The partners support countries in their implementation of the HEARTS technical package in various ways, including providing technical expertise, catalytic funding, capacity building and evidence generation and dissemination. HEARTS has demonstrated the feasibility and acceptability of a public health approach, with more than seven million people already on treatment for hypertension using a simple, algorithmic HEARTS approach. Additionally, HEARTS has demonstrated the feasibility of using hypertension as a pathfinder to universal health coverage and should be a key intervention of all basic benefit packages. The partner forum continues to find ways to expand support and reinvigorate enthusiasm and attention on preventing CVD. Proposed future HEARTS Partner Forum activities are related to more concrete information sharing between partners and among countries, expanded areas of partner synergy, support for implementation, capacity building, and advocacy with country ministries of health, professional societies, academy and civil societies organizations. Advancing toward the shared goals of the HEARTS partners will require a more formal, structured approach to the forum and include goals, targets and published reports. In this way, the HEARTS Partner Forum will mirror successful global partnerships on communicable diseases and assist countries in reducing CVD mortality and achieving global sustainable development goals (SDGs).
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Affiliation(s)
- Taskeen Khan
- Department of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
| | - Andrew E. Moran
- Resolve to Save Lives, New York, NY, United States
- Department of Medicine, Columbia University, New York, NY, United States
| | - Pablo Perel
- Centre for Global Chronic Conditions, Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- World Heart Federation, Geneva, Switzerland
| | - Paul K. Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
- World Hypertension League, New Orleans, LA, United States
| | - Michael Brainin
- Department of Clinical Neurology, Danube University, Krems, Austria
- World Stroke Organization, Geneva, Switzerland
| | - Valery Feigin
- World Stroke Organization, Geneva, Switzerland
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Deliana Kostova
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Non-communicable Diseases and Mental Health, Atlanta, GA, United States
| | - Patricia Richter
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Non-communicable Diseases and Mental Health, Atlanta, GA, United States
| | - Pedro Ordunez
- Pan American Health Organization/World Health Organization, Washington, DC, United States
| | - Anselm Hennis
- Pan American Health Organization/World Health Organization, Washington, DC, United States
| | - Daniel T. Lackland
- World Hypertension League, New Orleans, LA, United States
- Division of Translational Neurosciences and Population Studies, Department of Neurology, Medical University of South Carolina, Charleston, SC, United States
| | - Slim Slama
- Department of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
| | - Daniel Pineiro
- World Heart Federation, Geneva, Switzerland
- Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Sheila Martins
- World Stroke Organization, Geneva, Switzerland
- Universidade Federal of Rio Grande do Sul, Porto Alegre, Brazil
| | - Bryan Williams
- International Society of Hypertension, Essex, United Kingdom
| | - Leonard Hofstra
- Amsterdam UMC—Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Renu Garg
- Resolve to Save Lives, New York, NY, United States
| | - Bente Mikkelsen
- Department of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
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Kamath R, Brand H, Ravandhur Arun H, Lakshmi V, Sharma N, D'souza RMC. Spatial Patterns in the Distribution of Hypertension among Men and Women in India and Its Relationship with Health Insurance Coverage. Healthcare (Basel) 2023; 11:healthcare11111630. [PMID: 37297771 DOI: 10.3390/healthcare11111630] [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: 05/10/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
The present study explores district-level data associated with health insurance coverage (%) and the prevalence of hypertension (mildly, moderately, and severely elevated) observed across men and women as per NFHS 5. Coastal districts in the peninsular region of India and districts in parts of northeastern India have the highest prevalence of elevated blood pressure. Jammu and Kashmir, parts of Gujarat and parts of Rajasthan have a lower prevalence of elevated blood pressure. Intrastate heterogeneity in spatial patterns of elevated blood pressure is mainly seen in central India. The highest burden of elevated blood pressure is in the state of Kerala. Rajasthan is among the states with higher health insurance coverage and a lower prevalence of elevated blood pressure. There is a relatively low positive relationship between health insurance coverage and the prevalence of elevated blood pressure. Health insurance in India generally covers the cost of inpatient care to the exclusion of outpatient care. This might mean that health insurance has limited impact in improving the diagnosis of hypertension. Access to public health centers raises the probability of adults with hypertension receiving treatment with antihypertensives. Access to public health centers has been seen to be especially significant at the poorer end of the economic spectrum. The health and wellness center initiative under Ayushman Bharat will play a crucial role in hypertension control in India.
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Affiliation(s)
- Rajesh Kamath
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
- Department of International Health, Care and Public Health Research Institute-CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6211 LK Maastricht, The Netherlands
| | - Helmut Brand
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
- Department of International Health, Care and Public Health Research Institute-CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6211 LK Maastricht, The Netherlands
| | - Harshith Ravandhur Arun
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Vani Lakshmi
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | | | - Reshma Maria Cocess D'souza
- Department of Medical Laboratory Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
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Rao KD, Mehta A, Kautsar H, Kak M, Karem G, Misra M, Joshi H, Herbst CH, Perry HB. Improving quality of non-communicable disease services at primary care facilities in middle-income countries: A scoping review. Soc Sci Med 2023; 320:115679. [PMID: 36731302 DOI: 10.1016/j.socscimed.2023.115679] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 12/02/2022] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
Health systems in middle-income countries face important challenges in managing the high burden of Non-Communicable Diseases (NCD). Primary health care is widely recognized as key to managing NCDs in communities. However, the effectiveness of this approach is limited by poor quality of care (QoC), among others. This scoping review identifies the types of interventions that have been used in middle-income countries to improve the quality of NCD services at primary care facilities. Further, it identifies the range of outcomes these quality interventions have influenced. This scoping review covered both the grey and peer-reviewed literature. The 149 articles reviewed were classified into four domains - governance, service-delivery systems, health workforce, and patients and communities. There was a remarkable unevenness in the geographic distribution of studies - lower middle-income countries and some regions (Middle East, North Africa, and South East Asia) had a scarcity of published studies. NCDs such as stroke and cardiovascular disease, mental health, cancer, and respiratory disorders received less attention. The thrust of quality interventions was directed at the practice of NCD care by clinicians, facilities, or patients. Few studies provided evidence from interventions at the organizations or policy levels. Overall, effectiveness of quality interventions was mixed across domains. In general, positive or mixed effects on provider clinical skills and behavior, as well as, improvements in patient outcomes were found across interventions. Access to care and coverage of screening services were positively influenced by the interventions reviewed. This review shows that quality improvement interventions tried in middle-income countries mostly focused at the provider and facility level, with few focusing on the organizational and policy level. There is a need to further study the effectiveness of organizational and policy level interventions on the practice and outcomes of NCD care.
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Affiliation(s)
- Krishna D Rao
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Akriti Mehta
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Hunied Kautsar
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | | | - Madhavi Misra
- Johns Hopkins India Private Limited, New Delhi, India
| | - Harsha Joshi
- Johns Hopkins India Private Limited, New Delhi, India
| | | | - Henry B Perry
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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19
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Londoño Agudelo E, Battaglioli T, Díaz Piñera A, Rodríguez Salvá A, Smekens T, Achiong Estupiñán F, Carbonell García I, Van der Stuyft P. Effectiveness of a provider and patient-focused intervention to improve hypertension management and control in the primary health care setting in Cuba: a controlled before-after study. BMC PRIMARY CARE 2023; 24:10. [PMID: 36641434 PMCID: PMC9840256 DOI: 10.1186/s12875-022-01959-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 12/26/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Implementation research to improve hypertension control is scarce in Latin America. We assessed the effectiveness of an intervention aimed at primary care practitioners and hypertensive patients in a setting that provides integrated care through an accessible network of family practices. METHODS We conducted in Cardenas and Santiago, Cuba, a controlled before-after study in 122 family practices, which are staffed with a doctor and a nurse. The intervention comprised a control arm (usual care), an arm with a component targeting providers (hypertension management workshops), and an arm with, on top of the latter, a component targeting patients (hypertension schools). To evaluate the effect, we undertook a baseline survey before the intervention and an endline survey sixteen months after its start. In each survey, we randomly included 1400 hypertensive patients. Controlled hypertension, defined as a mean systolic and diastolic blood pressure below 140 and 90 mmHg, respectively, was the primary endpoint assessed. We performed linear and logistic regression with a Generalized Estimating Equations approach to determine if the proportion of patients with controlled hypertension changed following the intervention. RESULTS Seventy-three doctors, including substitutes, and 54 nurses from the 61 intervention family practices attended the provider workshops, and 3308 patients -51.6% of the eligible ones- participated in the hypertension schools. Adherence to anti-hypertensive medication improved from 42% at baseline to 63% at the endline in the intervention arms. Under the provider intervention, the proportion of patients with controlled hypertension increased by 18.9%, from 48.7% at baseline to 67.6% at endline. However, adding the component that targeted hypertensive patients did not augment the effect. Compared to patients in the control arm, the adjusted OR of having controlled hypertension was 2.36 (95% CI, 1.73-3.22) in the provider and 2.00 (95% CI, 1.68-2.37) in the provider plus patient intervention arm. CONCLUSIONS The intervention's patient component remains to be fine-tuned. Still, we demonstrate that it is feasible to substantially improve hypertension outcomes by intervention at the primary care level, despite an already relatively high control rate.
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Affiliation(s)
- Esteban Londoño Agudelo
- grid.412881.60000 0000 8882 5269Facultad Nacional de Salud Pública, Grupo de Epidemiología, Universidad de Antioquia, Calle 62 #52-59, Medellín, Colombia ,grid.5342.00000 0001 2069 7798Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University. Campus UZ-Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium ,grid.11505.300000 0001 2153 5088Department of Public Health, Institute of Tropical Medicine, St. Rochusstraat 43, 2000 Antwerp, Belgium ,grid.411140.10000 0001 0812 5789Facultad de Medicina, Universidad CES, Calle 10A #22-04, Medellín, Colombia
| | - Tullia Battaglioli
- grid.11505.300000 0001 2153 5088Department of Public Health, Institute of Tropical Medicine, St. Rochusstraat 43, 2000 Antwerp, Belgium
| | - Addys Díaz Piñera
- grid.493388.d0000 0004 0461 1191Centro de Epidemiología y Salud Ambiental, Instituto Nacional de Higiene, Epidemiología y Microbiología (INHEM), Infanta No. 1158 e/ Llinás y Clavel, Centro Habana, 10300 La Habana, Cuba
| | - Armando Rodríguez Salvá
- grid.493388.d0000 0004 0461 1191Centro de Epidemiología y Salud Ambiental, Instituto Nacional de Higiene, Epidemiología y Microbiología (INHEM), Infanta No. 1158 e/ Llinás y Clavel, Centro Habana, 10300 La Habana, Cuba
| | - Tom Smekens
- grid.11505.300000 0001 2153 5088Department of Public Health, Institute of Tropical Medicine, St. Rochusstraat 43, 2000 Antwerp, Belgium
| | | | - Isabel Carbonell García
- Centro Provincial de Higiene y Epidemiología, Calle J No. 1 entre 1ra y 2da Reparto Sueño, Santiago de Cuba, Cuba
| | - Patrick Van der Stuyft
- grid.5342.00000 0001 2069 7798Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University. Campus UZ-Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
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20
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Ordunez P, Campbell NR, Giraldo Arcila GP, Angell SY, Lombardi C, Brettler JW, Rodríguez Morales YA, Connell KL, Gamarra A, DiPette DJ, Rosende A, Jaffe MG, Rodríguez L, Piñeiro DJ, Martínez R, Sharman JE. [HEARTS in the Americas: innovations for improving hypertension and cardiovascular disease risk management in primary careHEARTS nas Américas: inovações para melhorar a gestão do risco de hipertensão e de doenças cardiovasculares na atenção primária]. Rev Panam Salud Publica 2022; 46:e197. [PMID: 36284552 PMCID: PMC9578652 DOI: 10.26633/rpsp.2022.197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/15/2022] [Indexed: 11/24/2022] Open
Abstract
Global Hearts is the flagship initiative of the World Health Organization to reduce the burden of cardiovascular diseases, the leading cause of death and disability worldwide. HEARTS in the Americas Initiative is the regional adaptation that envisions HEARTS as the model for cardiovascular disease risk management, including hypertension and diabetes, in primary health care in the Americas by 2025. This initiative is entering its sixth year of implementation and now includes 22 countries and 1 380 primary health care centers. The objectives of this report are three-fold. First, it describes the emergence and the main elements of HEARTS in the Americas. Secondly, it summarizes the main innovations developed to catalyze and sustain implementation of the initiative. These innovations include: a) introduction of hypertension control drivers; b) development of a comprehensive and practical clinical pathway; c) development of a strategy to improve the accuracy of blood pressure measurement; d) creation of a monitoring and evaluation platform; and e) development of a standardized set of training and education resources. Thirdly, this report discusses future priorities of the initiative. The goal of implementing these innovative and pragmatic solutions is to create a more effective health system and shift the focus of cardiovascular and hypertension programs from the highly specialized care level to primary health care. In addition, HEARTS in the Americas can serve as a model for more comprehensive, effective, and sustainable noncommunicable disease prevention and treatment practices.
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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, DC (Estados Unidos). Washington, D. C., Estados Unidos de América.
| | - Norm R.C. Campbell
- Departamento de Medicina, Fisiología y Farmacología y Ciencias de Salud de la ComunidadInstituto Cardiovascular Libin de AlbertaUniversidad de CalgaryCalgaryCanadáDepartamento de Medicina, Fisiología y Farmacología y Ciencias de Salud de la Comunidad, Instituto Cardiovascular Libin de Alberta, Universidad de Calgary, Calgary, Canadá.
| | - Gloria P. Giraldo Arcila
- 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, DC (Estados Unidos). Washington, D. C., Estados Unidos de América.
| | - Sonia Y. Angell
- Departamento de Epidemiología, Escuela de Salud Pública Bloomberg de la Universidad Johns HopkinsBaltimoreEstados Unidos de AméricaDepartamento de Epidemiología, Escuela de Salud Pública Bloomberg de la Universidad Johns Hopkins, Baltimore, 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, DC (Estados Unidos). Washington, D. C., Estados Unidos de América.
| | - Jeffrey W. Brettler
- Departamento de Ciencias de Sistemas de SaludFacultad de Medicina Bernard J. Tyson de Kaiser PermanentePasadenaEstados Unidos de AméricaDepartamento de Ciencias de Sistemas de Salud, Facultad de Medicina Bernard J. Tyson de Kaiser Permanente, Pasadena, Estados Unidos de América.
| | - Yenny A. Rodríguez Morales
- 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, DC (Estados Unidos). Washington, D. C., Estados Unidos de América.
| | - Kenneth L. Connell
- Facultad de Ciencias Médicas, Campus de Cave HillUniversidad de las Indias OccidentalesSt MichaelBarbadosFacultad de Ciencias Médicas, Campus de Cave Hill, Universidad de las Indias Occidentales, St Michael, Barbados.
| | - 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, DC (Estados Unidos). Washington, D. C., Estados Unidos de América.
| | - Donald J. DiPette
- Departamento de MedicinaFacultad de Medicina de la Universidad de Carolina del SurColumbiaEstados Unidos de AméricaDepartamento de Medicina, Facultad de Medicina de la Universidad de Carolina del Sur, Columbia, Estados Unidos de América.
| | - Andres 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, DC (Estados Unidos). Washington, D. C., Estados Unidos de América.
| | - Marc G. Jaffe
- Departamento de EndocrinologíaCentro Médico Kaiser Permanente de San FranciscoSan FranciscoEstados Unidos de AméricaDepartamento de Endocrinología, Centro Médico Kaiser Permanente de San Francisco, San Francisco, 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, DC (Estados Unidos). Washington, D. C., Estados Unidos de América.
| | - Daniel J. Piñeiro
- Departamento de Medicina Universidad de Buenos AiresBuenos AiresArgentinaDepartamento de Medicina Universidad de Buenos Aires, Buenos Aires, Argentina
| | - 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, DC (Estados Unidos). Washington, D. C., Estados Unidos de América.
| | - James E. Sharman
- Instituto Menzies de Investigación MédicaUniversidad de TasmaniaHobartAustraliaInstituto Menzies de Investigación Médica, Universidad de Tasmania, Hobart, Australia.
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21
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Valdés González Y, Morejón Giraldoni A, Pérez Perea L, Jiménez Chiquet A, López Lima C, Campbell N, Giraldo G. La Iniciativa HEARTS en Cuba: experiencias tras 5 años de implementación. Rev Panam Salud Publica 2022; 46:e176. [PMID: 36284551 PMCID: PMC9578651 DOI: 10.26633/rpsp.2022.176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/09/2022] [Indexed: 12/03/2022] Open
Abstract
Con el propósito de describir los cambios en el control de la hipertensión arterial desde 2016 a 2021 y la relación de los progresos con la madurez de implementación de la Iniciativa HEARTS en el primer nivel de atención de Cuba, se diseñó un estudio prospectivo de implementación que promovió la medición correcta de la presión arterial con esfigmomanómetros automáticos validados, la atención basada en riesgo, la introducción de protocolos de tratamiento antihipertensivo estandarizado, la prevención secundaria y el trabajo en equipo. Se fomentó además la educación a pacientes, la búsqueda activa de casos y las actividades comunitarias. Los datos se obtuvieron de los registros de implementación y fueron analizados con el programa estadístico SPSS versión 21, se reportan las medidas de resultados y sus intervalos de confianza del 95%. Se evaluaron los indicadores poblacionales: cobertura de registro, control entre tratados, control poblacional, así como el índice de madurez de procesos de HEARTS en Las Américas. Comparativamente, entre los años 2016 y 2021 aumentaron los centros participantes, desde un centro de demostración hasta 22 policlínicos en 6 provincias y 7 municipios. Se evidenció un incremento significativo en los valores absolutos del total de población atendida, el número de hipertensos registrados, de pacientes controlados entre los tratados e hipertensos controlados entre todos los adultos, aunque con variaciones anuales en los porcentajes de cobertura, control entre tratados y control poblacional. Los mayores progresos ocurrieron en los centros con equipos de salud de alto desempeño. Cinco años después de la implementación de la Iniciativa HEARTS en Cuba se transita hacia la institucionalización de la metodología.
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Affiliation(s)
| | | | | | | | | | | | - Gloria Giraldo
- Organización Panamericana de la Salud, Washington DC, Estados Unidos de América
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22
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Rodriguez G, Rosende A, Prado C, Cejas Mariño R, Irazola V, DiPette D, Orias M, Giraldo Arcila G, Laspiur S. [Implementation of the HEARTS Initiative in Argentina: initial resultsImplementação da Iniciativa HEARTS na Argentina: primeiros resultados]. Rev Panam Salud Publica 2022; 46:e181. [PMID: 36160765 PMCID: PMC9491484 DOI: 10.26633/rpsp.2022.181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/29/2022] [Indexed: 11/24/2022] Open
Abstract
Las enfermedades cardiovasculares son la principal causa de morbimortalidad, y la hipertensión es su principal factor de riesgo. En 2018, Argentina comenzó a implementar la Iniciativa HEARTS en 5 centros de atención primaria de salud a través del Plan Nacional de Prevención y Control de la Hipertensión Arterial. En este estudio se presenta el impacto de su implementación en los indicadores de cobertura efectiva, tratamiento, tratamiento combinado y control. La Iniciativa HEARTS incluye múltiples componentes; entre ellos se destacan la capacitación de los equipos de salud, la reorganización de las tareas basada en la transferencia de competencias clínicas, la provisión de dispositivos de medición de la presión arterial automáticos y clínicamente validados, y la utilización de un único protocolo de tratamiento estandarizado. Se utilizó un modelo de datos longitudinales del tipo ecuación de estimación generalizada, y se agrupó la información de los 5 centros de salud mediante promedios ponderados según el tamaño de la población bajo cobertura. El análisis de los resultados fue estratificado en dos períodos de tiempo delimitados por la irrupción de las restricciones debidas al COVID-19. Durante el primer período de 18 meses se observó una mejoría significativa en el tratamiento (5,9%; p<0,01) y el tratamiento combinado (13,4%; p<0,01), sin cambios significativos en la cobertura (8,4%; p=0,87) y con un descenso paradojal en el control (−3,3%; p=0,02). Durante las restricciones y respecto del período previo, se constató una reducción generalizada en todos los indicadores, principalmente en la cobertura (−23,6%; p<0,01) y el control (−12,5%; p<0,01). Sin embargo, los niveles de tratamiento y tratamiento combinado persistieron por encima de los valores basales (1,7%; p<0,01 y 5,4%; p<0,01, respectivamente).
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Affiliation(s)
- Gonzalo Rodriguez
- Organización Panamericana de la Salud Buenos Aires Argentina Organización Panamericana de la Salud, Buenos Aires, Argentina
| | - Andrés Rosende
- Organización Panamericana de la Salud Washington, DC Estados Unidos de América Organización Panamericana de la Salud, Washington, DC, Estados Unidos de América
| | - Carolina Prado
- Instituto de Efectividad Clínica y Sanitaria Buenos Aires Argentina Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Rubén Cejas Mariño
- Ministerio de Salud La Rioja Argentina Ministerio de Salud, La Rioja, Argentina
| | - Vilma Irazola
- Instituto de Efectividad Clínica y Sanitaria Buenos Aires Argentina Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Donald DiPette
- Escuela de Medicina de la Universidad de Carolina del Sur Columbia Estados Unidos de América Escuela de Medicina de la Universidad de Carolina del Sur, Columbia, Estados Unidos de América
| | - Marcelo Orias
- Escuela de Medicina de la Universidad de Yale New Haven Estados Unidos de América Escuela de Medicina de la Universidad de Yale, New Haven, Estados Unidos de América
| | - Gloria Giraldo Arcila
- Organización Panamericana de la Salud Washington, DC Estados Unidos de América Organización Panamericana de la Salud, Washington, DC, Estados Unidos de América
| | - Sebastián Laspiur
- Organización Panamericana de la Salud Buenos Aires Argentina Organización Panamericana de la Salud, Buenos Aires, Argentina
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Rivas Rivas S, Serna Tobón DC, Mahecha Gallego KY, Tejada Cardona MP, Castrillón Spitia JD, Moreno Gutierrez PA, Agudelo Ramírez A. Impacto de la Iniciativa HEARTS en una institución de salud de segundo nivel en Colombia. Rev Panam Salud Publica 2022; 46:e152. [PMID: 36133427 PMCID: PMC9484327 DOI: 10.26633/rpsp.2022.152] [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: 02/12/2022] [Accepted: 07/06/2022] [Indexed: 11/24/2022] Open
Abstract
RESUMEN
Objetivo.
Identificar el impacto de la iniciativa HEARTS en los pacientes con hipertensión arterial atendidos en un hospital colombiano.
Métodos.
Estudio cuasiexperimental, retrospectivo entre 2017 y 2019 con pacientes hipertensos mayores de 18 años, incluidos en la estrategia HEARTS, atendidos en el Hospital Santa Mónica del municipio de Dosquebradas, departamento de Risaralda. La unidad de análisis fue la historia clínica. Se evaluaron las metas de presión arterial (definido en la Iniciativa HEARTS como un paciente con presión arterial sistólica <140 mmHg y <90 mmHg en la presión diastólica) al momento del ingreso al programa HEARTS y un año después. Se incluyeron variables sociodemográficas, farmacológicas, clínicas, metas de presión arterial y cumplimiento de la iniciativa. Se realizaron análisis descriptivos y se aplicó regresión logística binaria (p <0.05).
Resultados.
Se analizaron 372 pacientes de los cuales 262 eran mujeres (70,4%). La edad media fue de 66,3 ± 12,2 años. En la primera consulta de control se reportaron 285 pacientes (76,6%) que presentaron cifras de tensión arterial en metas, en la segunda consulta este logro fue alcanzado por el 84,1% de los pacientes (n=313 diferencia media: 7,5%, IC95%: 1,8 a 13,1; p=0,005). Después de la implementación de la Iniciativa HEARTS el 77,4% en los pacientes (n=288) continuaron con el manejo inicial. Cumplir las recomendaciones HEARTS aumenta la probabilidad de estar en las metas (p=0,033; OR= 2,688; IC= 1,081 - 6,684).
Conclusiones.
La implementación de la Iniciativa HEARTS impactó favorablemente las cifras de tensión arterial en pacientes con hipertensión, con beneficios adicionales en variables que disminuyen el riesgo cardiovascular.
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Affiliation(s)
| | | | | | | | - Juan Daniel Castrillón Spitia
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia Universidad Tecnológica de Pereira-Audifarma S. A. Pereira, Colombia
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24
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Jaffe MG, DiPette DJ, Campbell NR, Angell SY, Ordunez P. Developing population-based hypertension control programs. Rev Panam Salud Publica 2022; 46:e153. [PMID: 36128474 PMCID: PMC9473451 DOI: 10.26633/rpsp.2022.153] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/29/2022] [Indexed: 11/24/2022] Open
Abstract
Hypertension remains the leading cause of cardiovascular disease globally despite the availability of safe and effective treatments. Unfortunately, many barriers exist to controlling hypertension, including a lack of effective screening and awareness, an inability to access treatment and challenges with its management when it is treated. Addressing these barriers is complex and requires engaging in a systematic and sustained approach across communities over time. This analysis aims to describe the key elements needed to create an effective delivery system for hypertension control. A successful system requires political will and supportive leadership at all levels of an organization, including at the point of care delivery (office or clinic), in the health care system, and at regional, state and national levels. Effective screening and outreach systems are necessary to identify individuals not previously diagnosed with hypertension, and a system for follow up and tracking is needed after people are diagnosed. Implementing simple protocols for treating hypertension can reduce confusion among providers and increase treatment efficiency. Ensuring easy access to safe, effective and affordable medications can increase blood pressure control and potentially decrease health care system costs. Task-sharing among members of the health care team can expand the services that are delivered. Finally, monitoring of and reporting on the performance of the health care team are needed to learn from those who are doing well, disseminate ideas to those in need of improvement and identify individual patients who need outreach or additional care. Successful large-scale hypertension programs in different settings share many of these key elements and serve as examples to improve systems of hypertension care delivery throughout the world.
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Affiliation(s)
- Marc G. Jaffe
- Department of Endocrinology, The Permanente Medical Group, Kaiser San Francisco Medical Center, San Francisco, California, USA
| | - Donald J. DiPette
- Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Norman R.C. Campbell
- Department of Medicine, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Sonia Y. Angell
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Pedro Ordunez
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, D.C., USA
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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: 5] [Impact Index Per Article: 1.7] [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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The India Hypertension Control Initiative-early outcomes in 26 districts across five states of India, 2018-2020. J Hum Hypertens 2022:10.1038/s41371-022-00742-5. [PMID: 35945426 DOI: 10.1038/s41371-022-00742-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 05/31/2022] [Accepted: 07/21/2022] [Indexed: 11/08/2022]
Abstract
Hypertension is the leading single preventable risk factor for cardiovascular disease. The India Hypertension Control Initiative (IHCI) project was designed to improve hypertension control in public sector clinics. The project was launched in 2018-2019 in 26 districts across five states: Punjab (5), Madhya Pradesh (3), Kerala (4), Maharashtra (4), and Telangana (10), with five core strategies: standard treatment protocol, reliable supply of free antihypertensive drugs, team-based care, patient-centered care, and an information system to track individual patient treatment and blood pressure control. All states implemented simple treatment protocols with three drugs: a long-acting dihydropyridine calcium channel blocker (amlodipine), angiotensin receptor blocker (telmisartan), and thiazide or a thiazide-like diuretic (hydrochlorothiazide or chlorthalidone). Medication supplies were adequate to support at least one month of treatment. Overall, 570,365 hypertensives were enrolled in 2018-2019; 11% did not have follow-up visits in the most recent 12 months. Clinic-level blood pressure control averaged 43% (range 22-79%) by Jan-March, 2020. The proportion of the estimated people with hypertension who had it controlled and documented in public clinics increased three-fold, albeit from very low levels (1.4-5.0%). The IHCI demonstrated the feasibility of implementing protocol-based hypertension treatment and control supported by a reliable drug supply and accurate information systems at scale in Indian primary health care facilities. Lessons from the IHCI's initial phase will inform plans to improve screening in health care facilities, increase retention in care, and ensure a sustained supply of drugs as part of a nationwide hypertension control program.
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27
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Baldridge AS, Aluka-Omitiran K, Orji IA, Shedul GL, Ojo TM, Eze H, Shedul G, Ugwuneji EN, Egenti NB, Okoli RCB, Ale BM, Nwankwo A, Osagie S, Ye J, Chopra A, Sanuade OA, Tripathi P, Kandula NR, Hirschhorn LR, Huffman MD, Ojji DB. Hypertension Treatment in Nigeria (HTN) Program: rationale and design for a type 2 hybrid, effectiveness, and implementation interrupted time series trial. Implement Sci Commun 2022; 3:84. [PMID: 35918703 PMCID: PMC9344662 DOI: 10.1186/s43058-022-00328-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background Hypertension is the most common cardiovascular disease in Nigeria and contributes to a large non-communicable disease burden. Our aim was to implement and evaluate a large-scale hypertension treatment and control program, adapted from the Kaiser Permanent Northern California and World Health Organization HEARTS models, within public primary healthcare centers in the Federal Capital Territory, Nigeria. Methods A type 2 hybrid, interrupted time series design was used to generate novel information on large-scale implementation and effectiveness of a multi-level hypertension control program within 60 primary healthcare centers in the Federal Capital Territory, Nigeria. During the formative phase, baseline qualitative assessments were held with patients, health workers, and administrators to inform implementation package adaptation. The package includes a hypertension patient registry with empanelment, performance and quality reporting, simplified treatment guideline emphasizing fixed-dose combination therapy, reliable access to quality essential medicines and technology, team-based care, and health coaching and home blood pressure monitoring. Strategies to implement and adapt the package were identified based on barriers and facilitators mapped in the formative phase, previous implementation experience, mid-term qualitative evaluation, and ongoing stakeholder and site feedback. The control phase included 11 months of sequential registration of hypertensive patients at participating primary healthcare centers, followed by implementation of the remainder of the package components and evaluation over 37 subsequent, consecutive months of the intervention phase. The formative phase was completed between April 2019 and August 2019, followed by initiation of the control phase in January 2020. The control phase included 11 months (January 2020 to November 2020) of sequential registration and empanelment of hypertensive patients at participating primary healthcare centers. After completion of the control phase in November 2020, the intervention phase commenced in December 2020 and will be completed in December 2023. Discussion This trial will provide robust evidence for implementation and effectiveness of a multi-level implementation package more broadly throughout the Federal Capital Territory, which may inform hypertension systems of care throughout Nigeria and in other low- and middle-income countries. Implementation outcome results will be important to understand what system-, site-, personnel-, and patient-level factors are necessary for successful implementation of this intervention. Trial registration ClinicalTrials.gov NCT04158154. The trial was prospectively registered on November 8, 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00328-9.
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Affiliation(s)
| | | | - Ikechukwu A Orji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Gabriel L Shedul
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Tunde M Ojo
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Abuja, Nigeria.,Federal Ministry of Health, Abuja, Nigeria.,University of Abuja, Abuja, Nigeria
| | - Helen Eze
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Grace Shedul
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Eugenia N Ugwuneji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Nonye B Egenti
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Abuja, Nigeria.,University of Abuja, Abuja, Nigeria
| | | | - Boni M Ale
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Abuja, Nigeria.,Holo Healthcare, Nairobi, Kenya
| | - Ada Nwankwo
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Abuja, Nigeria
| | | | - Jiancheng Ye
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Aashima Chopra
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Olutobi A Sanuade
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Spencer Fox Eccles School of Medicine, University of Utah, UT, Salt Lake City, USA
| | - Priya Tripathi
- Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | | | - Lisa R Hirschhorn
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mark D Huffman
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Cardiovascular Division and Global Health Center, Washington University in St. Louis, St. Louis, MO, USA.,The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Dike B Ojji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Abuja, Nigeria.,University of Abuja, Abuja, Nigeria
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Ordunez P, Campbell NR, Giraldo Arcila GP, Angell SY, Lombardi C, Brettler JW, Rodriguez Morales YA, Connell KL, Gamarra A, DiPette DJ, Rosende A, Jaffe MG, Rodriguez L, Piñeiro DJ, Martinez R, Sharman JE. HEARTS in the Americas: innovations for improving hypertension and cardiovascular disease risk management in primary care. Rev Panam Salud Publica 2022; 46:e96. [PMID: 35855441 PMCID: PMC9288223 DOI: 10.26633/rpsp.2022.96] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/15/2022] [Indexed: 12/11/2022] Open
Abstract
Global Hearts is the flagship initiative of the World Health Organization to reduce the burden of cardiovascular diseases, the leading cause of death and disability worldwide. HEARTS in the Americas Initiative is the regional adaptation that envisions HEARTS as the model for cardiovascular disease risk management, including hypertension and diabetes, in primary health care in the Americas by 2025. This initiative is entering its sixth year of implementation and now includes 22 countries and 1 380 primary health care centers. The objectives of this report are three-fold. First, it describes the emergence and the main elements of HEARTS in the Americas. Secondly, it summarizes the main innovations developed to catalyze and sustain implementation of the initiative. These innovations include: a) introduction of hypertension control drivers; b) development of a comprehensive and practical clinical pathway; c) development of a strategy to improve the accuracy of blood pressure measurement; d) creation of a monitoring and evaluation platform; and e) development of a standardized set of training and education resources. Thirdly, this report discusses future priorities of the initiative. The goal of implementing these innovative and pragmatic solutions is to create a more effective health system and shift the focus of cardiovascular and hypertension programs from the highly specialized care level to primary health care. In addition, HEARTS in the Americas can serve as a model for more comprehensive, effective, and sustainable noncommunicable disease prevention and treatment practices.
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Affiliation(s)
- Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization. Washington, DC, United States of America
| | - Norm R.C. Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Gloria P. Giraldo Arcila
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization. Washington, DC, United States of America
| | - Sonia Y. Angell
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | - Cintia Lombardi
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization. Washington, DC, United States of America
| | - Jeffrey W. Brettler
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, United States of America
| | - Yenny A. Rodriguez Morales
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization. Washington, DC, United States of America
| | - Kenneth L. Connell
- Faculty of Medical Sciences, Cave Hill Campus, University of the West Indies, St Michael, Barbados
| | - Angelo Gamarra
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization. Washington, DC, United States of America
| | - Donald J. DiPette
- Department of Medicine, University of South Carolina School of Medicine, Columbia, USA
| | - Andres Rosende
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization. Washington, DC, United States of America
| | - Marc G. Jaffe
- Department of Endocrinology, Kaiser Permanente San Francisco Medical Center, San Francisco, United States of America
| | - Libardo Rodriguez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization. Washington, DC, United States of America
| | - Daniel J. Piñeiro
- Department of Medicine. University of Buenos Aires, Buenos Aires, Argentina
| | - Ramon Martinez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization. Washington, DC, United States of America
| | - James E. Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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Campbell NRC, Paccot Burnens M, Whelton PK, Angell SY, Jaffe MG, Cohn J, Espinosa Brito A, Irazola V, Brettler JW, Roccella EJ, Maldonado Figueredo JI, Rosende A, Ordunez P. [2021 World Health Organization guideline on pharmacological treatment of hypertension: Policy implications for the region of the AmericasDiretrizes de 2021 da Organização Mundial da Saúde sobre o tratamento medicamentoso da hipertensão arterial: repercussões para as políticas na região das Américas]. Rev Panam Salud Publica 2022; 46:e54. [PMID: 35573116 PMCID: PMC9097923 DOI: 10.26633/rpsp.2022.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 12/02/2022] Open
Abstract
Las enfermedades cardiovasculares son la principal causa de muerte en la Región de las Américas y la hipertensión es la causa de más del 50% de ellas. En la Región, más de una cuarta parte de las mujeres adultas y cuatro de cada diez hombres adultos tienen hipertensión y su diagnóstico, tratamiento y control son deficientes. En el 2021, la Organización Mundial de la Salud (OMS) publicó directrices actualizadas sobre el tratamiento farmacológico de la hipertensión en personas adultas. En este artículo se destaca el papel facilitador de la iniciativa mundial HEARTS de la OMS y la iniciativa HEARTS en las Américas para catalizar la implementación de estas directrices, a la vez que se proporciona asesoramiento específico sobre políticas para dicha implementación y se destaca la necesidad de adoptar un enfoque estratégico general para el control de la hipertensión. Los autores instan a quienes abogan por la salud y a los responsables de las políticas a priorizar la prevención y el control de la hipertensión para mejorar la salud y el bienestar de la población, y a reducir las disparidades de salud en relación con las enfermedades cardiovasculares dentro de la población y entre las poblaciones de la Región de las Américas.
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Affiliation(s)
- Norm R C Campbell
- Departamento de Medicina Fisiología y Farmacología y Ciencias de Salud de la Comunidad Instituto Cardiovascular Libin de Alberta Universidad de Calgary Calgary Canadá Departamento de Medicina, Fisiología y Farmacología y Ciencias de Salud de la Comunidad, Instituto Cardiovascular Libin de Alberta, Universidad de Calgary, Calgary, Canadá.,Departamento de Enfermedades no Transmisibles y Salud Mental Organización Panamericana de la Salud Washington, DC Estados Unidos de América Departamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, DC, Estados Unidos de América
| | - Melanie Paccot Burnens
- Departamento de Enfermedades no Transmisibles Ministerio de Salud de Chile Santiago de Chile Chile Departamento de Enfermedades no Transmisibles, Ministerio de Salud de Chile, Santiago de Chile, Chile
| | - Paul K Whelton
- Departamento de Epidemiología Escuela de Salud Pública y Medicina Tropical de la Universidad de Tulane Nueva Orleans Estados Unidos de América Departamento de Epidemiología, Escuela de Salud Pública y Medicina Tropical de la Universidad de Tulane, Nueva Orleans, Estados Unidos de América
| | - Sonia Y Angell
- Departamento de Medicina Universidad de Columbia Colegio de Médicos y Cirujanos Vagelos Nueva York Estados Unidos de América Departamento de Medicina, Universidad de Columbia, Colegio de Médicos y Cirujanos Vagelos, Nueva York, Estados Unidos de América
| | - Marc G Jaffe
- Departamento de Endocrinología Centro Médico Kaiser Permanente de San Francisco San Francisco Estados Unidos de América Departamento de Endocrinología, Centro Médico Kaiser Permanente de San Francisco, San Francisco, Estados Unidos de América
| | - Jennifer Cohn
- Departamento de Medicina Interna Escuela de Medicina Universidad de Pensilvania Filadelfia Estados Unidos de América Departamento de Medicina Interna, Escuela de Medicina, Universidad de Pensilvania, Filadelfia, Estados Unidos de América
| | - Alfredo Espinosa Brito
- Departamento de Medicina Interna Hospital "Dr. Gustavo Aldereguía Lima", Cienfuegos Cienfuegos Cuba Departamento de Medicina Interna, Hospital "Dr. Gustavo Aldereguía Lima", Cienfuegos, Cuba
| | - Vilma Irazola
- Departamento de Investigación en Enfermedades Crónicas Centro de Excelencia en Salud Cardiovascular para América del Sur Instituto de Efectividad Clínica y Sanitaria Buenos Aires Argentina Departamento de Investigación en Enfermedades Crónicas, Centro de Excelencia en Salud Cardiovascular para América del Sur, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Jeffrey W Brettler
- Departamento de Ciencias de Sistemas de Salud Grupo Médico Permanente del Sur de California Escuela de Medicina Kaiser Permanente Bernard J. Tyson Los AngelesPasadena Estados Unidos de América Departamento de Ciencias de Sistemas de Salud, Grupo Médico Permanente del Sur de California, Los Ángeles, California, Escuela de Medicina Kaiser Permanente Bernard J. Tyson, Pasadena, Estados Unidos de América
| | - Edward J Roccella
- Programa Nacional de Educación sobre la Hipertensión Arterial de los Estados Unidos (Ret.) Instituto Nacional del Corazón los Pulmones y la Sangre Institutos Nacionales de Salud Bethesda Estados Unidos de América Programa Nacional de Educación sobre la Hipertensión Arterial de los Estados Unidos (Ret.) Instituto Nacional del Corazón, los Pulmones y la Sangre, Institutos Nacionales de Salud, Bethesda, Estados Unidos de América
| | | | - Andres Rosende
- Departamento de Enfermedades no Transmisibles y Salud Mental Organización Panamericana de la Salud Washington, DC Estados Unidos de América Departamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, DC, Estados Unidos de América
| | - Pedro Ordunez
- Departamento de Enfermedades no Transmisibles y Salud Mental Organización Panamericana de la Salud Washington, DC Estados Unidos de América Departamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, DC, Estados Unidos de América
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Campbell NRC, Paccot Burnens M, Whelton PK, Angell SY, Jaffe MG, Cohn J, Espinosa Brito A, Irazola V, Brettler JW, Roccella EJ, Maldonado Figueredo JI, Rosende A, Ordunez P. [2021 World Health Organization guideline on pharmacological treatment of hypertension: Policy implications for the Region of the AmericasDirectrices de la Organización Mundial de la Salud del 2021 sobre el tratamiento farmacológico de la hipertensión: implicaciones de política para la Región de las Américas]. Rev Panam Salud Publica 2022; 46:e55. [PMID: 35573114 PMCID: PMC9097927 DOI: 10.26633/rpsp.2022.55] [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: 11/29/2022] Open
Abstract
A doença cardiovascular (DCV) é a principal causa de morte nas Américas, e a pressão arterial elevada é responsável por mais de 50% dos casos de DCV. Nas Américas, mais de um quarto das mulheres adultas e quatro de cada dez homens adultos têm hipertensão arterial, sendo que diagnóstico, tratamento e controle estão abaixo do ideal. Em 2021, a Organização Mundial da Saúde (OMS) divulgou uma atualização das diretrizes para o tratamento medicamentoso da hipertensão arterial em adultos. Esta publicação ressalta o papel facilitador da iniciativa Global HEARTS da OMS e da iniciativa HEARTS nas Américas para catalisar a implementação dessas diretrizes, oferece recomendações específicas de políticas para sua implementação e enfatiza a necessidade de uma abordagem estratégica abrangente para o controle da hipertensão arterial. Os autores clamam para que tanto as pessoas que advogam pela Saúde, quanto as autoridades responsáveis, priorizem a prevenção e o controle da hipertensão arterial como forma de melhorar a saúde e o bem-estar das populações e reduzir as disparidades de saúde cardiovascular dentro das populações das Américas e entre elas.
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Affiliation(s)
- Norm R C Campbell
- Departamento de Medicina Fisiologia e Farmacologia e Ciências da Saúde Comunitária Libin Cardiovascular Institute of Alberta University of Calgary Calgary Canadá Departamento de Medicina, Fisiologia e Farmacologia e Ciências da Saúde Comunitária, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canadá.,Departamento de Doenças Não Transmissíveis e Saúde Mental Organização Pan-Americana da Saúde Washington EUA Departamento de Doenças Não Transmissíveis e Saúde Mental, Organização Pan-Americana da Saúde, Washington, EUA
| | - Melanie Paccot Burnens
- Chefe do Departamento de Doenças Não Transmissíveis Ministério da Saúde do Chile Santiago Chile Chefe do Departamento de Doenças Não Transmissíveis, Ministério da Saúde do Chile, Santiago, Chile
| | - Paul K Whelton
- Departamento de Epidemiologia Tulane University School of Public Health and Tropical Medicine Nova Orleans EUA Departamento de Epidemiologia, Tulane University School of Public Health and Tropical Medicine, Nova Orleans, EUA
| | - Sonia Y Angell
- Departamento de Medicina Columbia University Vagelos College of Physicians and Surgeons Nova York EUA Departamento de Medicina, Columbia University Vagelos College of Physicians and Surgeons, Nova York, EUA
| | - Marc G Jaffe
- Departamento de Endocrinologia Kaiser Permanente San Francisco Medical Center San Francisco EUA Departamento de Endocrinologia, Kaiser Permanente San Francisco Medical Center, San Francisco, EUA
| | - Jennifer Cohn
- Departamento de Medicina Interna Escola de Medicina University of Pennsylvania Filadélfia EUA Departamento de Medicina Interna, Escola de Medicina, University of Pennsylvania, Filadélfia, EUA
| | - Alfredo Espinosa Brito
- Departamento de Medicina Interna Hospital "Dr. Gustavo Aldereguía Lima" Cienfuegos Cuba Departamento de Medicina Interna, Hospital "Dr. Gustavo Aldereguía Lima", Cienfuegos, Cuba
| | - Vilma Irazola
- Departamento de Pesquisa em Doenças Crônicas Centro de Excelencia en Salud Cardiovascular para América del Sur, CESCAS Instituto de Efectividad Clínica y Sanitaria, IECS Buenos Aires Argentina Departamento de Pesquisa em Doenças Crônicas, Centro de Excelencia en Salud Cardiovascular para América del Sur, CESCAS, Instituto de Efectividad Clínica y Sanitaria, IECS, Buenos Aires, Argentina
| | - Jeffrey W Brettler
- Departamento de Ciências de Sistemas de Saúde Southern California Permanente Medical Group Kaiser Permanente Bernard J. Tyson School of Medicine Los AngelesPasadena EUA Departamento de Ciências de Sistemas de Saúde, Southern California Permanente Medical Group, Los Angeles; Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, EUA
| | - Edward J Roccella
- Programa Nacional de Educação em Hipertensão Arterial dos Estados Unidos (emérito) Instituto Nacional do Coração Pulmão e Sangue, Institutos Nacionais de Saúde Bethesda EUA Programa Nacional de Educação em Hipertensão Arterial dos Estados Unidos (emérito), Instituto Nacional do Coração, Pulmão e Sangue, Institutos Nacionais de Saúde, Bethesda, EUA
| | | | - Andres Rosende
- Departamento de Doenças Não Transmissíveis e Saúde Mental Organização Pan-Americana da Saúde Washington EUA Departamento de Doenças Não Transmissíveis e Saúde Mental, Organização Pan-Americana da Saúde, Washington, EUA
| | - Pedro Ordunez
- Departamento de Doenças Não Transmissíveis e Saúde Mental Organização Pan-Americana da Saúde Washington EUA Departamento de Doenças Não Transmissíveis e Saúde Mental, Organização Pan-Americana da Saúde, Washington, EUA
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Campbell NRC, Paccot Burnens M, Whelton PK, Angell SY, Jaffe MG, Cohn J, Espinosa Brito A, Irazola V, Brettler JW, Roccella EJ, Maldonado Figueredo JI, Rosende A, Ordunez P. 2021 World Health Organization guideline on pharmacological treatment of hypertension: Policy implications for the region of the Americas. LANCET REGIONAL HEALTH. AMERICAS 2022; 9:None. [PMID: 35711684 PMCID: PMC9107389 DOI: 10.1016/j.lana.2022.100219] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death in the Americas and raised blood pressure accounts for over 50% of CVD. In the Americas over a quarter of adult women and four in ten adult men have hypertension and the diagnosis, treatment and control are suboptimal. In 2021, the World Health Organization (WHO) released an updated guideline for the pharmacological treatment of hypertension in adults. This policy paper highlights the facilitating role of the WHO Global HEARTS initiative and the HEARTS in the Americas initiative to catalyze the implementation of this guideline, provides specific policy advice for implementation, and emphasizes that an overarching strategic approach for hypertension control is needed. The authors urge health advocates and policymakers to prioritize the prevention and control of hypertension to improve the health and wellbeing of their populations and to reduce CVD health disparities within and between populations of the Americas.
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Affiliation(s)
- Norm R C Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, North Tower, 9th Floor, 1403 - 29th Street NW, Calgary, AB T2N 2T9, Canada.,Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Melanie Paccot Burnens
- Head of the Department of Non-Communicable Diseases, Ministry of Health in Chile, Santiago, Chile
| | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Sonia Y Angell
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Marc G Jaffe
- Department of Endocrinology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - Jennifer Cohn
- Department of Internal Medicine, School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Alfredo Espinosa Brito
- Department of Internal Medicine, Hospital "Dr. Gustavo Aldereguía Lima", Cienfuegos, Cuba
| | - Vilma Irazola
- Department of Research in Chronic Diseases, Center of Excellence for Cardiovascular Health, CESCAS, Institute for Clinical Effectiveness and Health Policy, IECS, Buenos Aires, Argentina
| | - Jeffrey W Brettler
- Department of Health Systems Science, Southern California Permanente Medical Group, Los Angeles, California, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Edward J Roccella
- United States National High Blood Pressure Education Program (Ret.) National Heart, Lung and Blood Institute National Institutes of Health Bethesda, MD, USA
| | | | - Andres Rosende
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
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Jeemon P, Séverin T, Amodeo C, Balabanova D, Campbell NRC, Gaita D, Kario K, Khan T, Melifonwu R, Moran A, Ogola E, Ordunez P, Perel P, Piñeiro D, Pinto FJ, Schutte AE, Wyss FS, Yan LL, Poulter NR, Prabhakaran D. World Heart Federation Roadmap for Hypertension - A 2021 Update. Glob Heart 2021; 16:63. [PMID: 34692387 PMCID: PMC8447967 DOI: 10.5334/gh.1066] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 12/20/2022] Open
Abstract
The World Heart Federation (WHF) Roadmap series covers a large range of cardiovascular conditions. These Roadmaps identify potential roadblocks and their solutions to improve the prevention, detection and management of cardiovascular diseases and provide a generic global framework available for local adaptation. A first Roadmap on raised blood pressure was published in 2015. Since then, advances in hypertension have included the publication of new clinical guidelines (AHA/ACC; ESC; ESH/ISH); the launch of the WHO Global HEARTS Initiative in 2016 and the associated Resolve to Save Lives (RTSL) initiative in 2017; the inclusion of single-pill combinations on the WHO Essential Medicines' list as well as various advances in technology, in particular telemedicine and mobile health. Given the substantial benefit accrued from effective interventions in the management of hypertension and their potential for scalability in low and middle-income countries (LMICs), the WHF has now revisited and updated the 'Roadmap for raised BP' as 'Roadmap for hypertension' by incorporating new developments in science and policy. Even though cost-effective lifestyle and medical interventions to prevent and manage hypertension exist, uptake is still low, particularly in resource-poor areas. This Roadmap examined the roadblocks pertaining to both the demand side (demographic and socio-economic factors, knowledge and beliefs, social relations, norms, and traditions) and the supply side (health systems resources and processes) along the patient pathway to propose a range of possible solutions to overcoming them. Those include the development of population-wide prevention and control programmes; the implementation of opportunistic screening and of out-of-office blood pressure measurements; the strengthening of primary care and a greater focus on task sharing and team-based care; the delivery of people-centred care and stronger patient and carer education; and the facilitation of adherence to treatment. All of the above are dependent upon the availability and effective distribution of good quality, evidence-based, inexpensive BP-lowering agents.
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Affiliation(s)
- Panniyammakal Jeemon
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandum, IN
| | | | - Celso Amodeo
- Universidade Federal de São Paulo (UNIFESP), São Paulo, BR
| | | | | | - Dan Gaita
- Universitatea de Medicina si Farmacie Victor Babes, Timisoara, RO
| | - Kazuomi Kario
- Jichi Medical University School of Medicine, Shimotsuke, Tochigi, JP
| | | | | | - Andrew Moran
- Columbia University and Resolve to Save Lives, New York, US
| | | | - Pedro Ordunez
- Pan American Health Organization, Washington, DC, US
| | - Pablo Perel
- London School of Hygiene & Tropical Medicine and World Heart Federation, Geneva, GB
| | | | - Fausto J. Pinto
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisboa, PT
| | - Aletta E. Schutte
- University of New South Wales; The George Institute for Global Health, Sydney, AU
| | - Fernando Stuardo Wyss
- Cardiovascular Technology and Services of Guatemala – CARDIOSOLUTIONS, Guatemala, GT
| | | | | | - Dorairaj Prabhakaran
- London School of Hygiene & Tropical Medicine, London, GB
- Public Health Foundation of India, Gurugram, IN
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Research Letter: Antihypertensive Drugs Market in India: An Insight on Size, Trends, and Prescribing Preferences in the Private Health Sector, 2016-2018. Glob Heart 2021; 16:51. [PMID: 34381673 PMCID: PMC8344964 DOI: 10.5334/gh.999] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 07/06/2021] [Indexed: 11/20/2022] Open
Abstract
Background India has a high burden of hypertension. While the private sector provides 70% of out-patient care in the country, a significant proportion of patients seeking care from the public sector buy drugs from private markets. This study aimed to describe India's private sector antihypertensive drugs market at the national and state levels over 2016-2018. Methods Antihypertensive drugs sales in India from 2016-2018 were analysed using a large nationally representative dataset for the private pharmaceuticals market. In addition, data for five states (Punjab, Madhya Pradesh, Kerala, Telangana, and Maharashtra) that were the foci of a large hypertension control program were studied. Results The Indian hypertension drug market grew at a rate of 6.9% from 2016 to 2018 with a total of 21,066 million pills sales in 2018. Single-pill combinations (SPCs) contributed to 39.1% of total sale volumes. The market comprised of 182 different antihypertensive drugs including 134 SPCs. Total volume of sales covered a maximum of 26% of treatment need for the estimated population with hypertension. Two-drug SPCs had the highest market share (36%), followed by calcium channel blockers (18%), beta-blockers (16%) and angiotensin receptor blockers (14%). Among SPCs, amlodipine+atenolol had highest sales (9.8%). Twenty-five drugs, a mix of single drugs and SPCs, accounted for 80% of total sales. There were large state-to-state variations in sales per capita, preferred therapeutic classes and drugs. Conclusions Despite the large antihypertensive drugs market, there exists a high unmet need for treatment in India. Inter-state differences in product sales indicate variable treatment practices, underscoring the need for private sector engagement to improve hypertension care practices aligned with national and international guidelines. SPCs contributed to a large share of the private market and inclusion of select antihypertensive SPCs in the national list of essential medications should be considered for the public health system.
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Martinez R, Soliz P, Mujica OJ, Reveiz L, Campbell NRC, Ordunez P. The slowdown in the reduction rate of premature mortality from cardiovascular diseases puts the Americas at risk of achieving SDG 3.4: A population trend analysis of 37 countries from 1990 to 2017. J Clin Hypertens (Greenwich) 2021; 22:1296-1309. [PMID: 33289261 DOI: 10.1111/jch.13922] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/27/2020] [Accepted: 06/04/2020] [Indexed: 11/29/2022]
Abstract
Cardiovascular diseases (CVD) are leading causes of mortality and morbidity in the Americas, resulting in substantial negative economic and social impacts. This study describes the trends and inequalities of CVD burden in the Americas to guide programmatic interventions and health system responses. We examined the CVD burden trends by age, sex, and countries between 1990 and 2017 and quantified social inequalities in CVD burden across countries. In 2017, CVD accounted for 2 million deaths in the Americas, 29% of total deaths. Age-standardized DALY rates caused by CVD declined by -1.9% (95% uncertainty interval, -2.0 to -1.7) annually from 1990 to 2017. This trend varied with a striking decreasing trend over the interval 1994-2003 (annual percent change (APC) -2.4% [-2.5 to 2.2]) and 2003-2007 (APC -2.8% [-3.4 to -2.2]). This was followed by a slowdown in the rate of decline over 2007-2013 (APC -1.83% [-2.1 to -1.6]) and a stagnation during the most recent period 2013-2017 (APC -0.1% [-0.5 to 0.3]). The social inequality in CVD burden along the socio-demographic gradient across countries decreased 2.75-fold. The CVD burden and related social inequality have both substantially decreased in the Americas since 1990, driven by the reduction in premature mortality. This trend occurred in parallel with the improvement in the socioeconomic development and health care of the region. The deceleration and stagnation in the rate of improvement of CVD burden and persistent social inequality pose major challenges to reduce the CVD burden and the achievement of the United Nations' Sustainable Development Goals Target 3.4.
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Affiliation(s)
| | | | | | | | - Norm R C Campbell
- Department of Medicine and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Pedro Ordunez
- Pan American Health Organization, Washington, DC, USA
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Giraldo GP, Joseph KT, Angell SY, Campbell NRC, Connell K, DiPette DJ, Escobar MC, Valdés-Gonzalez Y, Jaffe MG, Malcolm T, Maldonado J, Lopez-Jaramillo P, Olsen MH, Ordunez P. Mapping stages, barriers and facilitators to the implementation of HEARTS in the Americas initiative in 12 countries: A qualitative study. J Clin Hypertens (Greenwich) 2021; 23:755-765. [PMID: 33738969 PMCID: PMC8678790 DOI: 10.1111/jch.14157] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/10/2020] [Accepted: 12/13/2020] [Indexed: 12/24/2022]
Abstract
The World Health Organization (WHO) Global Hearts Initiative offers technical packages to reduce the burden of cardiovascular diseases through population-wide and targeted health services interventions. The Pan American Health Organization (PAHO) has led implementation of the HEARTS in the Americas Initiative since 2016. The authors mapped the developmental stages, barriers, and facilitators to implementation among the 371 primary health care centers in the participating 12 countries. The authors used the qualitative method of document review to examine cumulative country reports, technical meeting notes, and reports to regional stakeholders. Common implementation barriers include segmentation of health systems, overcoming health care professionals' scope of practice legal restrictions, and lack of health information systems limiting operational evaluation and quality improvement mechanisms. Main implementation facilitators include political support from ministries of health and leading scientific societies, PAHO's role as a regional catalyst to implementation, stakeholder endorsement demonstrated by incorporating HEARTS into official documents, and having a health system oriented to primary health care. Key lessons include the need for political commitment and cultivating on-the-ground leadership to initiate a shift in hypertension care delivery, accompanied by specific progress in the development of standardized treatment protocols and a set of high-quality medicines. By systematizing an implementation strategy to ease integration of interventions into delivery processes, the program strengthened technical leadership and ensured sustainability. These study findings will aid the regional approach by providing a staged planning model that incorporates lessons learned. A systematic approach to implementation will enhance equity, efficiency, scale-up, and sustainability, and ultimately improve population hypertension control.
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Affiliation(s)
- Gloria P Giraldo
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Kristy T Joseph
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sonia Y Angell
- College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Norm R C Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AL, Canada
| | | | | | | | | | | | - Taraleen Malcolm
- Pan American Health Organization, Port of Spain, Trinidad and Tobago
| | | | - Patricio Lopez-Jaramillo
- Lancet Commission on Hypertension Group, London, UK.,University of Santander, Bucaramanga, Colombia
| | - Michaels Hecht Olsen
- Lancet Commission on Hypertension Group, London, UK.,Holbaek Hospital, Holbaek, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
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Kaur P, Kunwar A, Sharma M, Mitra J, Das C, Swasticharan L, Chakma T, Dipak Bangar S, Venkatasamy V, Dharamsoth R, Purohit S, Tayade S, Singh GB, Bitragunta S, Durgad K, Das B, Dar S, Bharadwaj R, Joshi C, Bharadwaj V, Khedkar S, Chenji S, Reddy SK, Sreedhar C, Parasuraman G, Kasiviswanathan S, Viswanathan V, Uike P, Gaigaware P, Yadav S, Dhaliwal RS, Ramakrishnan S, Tullu FT, Bhargava B. India Hypertension Control Initiative-Hypertension treatment and blood pressure control in a cohort in 24 sentinel site clinics. J Clin Hypertens (Greenwich) 2020; 23:720-729. [PMID: 33369074 PMCID: PMC8678731 DOI: 10.1111/jch.14141] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/28/2020] [Accepted: 12/05/2020] [Indexed: 11/28/2022]
Abstract
The India Hypertension Control Initiative (IHCI) is a multi‐partner initiative, implementing and scaling up a public health hypertension control program across India. A cohort of 21,895 adult hypertension patients in 24 IHCI sentinel site facilities in four Indian states (Punjab, Madhya Pradesh, Maharashtra, and Telangana), registered from January 2018 until June 2019 were assessed at baseline and then followed up for blood pressure (BP) control and antihypertensive medication use. Among all registrations, 11 274 (51%) of the patients returned for a follow‐up visit between July 2019 and September 2019. Among patients returning for follow‐up, 26.3% had BP controlled at registration, and 59.8% had BP controlled at follow‐up (p < .001). The absolute improvement in BP control was more than two times greater in primary care (48.1 percentage point increase) than secondary care facilities (22.9 percentage point increase). Most IHCI patients received prescriptions according to state‐specific treatment protocols. This study demonstrates that a scalable public health hypertension control program can yield substantial BP control improvements, especially in primary care settings. However, high loss to follow‐up limits population health impact; future efforts should focus on improving systems to increase the likelihood that patients will return to the clinic for routine hypertension care.
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Affiliation(s)
| | | | | | - Jhilam Mitra
- ICMR-National Institute of Epidemiology, Chennai, India
| | - Chinmoyee Das
- Directorate General of Health Services I Ministry of Health and Family Welfare, New Delhi, India
| | - Leimapokpam Swasticharan
- Directorate General of Health Services I Ministry of Health and Family Welfare, New Delhi, India
| | - Tapas Chakma
- ICMR-National Institute of Research in Tribal Health, Jabalpur, India
| | | | | | - Raviteja Dharamsoth
- State NCD Cell, Department of Health, Medical and Family Welfare, Govt of Telangana, Hyderabad, India
| | - Saurabh Purohit
- State NCD Cell, Directorate of Health Services, Govt of Madhya Pradesh, Bhopal, India
| | - Sadhana Tayade
- State NCD Cell, Directorate of Health Services, Govt of Maharashtra, Mumbai, India
| | - Gurinder B Singh
- State NCD Cell, Department of Health and Family Welfare, Govt of Punjab, Chandigarh, India
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Pankaj Uike
- ICMR-National Institute of Research in Tribal Health, Jabalpur, India
| | | | - Suniti Yadav
- Indian Council of Medical Research (ICMR), New Delhi, India
| | - R S Dhaliwal
- Indian Council of Medical Research (ICMR), New Delhi, India
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Sujarwoto S, Maharani A. Participation in community-based health care interventions (CBHIs) and its association with hypertension awareness, control and treatment in Indonesia. PLoS One 2020; 15:e0244333. [PMID: 33370385 PMCID: PMC7769427 DOI: 10.1371/journal.pone.0244333] [Citation(s) in RCA: 5] [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: 07/21/2020] [Accepted: 12/07/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Little attention has been paid to whether CBHIs improve awareness, treatment and control of hypertension in the contexts of low- and middle- income countries (LMICs). This study therefore aims to examine participation in CBHIs for non-communicable diseases (NCDs) and its association with awareness, treatment, and control of hypertension among Indonesians. METHODS This study used data from the 2014 Indonesia Family Life Survey (IFLS), drawn from 30,351 respondents aged 18 years and older. Participation in CBHIs was measured by respondents' participation in CBHIs for NCDs (Posbindu PTM and Posbindu Lansia) during the 12 months prior to the survey. Logistic regressions were used to identify the relationships between participation in CBHIs for NCDs and awareness, treatment, and control of blood pressure among respondents with hypertension. RESULTS The age-adjusted prevalence of hypertension was 31.2% and 29.2% in urban and rural areas, respectively. The overall age-adjusted prevalence was 30.2%. Approximately 41.8% of respondents with hypertension were aware of their condition, and only 6.6% of respondents were receiving treatment. Participation in CBHIs for NCDs was associated with 50% higher odds of being aware and 118% higher odds of receiving treatment among adults with hypertension. There was no significant association between participation in CBHIs for NCDs and controlled hypertension. CONCLUSION Our data emphasise the importance of CBHIs for NCDs to improve the awareness and treatment of hypertension in the Indonesian population.
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Affiliation(s)
- Sujarwoto Sujarwoto
- Portsmouth Brawijaya Center for Global Health, Population and Policy & Department of Public Administration, Universitas Brawijaya, Malang, Indonesia
| | - Asri Maharani
- Division of Nursing, Midwifery, & Social Work, University of Manchester, Manchester, United Kingdom
- Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia
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Campbell NRC, Ordunez P, Giraldo G, Rodriguez Morales YA, Lombardi C, Khan T, Padwal R, Tsuyuki RT, Varghese C. WHO HEARTS: A Global Program to Reduce Cardiovascular Disease Burden: Experience Implementing in the Americas and Opportunities in Canada. Can J Cardiol 2020; 37:744-755. [PMID: 33310142 DOI: 10.1016/j.cjca.2020.12.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 12/14/2022] Open
Abstract
Globally, cardiovascular diseases (CVDs) are the leading cause of death. Viewed as a threat to the global economy, the United Nations included reducing noncommunicable diseases, including CVDs, in the 2030 sustainable development goals, and the World Health Assembly agreed to a target to reduce noncommunicable diseases 25% by the year 2025. In response, the World Health Organisation led the development of HEARTS, a technical package to guide governments in strengthening primary care to reduce CVDs. HEARTS recommends a public health and health system approach to introduce highly simplified interventions done systematically at a primary health care level and has a focus on hypertension as a clinical entry point. The HEARTS modules include healthy lifestyle counselling, evidence-based treatment protocols, access to essential medicines and technology, CVD risk-based management, team-based care, systems for monitoring, and an implementation guide. There are early positive global experiences in implementing HEARTS. Led by the Pan American Health Organisation, many national governments in the Americas are adopting HEARTS and have shown early success. Unfortunately, in Canada hypertension control is declining in women since 2010-2011 and the dramatic reductions in rates of CVD seen before 2010 have flattened when age adjusted and increased for rates that are not age adjusted, and there are marked increases in absolute numbers of Canadians with adverse CVD outcomes. Several steps that Canada could take to enhance hypertension control are outlined, the core of which is to implement a strong governmental nongovernmental collaborative strategy to prevent and control CVDs, focusing on HEARTS.
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Affiliation(s)
- Norm R C Campbell
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organisation, Washington, DC, USA
| | - Gloria Giraldo
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organisation, Washington, DC, USA
| | - Yenny A Rodriguez Morales
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organisation, Washington, DC, USA
| | - Cintia Lombardi
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organisation, Washington, DC, USA
| | - Taskeen Khan
- Department of Non-Communicable Diseases, World Health Organisation, Geneva, Switzerland
| | - Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ross T Tsuyuki
- Departments of Pharmacology and Medicine (Cardiology) and EPICORE Centre, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Cherian Varghese
- Department of Non-Communicable Diseases, World Health Organisation, Geneva, Switzerland
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DiPette DJ, Goughnour K, Zuniga E, Skeete J, Ridley E, Angell S, Brettler J, Campbell NRC, Coca A, Connell K, Doon R, Jaffe M, Lopez‐Jaramillo P, Moran A, Orias M, Pineiro DJ, Rosende A, González YV, Ordunez P. Standardized treatment to improve hypertension control in primary health care: The HEARTS in the Americas Initiative. J Clin Hypertens (Greenwich) 2020; 22:2285-2295. [PMID: 33045133 PMCID: PMC8029673 DOI: 10.1111/jch.14072] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/03/2020] [Accepted: 09/13/2020] [Indexed: 01/12/2023]
Abstract
Hypertension is the leading risk factor for cardiovascular disease (CVD) worldwide. Despite the availability of effective antihypertensive medications, the control of hypertension at a global level is dismal, and consequently, the CVD burden continues to increase. In response, countries in Latin America and the Caribbean are implementing the HEARTS in the Americas, a community-based program that focuses on increasing hypertension control and CVD secondary prevention through risk factor mitigation. One key pillar is the implementation of a standardized hypertension treatment protocol supported by a small, high-quality formulary. This manuscript describes the methodology used by the HEARTS in the Americas program to implement a population-based standardized hypertension treatment protocol. It is rooted in a seamless transition from existing treatment practices to best practice using pharmacologic protocols built around a core set of ideal antihypertensive medications. In alignment with recent major hypertension guidelines, the HEARTS in the Americas protocols call for the rapid control of blood pressure, through the use of two antihypertensive medications, preferably in the form of a single pill, fixed-dose combination, in the initial treatment of hypertension. To date, the HEARTS in the Americas program has seen the improvement in antihypertensive medication formularies and the establishment of pharmacologic treatment protocols tailored to individual participating countries. This has translated to significant increases in hypertension control rates post-program implementation in these jurisdictions. Thus, the HEARTS in the Americas program could serve as a model, for not only the Americas Region but globally, and ultimately decrease the burden of CVD.
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Affiliation(s)
| | - Kenneth Goughnour
- Women Influencing Health, Education and Rule of Law (WI‐HER)ViennaVAUSA
| | - Eric Zuniga
- Health Service of AntofagastaUniversity of AntofagastaAntofagastaChile
| | - Jamario Skeete
- Department of Internal MedicineDivision of CardiologyRush University Medical CenterChicagoILUSA
| | | | - Sonia Angell
- California Department of Public HealthCaliforniaILUSA
| | | | - Norm R. C. Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health SciencesO’Brien Institute for Public Health and Libin Cardiovascular Institute of AlbertaUniversity of CalgaryCalgaryABCanada
| | - Antionio Coca
- Department of Internal MedicineHypertension and Vascular Risk UnitHospital ClinicUniversity of BarcelonaBarcelonaSpain
| | - Kenneth Connell
- Faculty of Medical SciencesThe University of the West IndiesSt MichaelBarbados
| | - Rohit Doon
- Ministry of HealthPort of SpainTrinidad and Tobago
| | - Marc Jaffe
- Division of EndocrinologyKaiser PermanenteSan FranciscoCAUSA
| | | | - Andrew Moran
- Resolve to Save LivesAn initiative of Vital StrategiesNew YorkNYUSA
- Columbia University Irving Medical CenterNew YorkNYUSA
| | - Marcelo Orias
- Sanatorio Allende CórdobaUniversidad Nacional de CórdobaCordobaArgentina
| | | | | | - Yamilé Valdés González
- National Technical Advisory Commission on HypertensionHavanaCuba
- University Hospital "General Calixto García"HavanaCuba
| | - Pedro Ordunez
- Department of Non‐Communicable Diseases and Mental HealthPan American Health OrganizationWashingtonDCUSA
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40
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Campbell NRC, Khalsa T, Ordunez P, Rodriguez Morales YA, Zhang X, Parati G, Padwal R, Tsuyuki RT, Cloutier L, Sharman JE. Brief online certification course for measuring blood pressure with an automated blood pressure device. A free new resource to support World Hypertension Day Oct 17, 2020. J Clin Hypertens (Greenwich) 2020; 22:1754-1756. [PMID: 32882074 PMCID: PMC8029906 DOI: 10.1111/jch.14017] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/21/2020] [Accepted: 08/07/2020] [Indexed: 11/28/2022]
Abstract
Detection, diagnosis, and treatment of hypertension require accurate blood pressure assessment. However, in clinical practice, lack of training in or nonadherence to measurement recommendations, lack of patient preparation, unsuitable environments where blood pressure is measured, and inaccurate and inappropriate equipment are widespread and commonly lead to inaccurate blood pressure readings. This has led to calls to require regular training and certification for people assessing blood pressure. Hence, the Pan American Health Organization in collaboration with Resolve to Save Lives, the World Hypertension League, Lancet Commission on Hypertension Group, and Hypertension Canada has developed a free brief training and certification course in blood pressure measurement. The course is available at www. The release of the online certification course is timed to help support World Hypertension Day. This year World Hypertension Day has been delayed to October 17 due to the COVID-19 pandemic. For 2020, the World Hypertension League calls on all health care professionals, health care professional organizations, and indeed all of society, to assess the blood pressure of all adults, measure blood pressure accurately, and achieve blood pressure control in those with hypertension.
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Affiliation(s)
| | | | - Pedro Ordunez
- Department of Non‐Communicable Diseases and Mental HealthPan American Health OrganizationWashingtonDCUSA
| | - Yenny A. Rodriguez Morales
- Department of Non‐Communicable Diseases and Mental HealthPan American Health OrganizationWashingtonDCUSA
| | | | - Gianfranco Parati
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanoItaly
- Department of Cardiovascular, Neural and Metabolic SciencesIstituto Auxologico ItalianoIRCCSItaly
| | - Raj Padwal
- Department of MedicineUniversity of AlbertaEdmontonABCanada
| | - Ross T. Tsuyuki
- Departments of Pharmacology and Medicine (Cardiology)Faculty of Medicine and DentistryUniversity of AlbertaEdmontonABCanada
| | | | - James E. Sharman
- Menzies Institute for Medical ResearchUniversity of TasmaniaHobartTasAustralia
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41
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Gelfer M, Bell A, Petrella R, Campbell NRC, Cloutier L, Lindsay P, Leung AA, Morris D, McLean D, Tsuyuki RT, Dattani S, Kaczorowski J. Take urgent action diagnosing, treating, and controlling hypertension in older women. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2020; 66:726-731. [PMID: 33077448 PMCID: PMC7571660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Mark Gelfer
- Clinical Assistant Professor in the Department of Family Practice at the University of British Columbia and the Copeman Healthcare Centre in Vancouver
| | - Alan Bell
- Assistant Professor in the Department of Family and Community Medicine at the University of Toronto in Ontario
| | - Robert Petrella
- Professor in and Head of the Department of Family Practice at the University of British Columbia
| | - Norm R C Campbell
- Emeritus Professor in the Department of Medicine, the Department of Physiology and Pharmacology, and the Department of Community Health Sciences in the O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta at the University of Calgary.
| | - Lyne Cloutier
- Professor in the Department of Nursing at the Université du Québec à Trois-Rivières
| | - Patrice Lindsay
- Director of Systems Change and the Stroke Program for the Heart & Stroke Foundation of Canada in Ottawa, Ont
| | - Alexander A Leung
- Assistant Professor in the Department of Medicine and the Department of Community Health Sciences in the Cumming School of Medicine at the University of Calgary
| | - Dorothy Morris
- Clinical Nurse Educator for the Coronary Care Unit and the Cardiovascular Unit at the Royal Jubilee Hospital in Victoria, BC
| | - Donna McLean
- Member of faculty in the Faculty of Nursing at MacEwan University and a nurse practitioner in internal and emergency medicine for Covenant Health-Misericordia Hospital in Edmonton, Alta
| | - Ross T Tsuyuki
- Professor in and Chair of the Department of Pharmacology, Professor in the Department of Medicine and the Division of Cardiology, and Director of the EPICORE Centre in the Faculty of Medicine and Dentistry at the University of Alberta in Edmonton
| | - Shelita Dattani
- Director of Practice Development and Knowledge Translation for the Canadian Pharmacists Association in Toronto
| | - Janusz Kaczorowski
- Professor and Research Director in the Department of Family and Emergency Medicine at the University of Montreal and the Centre de recherche du CHUM in Quebec
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42
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Skeete J, Connell K, Ordunez P, DiPette DJ. Approaches to the Management of Hypertension in Resource-Limited Settings: Strategies to Overcome the Hypertension Crisis in the Post-COVID Era. Integr Blood Press Control 2020; 13:125-133. [PMID: 33061561 PMCID: PMC7532072 DOI: 10.2147/ibpc.s261031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/15/2020] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic has changed most aspects of everyday life in both the non-medical and medical settings. In the medical world, the pandemic has altered how healthcare is delivered and has necessitated an aggressive and new coordinated public health approach to limit its spread and reduce its disease burden and socioeconomic impact. This pandemic has resulted in a staggering morbidity and mortality and massive economic and physical hardships. Meanwhile, non-communicable diseases such as hypertension, diabetes mellitus, and cardiovascular disease in general continue to cause significant disease burden globally in the background. Though presently receiving less attention in the public eye than the COVID-19 pandemic, the hypertension crisis cannot be separated from the minds of healthcare providers, policymakers and the general public, as it continues to wreak havoc, particularly in vulnerable populations in resource limited settings. On this background, many of the strategies being employed to combat the COVID-19 pandemic can be used to re-energize and galvanize the fight against hypertension and hopefully bring the public health crisis associated with uncontrolled hypertension to an end.
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Affiliation(s)
- Jamario Skeete
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Kenneth Connell
- Faculty of Medical Sciences, University of the West Indies, Cave Hill Campus, St. Michael, Barbados
| | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan-American Health Organization, Washington, DC, USA
| | - Donald J DiPette
- Department of Internal Medicine, University of South Carolina School of Medicine, University of South Carolina, Columbia, SC, USA
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43
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Edwards EW, Battle S, DiPette DJ. Apparent resistant hypertension in sub‐Saharan Africa: Frequency and associated factors. J Clin Hypertens (Greenwich) 2020; 22:1603-1605. [DOI: 10.1111/jch.13970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 07/06/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Elizabeth W. Edwards
- Department of Internal Medicine University of South Carolina and University of South Carolina School of Medicine Columbia SC USA
| | - Sean Battle
- Department of Internal Medicine University of South Carolina and University of South Carolina School of Medicine Columbia SC USA
| | - Donald J. DiPette
- Department of Internal Medicine University of South Carolina and University of South Carolina School of Medicine Columbia SC USA
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44
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Campbell NRC, Dattani S, Bell A, Gelfer M, Cloutier L, Petrella R, Lindsay P, Leung AA, McLean D, Kaczorowski J, Tsuyuki RT. Urgent need to increase the rates of diagnosing, treating and controlling hypertension in older women: A call for action. Can Pharm J (Ott) 2020; 153:264-269. [PMID: 33110465 DOI: 10.1177/1715163520947006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Norm R C Campbell
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Shelita Dattani
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Alan Bell
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Mark Gelfer
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Lyne Cloutier
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Robert Petrella
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Patrice Lindsay
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Alexander A Leung
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Donna McLean
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Janusz Kaczorowski
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Ross T Tsuyuki
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
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45
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Campbell NRC, Padwal R, Picone DS, Su H, Sharman JE. The impact of small to moderate inaccuracies in assessing blood pressure on hypertension prevalence and control rates. J Clin Hypertens (Greenwich) 2020; 22:939-942. [PMID: 32485090 PMCID: PMC8029741 DOI: 10.1111/jch.13915] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/22/2020] [Accepted: 04/28/2020] [Indexed: 01/13/2023]
Affiliation(s)
- Norm R. C. Campbell
- Department of Medicine and Libin Cardiovascular InstituteUniversity of CalgaryCalgaryABCanada
| | - Raj Padwal
- Department of MedicineUniversity of AlbertaEdmontonABCanada
| | - Dean S. Picone
- Menzies Institute for Medical ResearchUniversity of TasmaniaHobartTASAustralia
| | - Hai Su
- Department of Cardiovascular MedicineThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - James E. Sharman
- Menzies Institute for Medical ResearchUniversity of TasmaniaHobartTASAustralia
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46
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Mercer T, Nulu S, Vedanthan R. Innovative Implementation Strategies for Hypertension Control in Low- and Middle-Income Countries: a Narrative Review. Curr Hypertens Rep 2020; 22:39. [PMID: 32405820 DOI: 10.1007/s11906-020-01045-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW This review summarizes the most recent and innovative implementation strategies for hypertension control in low- and middle-income countries (LMICs). RECENT FINDINGS Implementation strategies from Latin America, Africa, and Asia were organized across three levels: community, health system, and policy/population. Multicomponent interventions involving task-shifting strategies, with or without mobile health tools, had the most supporting evidence, with policy or population-level interventions having the least, focused only on salt reduction with mixed results. More research is needed to better understand how context affects intervention implementation. There is an emerging evidence base for implementation strategies for hypertension control and CVD risk reduction in LMICs at the community and health system levels, but further research is needed to determine the most effective policy and population-level strategies. How to best account for local context in adapting and implementing these evidence-based interventions in LMICs still remains largely unknown. Accelerating the translation of this implementation research into policy and practice is imperative to improve health and save lives globally.
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Affiliation(s)
- Tim Mercer
- Department of Population Health, Division of Global Health, The University of Texas at Austin Dell Medical School, 1601 Trinity St., Bldg. B, Austin, TX, 78712, USA.
| | - Shanti Nulu
- Department of Internal Medicine, Division of Cardiology, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Rajesh Vedanthan
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
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