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Satheesh G, Dhurjati R, Huffman MD, Rosende A, Rodgers A, Prabhakaran D, Ordunez P, Jha V, Salam A. Standardized treatment protocols for hypertension: global availability, characteristics, and alignment with the hypertension guideline recommendations. J Hypertens 2024; 42:902-908. [PMID: 38108382 DOI: 10.1097/hjh.0000000000003636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
BACKGROUND Hypertension control is suboptimal globally. Implementing evidence-based, simple, standardized treatment protocols (STPs) has been instrumental in effectively and efficiently improving treatment and control of hypertension. We aimed to identify, characterize, and critically appraise hypertension STPs. METHODS We defined STP as a series of steps for the pharmacological treatment of primary hypertension, with information on target population, BP threshold for treatment initiation, target BP, specific drugs/classes/doses, and follow-up frequency. STPs for adult patients were identified from the websites of relevant health organizations, Google search, and through expert consultations (until July 2023). STPs for secondary, gestational, or malignant hypertension or those that were templates/samples were excluded. Included STPs were critically appraised using HEARTS in the Americas Checklist for hypertension management in primary care and compared with the 2021 WHO hypertension management guideline recommendations. RESULTS Fifty STPs were identified. All STPs had a stepwise treatment approach, involved guideline-recommended first-line drugs, and 98% consisted of at least four steps. Majority (54%) recommended monotherapy with calcium channel blockers as first-line treatment. Only 44% STPs recommended treatment initiation with combination therapy, and 16% recommended single-pill combinations. Most (62%) had dose-intensification as the second step. Most (74%) STPs did not provide complete dosing information. Only one STP mentioned a target time for achieving BP control. On average, STPs scored a performance of 68% on the HEARTS Checklist. CONCLUSION Several STPs are available globally; however, most of them have enormous scope for improvement through interventions aimed at alignment with the latest evidence-based guidelines and multistakeholder engagement.
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Affiliation(s)
- Gautam Satheesh
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Rupasvi Dhurjati
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Mark D Huffman
- Washington University in St. Louis, St. Louis, Missouri, USA
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Andres Rosende
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, District of Columbia, USA
| | - Anthony Rodgers
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Pedro Ordunez
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, District of Columbia, USA
| | - Vivekanand Jha
- School of Public Health, Imperial College, London, UK
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Abdul Salam
- The George Institute for Global Health, Sydney, New South Wales, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Dumith SC, Dushpanova A, Dwyer T, Dyussupova A, Dzerve V, Dziankowska-Zaborszczyk E, Ebrahimi N, Echeverría G, Eddie R, Eftekhar E, Efthymiou V, Egbagbe EE, Eggertsen R, Eghtesad S, Eiben G, Ekelund U, El-Khateeb M, El Ammari L, El Ati J, Eldemire-Shearer D, Elliott P, Enang O, Endevelt R, Engle-Stone R, Erasmus RT, Erem C, Ergor G, Eriksen L, Eriksson JG, Escobedo-de la Peña J, Eslami S, Esmaeili A, Evans A, Evans RG, Faeh D, Fagherazzi G, Fakhradiyev I, Fakhretdinova AA, Fall CH, Faramarzi E, Farjam M, Farrugia Sant'Angelo V, Farzi Y, Fattahi MR, Fawwad A, Fawzi WW, Felix-Redondo FJ, Ferguson TS, Fernandes RA, Fernández-Bergés D, Ferrante D, Ferrao T, Ferrari G, Ferrari M, Ferrario MM, Ferreccio C, Ferreira HS, Ferrer E, Ferrieres J, Figueiró TH, Fijalkowska A, Fink G, Fisberg M, Fischer K, Foo LH, Forsner M, Fottrell EF, Fouad HM, Francis DK, Franco MDC, Fras Z, Fraser B, Frontera G, Fuchs FD, Fuchs SC, Fujiati II, Fujita Y, Fumihiko M, Furdela V, Furusawa T, Gabriela SA, Gaciong Z, 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Michels N, Mikkel K, Miłkowska K, Miller JC, Milushkina O, Minderico CS, Mini GK, Miquel JF, Mirjalili MR, Mirkopoulou D, Mirrakhimov E, Mišigoj-Duraković M, Mistretta A, Mocanu V, Modesti PA, Moghaddam SS, Mohamed SF, Mohammad K, Mohammadi MR, Mohammadi Z, Mohammadifard N, Mohammadpourhodki R, Mohan V, Mohanna S, Mohd Yusoff MF, Mohebbi I, Moitry M, Møllehave LT, Møller NC, Molnár D, Momenan A, Mondo CK, Monroy-Valle M, Montenegro Mendoza RA, Monterrubio-Flores E, Monyeki KDK, Moon JS, Moosazadeh M, Mopa HT, Moradpour F, Moreira LB, Morejon A, Moreno LA, Morey F, Morgan K, Morin SN, Mortensen EL, Moschonis G, Moslem A, Mosquera M, Mossakowska M, Mostafa A, Mostafavi SA, Mota-Pinto A, Mota J, Motlagh ME, Motta J, Moura-dos-Santos MA, Movsesyan Y, Mridha MK, Msyamboza KP, Mu TT, Muc M, Muca F, Mugoša B, Muiesan ML, Müller-Nurasyid M, Münzel T, Mursu J, Murtagh EM, Musa KI, Musić Milanović S, Musil V, Musinguzi G, Muyer MT, Nabipour I, Nagel G, Najafi F, Nakamura H, Nalecz H, Námešná J, Nang EEK, Nangia VB, Nankap M, Narake S, Narayan KMV, Nardone P, Naseri T, Nathalie M, Neal WA, Neelapaichit N, Nejatizadeh A, Nekkantti C, Nelis K, Nenko I, Neovius M, Nervi F, Ng TP, Nguyen CT, Nguyen ND, Nguyen QN, Ni MY, Nicolescu R, Nie P, Nieto-Martínez RE, Nikitin YP, Ning G, Ninomiya T, Nishi N, Nishtar S, Noale M, Noboa OA, Nogueira H, Nordendahl M, Nordestgaard BG, Norton KI, Noto D, Nowak-Szczepanska N, Nsour MA, Nuhoğlu I, Nunes B, Nurk E, Nuwaha F, Nyirenda M, O'Neill TW, O'Reilly D, Obreja G, Ochimana C, Ochoa-Avilés AM, Oda E, Odili AN, Oh K, Ohara K, Ohlsson C, Ohtsuka R, Olafsson Ö, Oldenburg B, Olinto MTA, Oliveira IO, Omar MA, Omar SM, Onat A, Ong SK, Onland-Moret NC, Ono LM, Onodugo O, Ordunez P, Ornelas R, Ortiz AP, Ortiz PJ, Osler M, Osmond C, Ostojic SM, Ostovar A, Otero JA, Ottendahl CB, Otu A, Overvad K, Owusu-Dabo E, Oyeyemi AY, Oyeyemi AL, Paccaud FM, Padez CP, Pagkalos I, Pahomova E, de Paiva KM, Pająk A, Pajula N, Palloni A, Palmieri L, Pan WH, Panda-Jonas S, Pandey A, Pang Z, Panza F, Paoli M, Papadopoulou SK, Papandreou D, Pareja RG, Park SW, Park S, Parnell WR, Parsaeian M, Pascanu IM, Pasquet P, Patel ND, Pattussi M, Pavlyshyn H, Pechlaner R, Pećin I, Pednekar MS, Pedro JM, Peer N, Peixoto SV, Peltonen M, Pereira AC, Peres MA, Perez-Londoño A, Pérez CM, Peterkova V, Peters A, Petkeviciene J, Petrauskiene A, Petrovna Kovtun O, Pettenuzzo E, Peykari N, Pfeiffer N, Phall MC, Pham ST, Phiri FP, Pichardo RN, Pierannunzio D, Pierre-Marie P, Pigeot I, Pikhart H, Pilav A, Piler P, Pilotto L, Pistelli F, Pitakaka F, Piwonska A, Pizarro AN, Plans-Rubió P, Platonova AG, Poh BK, Pohlabeln H, Polka NS, Pop RM, Popkin BM, Popovic SR, Porta M, Posch G, Poudyal A, Poulimeneas D, Pouraram H, Pourfarzi F, Pourshams A, Poustchi H, Price AJ, Price JF, Prista A, Providencia R, Puder JJ, Pudule I, Puhakka S, Puiu M, Punab M, Qadir MS, Qasrawi RF, Qiao Q, Qorbani M, Quintana HK, Quiroga-Padilla PJ, Quoc Bao T, Rach S, Radic I, Radisauskas R, Rahimikazerooni S, Rahman M, Rahman M, Raitakari O, Raj M, Rajabov T, Rakhmatulloev S, Rakovac I, Ramachandra Rao S, Ramachandran A, Ramadan OPC, Ramires VV, Ramirez-Zea M, Ramke J, Ramos E, Ramos R, Rampal L, Rampal S, Ramsay SE, Rangelova LS, Rarra V, Rascon-Pacheco RA, Rashidi MM, Rech CR, Redon J, Reganit PFM, Regecová V, Renner JDP, Repasy JA, Reuter CP, Revilla L, Reynolds A, Rezaei N, Rezaianzadeh A, Rho Y, Ribas-Barba L, Ribeiro R, Riboli E, Rigo F, Rigotti A, Rinaldo N, Rinke de Wit TF, Risérus U, Rito AI, Ritti-Dias RM, Rivera JA, Roa RG, Robinson L, Roccaldo R, Rodrigues D, Rodriguez-Perez MDC, Rodríguez-Villamizar LA, Rodríguez AY, Roggenbuck U, Rohloff P, Rohner F, Rojas-Martinez R, Rojroongwasinkul N, Romaguera D, Romeo EL, Rosario RV, Rosengren A, Rouse I, Rouzier V, Roy JGR, Ruano MH, Rubinstein A, Rühli FJ, Ruidavets JB, Ruiz-Betancourt BS, Ruiz-Castell M, Ruiz Moreno E, Rusakova IA, Rusek W, Russell Jonsson K, Russo P, Rust P, Rutkowski M, Saamel M, Saar CG, Sabanayagam C, Sabbaghi H, Sacchini E, Sachdev HS, Sadjadi A, Safarpour AR, Safi S, Safiri S, Saghi MH, Saidi O, Saieva C, Sakata S, Saki N, Šalaj S, Salanave B, Salazar Martinez E, Salhanova A, Salmerón D, Salomaa V, Salonen JT, Salvetti M, Samoutian M, Sánchez-Abanto J, Sánchez Rodríguez I, Sandjaja, Sans S, Santa-Marina L, Santacruz E, Santos DA, Santos IS, Santos LC, Santos MP, Santos O, Santos R, Santos TR, Saramies JL, Sardinha LB, Sarrafzadegan N, Sathish T, Saum KU, Savva S, Savy M, Sawada N, Sbaraini M, Scazufca M, Schaan BD, Schaffrath Rosario A, Schargrodsky H, Schienkiewitz A, Schindler K, Schipf S, Schmidt B, Schmidt CO, Schmidt IM, Schneider A, Schnohr P, Schöttker B, Schramm S, Schramm S, Schröder H, Schultsz C, Schultz G, Schulze MB, Schutte AE, Sebert S, Sedaghattalab M, Selamat R, Sember V, Sen A, Senbanjo IO, Sepanlou SG, Sequera G, Serra-Majem L, Servais J, Ševčíková Ľ, Sewpaul R, Shalnova S, Shamah-Levy T, Shamshirgaran SM, Shanthirani CS, Sharafkhah M, Sharma SK, Sharman A, Shaw JE, Shayanrad A, Shayesteh AA, Shengelia L, Shi Z, Shibuya K, Shimizu-Furusawa H, Shimony T, Shiri R, Shrestha N, Si-Ramlee K, Siani A, Siantar R, Sibai AM, Sidossis LS, Silitrari N, Silva AM, Silva CRDM, Silva DAS, Silva KS, Sim X, Simon M, Simons J, Simons LA, Sjöberg A, Sjöström M, Skoblina EV, Skoblina NA, Slazhnyova T, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, So HK, Soares FC, Sobek G, Sobngwi E, Sodemann M, Söderberg S, Soekatri MYE, Soemantri A, Sofat R, Solfrizzi V, Solovieva YV, Somi MH, Sonestedt E, Song Y, Soofi S, Sørensen TIA, Sørgjerd EP, Sossa Jérome C, Soto-Rojas VE, Soumaré A, Sousa-Poza A, Sovic S, Sparboe-Nilsen B, Sparrenberger K, Spencer PR, Spinelli A, Spiroski I, Staessen JA, Stamm H, Stang A, Starc G, Staub K, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Steinsbekk S, Stergiou GS, Stessman J, Stevanović R, Stieber J, Stöckl D, Stokwiszewski J, Stoyanova E, Stratton G, Stronks K, Strufaldi MW, Sturua L, Suárez-Medina R, Suarez-Ortegón MF, Suebsamran P, Sugiyama M, Suka M, Sulo G, Sun CA, Sun L, Sund M, Sundström J, Sung YT, Sunyer J, Suriyawongpaisal P, Sweis NWG, Swinburn BA, Sy RG, Sylva RC, Szponar L, Tabone L, Tai ES, Takuro F, Tambalis KD, Tammesoo ML, Tamosiunas A, Tan EJ, Tang X, Tanrygulyyeva M, Tanser F, Tao Y, Tarawneh MR, Tarp J, Tarqui-Mamani CB, Taxová Braunerová R, Taylor A, Taylor J, Tchibindat F, Te Velde S, Tebar WR, Tell GS, Tello T, Tessema M, Tham YC, Thankappan KR, Theobald H, Theodoridis X, Thomas N, Thorand B, Thrift AG, Tichá Ľ, Timmermans EJ, Tjandrarini DH, Tjonneland A, Tolonen HK, Tolstrup JS, Tomaszewski M, Topbas M, Topór-Mądry R, Torheim LE, Tornaritis MJ, Torrent M, Torres-Collado L, Toselli S, Touloumi G, Traissac P, Tran TTH, Tremblay MS, Triantafyllou A, Trichopoulos D, Trichopoulou A, Trinh OTH, Trivedi A, Tshepo L, Tsigga M, Tsintavis P, Tsugane S, Tuitele J, Tuliakova AM, Tulloch-Reid MK, Tullu F, Tuomainen TP, Tuomilehto J, Twig G, Tynelius P, Tzala E, Tzotzas T, Tzourio C, Udoji N, Ueda P, Ugel E, Ukoli FAM, Ulmer H, Unal B, Usupova Z, Uusitalo HMT, Uysal N, Vaitkeviciute J, Valdivia G, Vale S, Valvi D, van Dam RM, van den Born BJ, Van der Heyden J, van der Schouw YT, Van Herck K, Van Lippevelde W, Van Minh H, Van Schoor NM, van Valkengoed IGM, Vanderschueren D, Vanuzzo D, Varbo A, Varela-Moreiras G, Vargas LN, Varona-Pérez P, Vasan SK, Vasques DG, Vatasescu R, Vega T, Veidebaum T, Velasquez-Melendez G, Velika B, Verloigne M, Veronesi G, Verschuren WMM, Victora CG, Viegi G, Viet L, Vik FN, Vilar M, Villalpando S, Vioque J, Viriyautsahakul N, Virtanen JK, Visser M, Visvikis-Siest S, Viswanathan B, Vladulescu M, Vlasoff T, Vocanec D, Vollenweider P, Völzke H, Vourli G, Voutilainen A, Vrijheid M, Vrijkotte TGM, Vuletić S, Wade AN, Waldhör T, Walton J, Wambiya EOA, Wan Bebakar WM, Wan Mohamud WN, Wanderley Júnior RDS, Wang C, Wang H, Wang MD, Wang N, Wang Q, Wang X, Wang YX, Wang YW, Wannamethee SG, Wareham N, Wartha O, Weber A, Wedderkopp N, Weghuber D, Wei W, Weres A, Werner B, Westbury LD, Whincup PH, Wichstrøm L, Wickramasinghe K, Widhalm K, Widyahening IS, Więcek A, Wild PS, Wilks RJ, Willeit J, Willeit P, Williams J, Wilsgaard T, Wirth JP, Wojtyniak B, Woldeyohannes M, Wolf K, Wong-McClure RA, Wong A, Wong EB, Wong JE, Wong TY, Woo J, Woodward M, Wu FC, Wu HY, Wu J, Wu LJ, Wu S, Wyszyńska J, Xu H, Xu L, Yaacob NA, Yamborisut U, Yan L, Yan W, Yang L, Yang X, Yang Y, Yardim N, Yasuharu T, Yépez García M, Yiallouros PK, Yngve A, Yoosefi M, Yoshihara A, Yotov Y, You QS, You SL, Younger-Coleman NO, Yu YL, Yu Y, Yusof SM, Yusoff AF, Zaccagni L, Zafiropulos V, Zainuddin AA, Zakavi SR, Zamani F, Zambon S, Zampelas A, Zamrazilová H, Zapata ME, Zargar AH, Zaw KK, Zayed AA, Zdrojewski T, Żegleń M, Zejglicova K, Zeljkovic Vrkic T, Zeng Y, Zentai A, Zhang B, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhao W, Zhecheva YV, Zhen S, Zheng W, Zheng Y, Zholdin B, Zhou M, Zhu D, Zimmet P, Zins M, Zitt E, Zocalo Y, Zoghlami N, Zuñiga Cisneros J, Zuziak M, Ezzati M. Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet 2024; 403:1027-1050. [PMID: 38432237 PMCID: PMC7615769 DOI: 10.1016/s0140-6736(23)02750-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/22/2023] [Accepted: 12/05/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. METHODS We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5-19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school-aged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). FINDINGS From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. INTERPRETATION The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity. FUNDING UK Medical Research Council, UK Research and Innovation (Research England), UK Research and Innovation (Innovate UK), and European Union.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Desson Z, Sharman JE, Searles A, Schutte AE, Delles C, Olsen MH, Ordunez P, Hure A, Morton R, Figtree G, Webster J, Jennings G, Redfern J, Nicholls SJ, McNamara M, Deeming S, Doyle K, Ramanathan S. Improving the accuracy of blood pressure measuring devices in Australia: a modelled return on investment study. J Hum Hypertens 2024; 38:177-186. [PMID: 37938294 PMCID: PMC10844083 DOI: 10.1038/s41371-023-00866-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 04/20/2023] [Accepted: 07/10/2023] [Indexed: 11/09/2023]
Abstract
The VALID BP project was initiated to increase the availability of validated blood pressure measuring devices (BPMDs). The goal is to eliminate non validated BPMDs and minimise over- and underdiagnosis of hypertension caused by inaccurate readings. This study was undertaken to assess the potential return on investment in the VALID BP project. The Framework to Assess the Impact of Translational Health Research was applied to the VALID BP project. This paper focuses on the implementation of the cost benefit analysis aspect of this framework to monetise past research investment and model future research costs, implementation costs, and benefits. Analysis was based on reasoned assumptions about potential impacts from availability and use of validated BPMDs (assuming an end goal of 100% validated BPMDs available in Australia by 2028) and improved skills leading to more accurate BP measurement. After 5 years, with 20% attribution of benefits, there is a potential $1.14-$1.30 return for every dollar spent if the proportion of validated BPMDs and staff trained in proper BP measurement technique increased from 20% to 60%. After eight years (2020-2028) and assuming universal validation and training coverage, the returns would be between $2.70 and $3.20 per dollar spent (not including cost of side effects of unnecessary medication or downstream patient impacts from unmanaged hypertension). This modelled economic analysis indicates there will be positive downstream economic benefits if the availability of validated BPMDs is increased. The findings support ongoing efforts toward a universal regulatory framework for BPMDs and can be considered within more detailed future economic analyses.
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Affiliation(s)
- Zachary Desson
- Health Research Economics, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Andrew Searles
- College of Health, Medicine and Wellbeing, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Aletta E Schutte
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Alexis Hure
- College of Health, Medicine and Wellbeing, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Rachael Morton
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Gemma Figtree
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Australian Cardiovascular Alliance, Chittaway Bay, NSW, Australia
| | - Jacqui Webster
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Garry Jennings
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Australian Cardiovascular Alliance, Chittaway Bay, NSW, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Julie Redfern
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- The George Institute for Global Health, Sydney, NSW, Australia
| | | | | | - Simon Deeming
- Health Research Economics, Hunter Medical Research Institute, Newcastle, NSW, Australia
- College of Health, Medicine and Wellbeing, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Kerry Doyle
- Australian Cardiovascular Alliance, Chittaway Bay, NSW, Australia
| | - Shanthi Ramanathan
- Health Research Economics, Hunter Medical Research Institute, Newcastle, NSW, Australia.
- College of Health, Medicine and Wellbeing, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.
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Zhou B, Sheffer KE, Bennett JE, Gregg EW, Danaei G, Singleton RK, Shaw JE, Mishra A, Lhoste VPF, Carrillo-Larco RM, Kengne AP, Phelps NH, Heap RA, Rayner AW, Stevens GA, Paciorek CJ, Riley LM, Cowan MJ, Savin S, Vander Hoorn S, Lu Y, Pavkov ME, Imperatore G, Aguilar-Salinas CA, Ahmad NA, Anjana RM, Davletov K, Farzadfar F, González-Villalpando C, Khang YH, Kim HC, Laatikainen T, Laxmaiah A, Mbanya JCN, Narayan KMV, Ramachandran A, Wade AN, Zdrojewski T, Abbasi-Kangevari M, Rahim HFA, Abu-Rmeileh NM, Adambekov S, Adams RJ, Aekplakorn W, Agdeppa IA, Aghazadeh-Attari J, Agyemang C, Ahmadi A, Ahmadi N, Ahmadi N, Ahmed SH, Ajlouni K, Al-Hinai H, Al-Lahou B, Al-Lawati JA, Asfoor DA, Al Qaoud NM, Alarouj M, AlBuhairan F, AlDhukair S, Aldwairji MA, Ali MM, Alinezhad F, Alkandari A, Alomirah HF, Aly E, Amarapurkar DN, Andersen LB, Anderssen SA, Andrade DS, Ansari-Moghaddam A, Aounallah-Skhiri H, Aris T, Arlappa N, Aryal KK, Assah FK, Assembekov B, Auvinen J, Avdičová M, Azad K, Azimi-Nezhad M, Azizi F, Bacopoulou F, Balakrishna N, Bamoshmoosh M, Banach M, Bandosz P, Banegas JR, Barbagallo CM, Barceló A, Baretić M, Barrera L, Basit A, Batieha AM, Batista AP, Baur LA, Belavendra A, Ben Romdhane H, Benet M, Berkinbayev S, Bernabe-Ortiz A, Berrios Carrasola X, Bettiol H, Beybey AF, Bhargava SK, Bika Lele EC, Bikbov MM, Bista B, Bjerregaard P, Bjertness E, Bjertness MB, Björkelund C, Bloch KV, Blokstra A, Bo S, Bobak M, Boggia JG, Bonaccio M, Bonilla-Vargas A, Borghs H, Bovet P, Brajkovich I, Brenner H, Brewster LM, Brian GR, Briceño Y, Brito M, Bugge A, Buntinx F, Cabrera de León A, Caixeta RB, Can G, Cândido APC, Capanzana MV, Čapková N, Capuano E, Capuano R, Capuano V, Cardoso VC, Carlsson AC, Casanueva FF, Censi L, Cervantes‐Loaiza M, Chamnan P, Chamukuttan S, Chan Q, Charchar FJ, Chaturvedi N, Chen H, Cheraghian B, Chirlaque MD, Chudek J, Cifkova R, Cirillo M, Claessens F, Cohen E, Concin H, Cooper C, Costanzo S, Cowell C, Crujeiras AB, Cruz JJ, Cureau FV, Cuschieri S, D’Arrigo G, d’Orsi E, Dallongeville J, Damasceno A, Dastgiri S, De Curtis A, de Gaetano G, De Henauw S, Deepa M, DeGennaro V, Demarest S, Dennison E, Deschamps V, Dhimal M, Dika Z, Djalalinia S, Donfrancesco C, Dong G, Dorobantu M, Dörr M, Dragano N, Drygas W, Du Y, Duante CA, Duboz P, Dushpanova A, Dziankowska-Zaborszczyk E, Ebrahimi N, Eddie R, Eftekhar E, Efthymiou V, Egbagbe EE, Eghtesad S, El-Khateeb M, El Ati J, Eldemire-Shearer D, Elosua R, Enang O, Erasmus RT, Erbel R, Erem C, Ergor G, Eriksen L, Eriksson JG, Esmaeili A, Evans RG, Fakhradiyev I, Fall CH, Faramarzi E, Farjam M, Farzi Y, Fattahi MR, Fawwad A, Felix-Redondo FJ, Ferguson TS, Fernández-Bergés D, Ferrari M, Ferreccio C, Ferreira HS, Ferrer E, Feskens EJM, Flood D, Forsner M, Fosse S, Fottrell EF, Fouad HM, Francis DK, Frontera G, Furusawa T, Gaciong Z, Garnett SP, Gasull M, Gazzinelli A, Gehring U, Ghaderi E, Ghamari SH, Ghanbari A, Ghasemi E, Gheorghe-Fronea OF, Ghimire A, Gialluisi A, Giampaoli S, Gianfagna F, Gill TK, Gironella G, Giwercman A, Goltzman D, Gomula A, Gonçalves H, Gonçalves M, Gonzalez-Chica DA, Gonzalez-Gross M, González-Rivas JP, González-Villalpando ME, Gonzalez AR, Gottrand F, Grafnetter D, Grodzicki T, Grøntved A, Guerrero R, Gujral UP, Gupta R, Gutierrez L, Gwee X, Haghshenas R, Hakimi H, Hambleton IR, Hamzeh B, Hanekom WA, Hange D, Hantunen S, Hao J, Hari Kumar R, Harooni J, Hashemi-Shahri SM, Hata J, Heidemann C, Henrique RDS, Herrala S, Herzig KH, Heshmat R, Ho SY, Holdsworth M, Homayounfar R, Hopman WM, Horimoto ARVR, Hormiga C, Horta BL, Houti L, Howitt C, Htay TT, Htet AS, Htike MMT, Huerta JM, Huhtaniemi IT, Huisman M, Husseini A, Huybrechts I, Iacoviello L, Iakupova EM, Iannone AG, Ibrahim Wong N, Ijoma C, Irazola VE, Ishida T, Isiguzo GC, Islam SMS, Islek D, Ittermann T, Iwasaki M, Jääskeläinen T, Jacobs JM, Jaddou HY, Jadoul M, Jallow B, James K, Jamil KM, Janus E, Jarvelin MR, Jasienska G, Jelaković A, Jelaković B, Jennings G, Jha AK, Jimenez RO, Jöckel KH, Jokelainen JJ, Jonas JB, Joshi P, Josipović J, Joukar F, Jóźwiak J, Kafatos A, Kajantie EO, Kalmatayeva Z, Karki KB, Katibeh M, Kauhanen J, Kazakbaeva GM, Kaze FF, Ke C, Keinänen-Kiukaanniemi S, Kelishadi R, Keramati M, Kersting M, Khader YS, Khaledifar A, Khalili D, Kheiri B, Kheradmand M, Khosravi A, Kiechl-Kohlendorfer U, Kiechl SJ, Kiechl S, Kingston A, Klakk H, Klanova J, Knoflach M, Kolsteren P, König J, Korpelainen R, Korrovits P, Kos J, Koskinen S, Kowlessur S, Koziel S, Kriemler S, Kristensen PL, Kromhout D, Kubinova R, Kujala UM, Kulimbet M, Kurjata P, Kyobutungi C, La QN, Labadarios D, Lachat C, Laid Y, Lall L, Lankila T, Lanska V, Lappas G, Larijani B, Latt TS, Laurenzi M, Lehmann N, Lehtimäki T, Lemogoum D, Leung GM, Li Y, Lima-Costa MF, Lin HH, Lind L, Lissner L, Liu X, Lopez-Garcia E, Lopez T, Lozano JE, Luksiene D, Lundqvist A, Lunet N, Lustigová M, Machado-Coelho GLL, Machado-Rodrigues AM, Macia E, Macieira LM, Madar AA, Maestre GE, Maggi S, Magliano DJ, Magriplis E, Mahasampath G, Maire B, Makdisse M, Malekpour MR, Malekzadeh F, Malekzadeh R, Mallikharjuna Rao K, Malyutina S, Maniego LV, Manios Y, Mannix MI, Mansour-Ghanaei F, Manzato E, Margozzini P, Mariño J, Marques LP, Martorell R, Mascarenhas LP, Masinaei M, Mathiesen EB, Matsha TE, Mc Donald Posso AJ, McFarlane SR, McGarvey ST, Mediene Benchekor S, Mehlig K, Mehrparvar AH, Melgarejo JD, Méndez F, Menezes AMB, Mereke A, Meshram II, Meto DT, Minderico CS, Mini GK, Miquel JF, Miranda JJ, Mirjalili MR, Modesti PA, Moghaddam SS, Mohamed MK, Mohammad K, Mohammadi MR, Mohammadi Z, Mohammadifard N, Mohammadpourhodki R, Mohan V, Mohd Yusoff MF, Mohebbi I, Møller NC, Molnár D, Momenan A, Mondo CK, Montenegro Mendoza RA, Monterrubio-Flores E, Moosazadeh M, Moradpour F, Morejon A, Moreno LA, Morgan K, Morin SN, Moslem A, Mosquera M, Mossakowska M, Mostafa A, Mostafavi SA, Motlagh ME, Motta J, Msyamboza KP, Mu TT, Muiesan ML, Mursu J, Musa KI, Mustafa N, Muyer MTMC, Nabipour I, Nagel G, Naidu BM, Najafi F, Námešná J, Nangia VB, Naseri T, Neelapaichit N, Nejatizadeh A, Nenko I, Nervi F, Ng TP, Nguyen CT, Nguyen QN, Ni MY, Nie P, Nieto-Martínez RE, Ninomiya T, Noale M, Noboa OA, Noto D, Nsour MA, Nuhoğlu I, O’Neill TW, Odili AN, Oh K, Ohtsuka R, Omar MA, Onat A, Ong SK, Onodugo O, Ordunez P, Ornelas R, Ortiz PJ, Osmond C, Ostovar A, Otero JA, Ottendahl CB, Otu A, Owusu-Dabo E, Palmieri L, Pan WH, Panda-Jonas S, Panza F, Paoli M, Park S, Parsaeian M, Patel ND, Pechlaner R, Pećin I, Pedro JM, Peixoto SV, Peltonen M, Pereira AC, Pessôa dos Prazeres TM, Peykari N, Phall MC, Pham ST, Phan HH, Pichardo RN, Pikhart H, Pilav A, Piler P, Pitakaka F, Piwonska A, Pizarro AN, Plans-Rubió P, Plata S, Porta M, Poudyal A, Pourfarzi F, Pourshams A, Poustchi H, Pradeepa R, Providencia R, Puder JJ, Puhakka S, Punab M, Qorbani M, Quintana HK, Quoc Bao T, Rahimikazerooni S, Raitakari O, Ramirez-Zea M, Ramke J, Ramos R, Rampal L, Rampal S, Rangel Reina DA, Rashidi MM, Redon J, Renner JDP, Reuter CP, Revilla L, Rezaei N, Rezaianzadeh A, Rigo F, Roa RG, Robinson L, Rodríguez-Artalejo F, Rodriguez-Perez MDC, Rodríguez-Villamizar LA, Rodríguez AY, Roggenbuck U, Rohloff P, Romeo EL, Rosengren A, Rubinstein A, Rust P, Rutkowski M, Sabbaghi H, Sachdev HS, Sadjadi A, Safarpour AR, Safi S, Safiri S, Saghi MH, Saidi O, Saki N, Šalaj S, Salanave B, Salonen JT, Salvetti M, Sánchez-Abanto J, Santos DA, Santos LC, Santos MP, Santos TR, Saramies JL, Sardinha LB, Sarrafzadegan N, Saum KU, Sbaraini M, Scazufca M, Schaan BD, Scheidt-Nave C, Schipf S, Schmidt CO, Schöttker B, Schramm S, Sebert S, Sedaghattalab M, Sein AA, Sepanlou SG, Sewpaul R, Shamah-Levy T, Shamshirgaran SM, Sharafkhah M, Sharma SK, Sharman A, Shayanrad A, Shayesteh AA, Shimizu-Furusawa H, Shiri R, Shrestha N, Si-Ramlee K, Silva DAS, Simon M, Simons J, Simons LA, Sjöström M, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, Sobngwi E, Söderberg S, Soemantri A, Sofat R, Solfrizzi V, Somi MH, Soumaré A, Sousa-Poza A, Sparrenberger K, Staessen JA, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Stessman J, Stokwiszewski J, Stronks K, Suarez-Ortegón MF, Suebsamran P, Sundström J, Suriyawongpaisal P, Sylva RC, Szklo M, Tamosiunas A, Tarawneh MR, Tarqui-Mamani CB, Taylor A, Taylor J, Tello T, Thankappan KR, Theobald H, Theodoridis X, Thomas N, Thrift AG, Timmermans EJ, Tjandrarini DH, Tolonen HK, Tolstrup JS, Tomaszewski M, Topbas M, Torres-Collado L, Traissac P, Triantafyllou A, Tuitele J, Tuliakova AM, Tulloch-Reid MK, Tuomainen TP, Tzala E, Tzourio C, Ueda P, Ugel E, Ukoli FAM, Ulmer H, Uusitalo HMT, Valdivia G, van den Born BJ, Van der Heyden J, Van Minh H, van Rossem L, Van Schoor NM, van Valkengoed IGM, van Zutphen EM, Vanderschueren D, Vanuzzo D, Vasan SK, Vega T, Velasquez-Melendez G, Verstraeten R, Viet L, Villalpando S, Vioque J, Virtanen JK, Viswanathan B, Voutilainen A, Wan Bebakar WM, Wan Mohamud WN, Wang C, Wang N, Wang Q, Wang YX, Wang YW, Wannamethee SG, Webster-Kerr K, Wedderkopp N, Wei W, Westbury LD, Whincup PH, Widhalm K, Widyahening IS, Więcek A, Wilks RJ, Willeit J, Willeit P, Wilsgaard T, Wojtyniak B, Wong A, Wong EB, Woodward M, Wu FC, Xu H, Xu L, Yaacob NA, Yan L, Yan W, Yoosefi M, Yoshihara A, Younger-Coleman NO, Yu YL, Yu Y, Yusoff AF, Zainuddin AA, Zamani F, Zambon S, Zampelas A, Zaw KK, Zeljkovic Vrkic T, Zeng Y, Zhang ZY, Zholdin B, Zimmet P, Zitt E, Zoghlami N, Zuñiga Cisneros J, Ezzati M. Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c. Nat Med 2023; 29:2885-2901. [PMID: 37946056 PMCID: PMC10667106 DOI: 10.1038/s41591-023-02610-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 09/25/2023] [Indexed: 11/12/2023]
Abstract
Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance.
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Peiris S, Izcovich A, Ordunez P, Luciani S, Martinez C, Aldighieri S, Reveiz L. Challenges to delivering evidence-based management for long COVID. BMJ Evid Based Med 2023; 28:295-298. [PMID: 37491142 PMCID: PMC10579509 DOI: 10.1136/bmjebm-2023-112311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 07/27/2023]
Affiliation(s)
- Sasha Peiris
- Pan American Health Organization, Washington, District of Columbia, USA
| | - Ariel Izcovich
- Pan American Health Organization, Washington, District of Columbia, USA
| | - Pedro Ordunez
- Pan American Health Organization, Washington, District of Columbia, USA
| | - Silvana Luciani
- Pan American Health Organization, Washington, District of Columbia, USA
| | - Carmen Martinez
- Pan American Health Organization, Washington, District of Columbia, USA
| | | | - Ludovic Reveiz
- Pan American Health Organization, Washington, District of Columbia, USA
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Campbell NRC, Martinez R, Ordunez P. The Estimated Impact of Changes in Population Hypertension Control on Cardiovascular Disease in Canada From 2000 to 2017. Can J Cardiol 2023; 39:886-888. [PMID: 36931621 DOI: 10.1016/j.cjca.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/21/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023] Open
Affiliation(s)
- Norm R C Campbell
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
| | - Ramon Martinez
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organisation, Washington, DC, USA
| | - Pedro Ordunez
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organisation, Washington, DC, USA
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Prado P, Gamarra Á, Rodríguez L, Brettler J, Farrell M, Girola ME, Malcolm T, Martínez R, Molina V, Moran AE, Neupane D, Rosende A, Valdés González Y, Mukhtar Q, Ordunez P. [Monitoring and evaluation platform for HEARTS in the Americas: improving population-based hypertension control programs in primary health carePlataforma de monitoramento e avaliação do programa HEARTS nas Américas: melhoria dos programas de controle da hipertensão de base populacional na atenção primária à saúde]. Rev Panam Salud Publica 2023; 47:e90. [PMID: 37223327 PMCID: PMC10202337 DOI: 10.26633/rpsp.2023.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/15/2022] [Indexed: 05/25/2023] Open
Abstract
HEARTS in the Americas is the Pan American Health Organization flagship program to accelerate the reduction of the cardiovascular disease (CVD) burden by improving hypertension control and CVD secondary prevention in primary health care. A monitoring and evaluation (M&E) platform is needed for program implementation, benchmarking, and informing policy-makers. This paper describes the conceptual bases of the HEARTS M&E platform including software design principles, contextualization of data collection modules, data structure, reporting, and visualization. The District Health Information Software 2 (DHIS2) web-based platform was chosen to implement aggregate data entry of CVD outcome, process, and structural risk factor indicators. In addition, PowerBI was chosen for data visualization and dashboarding for the analysis of performance and trends above the health care facility level. The development of this new information platform was focused on primary health care facility data entry, timely data reporting, visualizations, and ultimately active use of data to drive decision-making for equitable program implementation and improved quality of care. Additionally, lessons learnt and programmatic considerations were assessed through the experience of the M&E software development. Building political will and support is essential to developing and deploying a flexible platform in multiple countries which is contextually specific to the needs of various stakeholders and levels of the health care system. The HEARTS M&E platform supports program implementation and reveals structural and managerial limitations and care gaps. The HEARTS M&E platform will be central to monitoring and driving further population-level improvements in CVD and other noncommunicable disease-related health.
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Affiliation(s)
- Patric Prado
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud. Washington, D.C., Estados Unidos de América.
| | - Ángelo Gamarra
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud. Washington, D.C., Estados Unidos de América.
| | - Libardo Rodríguez
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud. Washington, D.C., Estados Unidos de América.
| | - Jeffrey 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.
| | - Margaret Farrell
- Resolve to Save LivesNueva YorkEstados Unidos de AméricaResolve to Save Lives, Nueva York, Estados Unidos de América.
| | - María E. Girola
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud. Washington, D.C., Estados Unidos de América.
| | - Taraleen Malcolm
- Organización Panamericana de la SaludPuerto EspañaTrinidad y TobagoOrganización Panamericana de la Salud, Puerto España, Trinidad y Tobago.
| | - Ramón Martínez
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud. Washington, D.C., Estados Unidos de América.
| | - Virginia Molina
- Organización Panamericana de la SaludCiudad de MéxicoMéxicoOrganización Panamericana de la Salud, Ciudad de México, México.
| | - Andrew E. Moran
- Resolve to Save LivesNueva YorkEstados Unidos de AméricaResolve to Save Lives, Nueva York, Estados Unidos de América.
| | - Dinesh Neupane
- Departamento de EpidemiologíaEscuela 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.
| | - Andrés Rosende
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud. Washington, D.C., Estados Unidos de América.
| | - Yamilé Valdés González
- Hospital Universitario General Calixto GarcíaComisión Nacional Técnica Asesora del Programa de Hipertensión ArterialLa HabanaCubaHospital Universitario General Calixto García, Comisión Nacional Técnica Asesora del Programa de Hipertensión Arterial, La Habana, Cuba.
| | - Qaiser Mukhtar
- División de Protección de la Salud MundialCentros para el Control y la Prevención de EnfermedadesAtlantaEstados Unidos de AméricaDivisión de Protección de la Salud Mundial, Centros para el Control y la Prevención de Enfermedades, Atlanta, Estados Unidos de América.
| | - Pedro Ordunez
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud. Washington, D.C., Estados Unidos de América.
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Rosende A, DiPette DJ, Martinez R, Brettler JW, Rodriguez G, Zuniga E, Ordunez P. HEARTS in the Americas clinical pathway. Strengthening the decision support system to improve hypertension and cardiovascular disease risk management in primary care settings. Front Cardiovasc Med 2023; 10:1102482. [PMID: 37180772 PMCID: PMC10169833 DOI: 10.3389/fcvm.2023.1102482] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/27/2023] [Indexed: 05/16/2023] Open
Abstract
Background HEARTS in the Americas is the regional adaptation of the WHO Global HEARTS Initiative. It is implemented in 24 countries and over 2,000 primary healthcare facilities. This paper describes the results of a multicomponent, stepwise, quality improvement intervention designed by the HEARTS in the Americas to support advances in hypertension treatment protocols and evolution towards the Clinical Pathway. Methods The quality improvement intervention comprised: 1) the use of the appraisal checklist to evaluate the current hypertension treatment protocols, 2) a peer-to-peer review and consensus process to resolve discrepancies, 3) a proposal of a clinical pathway to be considered by the countries, and 4) a process of review, adopt/adapt, consensus and approval of the clinical pathway by the national HEARTS protocol committee. A year later, 16 participants countries (10 and 6 from each cohort, respectively) were included in a second evaluation using the HEARTS appraisal checklist. We used the median and interquartile scores range and the percentages of the maximum possible total score for each domain as a performance measure to compare the results pre and post-intervention. Results Among the eleven protocols from the ten countries in the first cohort, the baseline assessment achieved a median overall score of 22 points (ICR 18 -23.5; 65% yield). After the intervention, the overall score reached a median of 31.5 (ICR 28.5 -31.5; 93% yield). The second cohort of countries developed seven new clinical pathways with a median score of 31.5 (ICR 31.5 -32.5; 93% yield). The intervention was effective in three domains: 1. implementation (clinical follow-up intervals, frequency of drug refills, routine repeat blood pressure measurement when the first reading is off-target, and a straightforward course of action). 2. treatment (grouping all medications in a single daily intake and using a combination of two antihypertensive medications for all patients in the first treatment step upon the initial diagnosis of hypertension) and 3. management of cardiovascular risk (lower BP thresholds and targets based on CVD risk level, and the use of aspirin and statins in high-risk patients). Conclusion This study confirms that this intervention was feasible, acceptable, and instrumental in achieving progress in all countries and all three domains of improvement: implementation, blood pressure treatment, and cardiovascular risk management. It also highlights the challenges that prevent a more rapid expansion of HEARTS in the Americas and confirms that the main barriers are in the organization of health services: drug titration by non-physician health workers, the lack of long-acting antihypertensive medications, lack of availability of fixed-doses combination in a single pill and cannot use high-intensity statins in patients with established cardiovascular diseases. Adopting and implementing the HEARTS Clinical Pathway can improve the efficiency and effectiveness of hypertension and cardiovascular disease risk management programs.
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Affiliation(s)
- Andres Rosende
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States
| | - Donald J. DiPette
- School of Medicine Columbia, University of South Carolina, Columbia, SC, United States
| | - Ramon Martinez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States
| | - Jeffrey W. Brettler
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States
- Southern California Permanente Medical Group, Los Angeles, CA, United States
| | - Gonzalo Rodriguez
- Consultant for HEARTS in the Americas, PAHO/WHO Office in Argentina, Buenos Aires, Argentina
| | - Eric Zuniga
- Antofagasta Health Service, University of Antofagasta, Antofagasta, Chile
| | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States
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A, Rinaldo N, Rinke de Wit TF, Rito AI, Ritti-Dias RM, Rivera JA, Roa RG, Robinson L, Robitaille C, Roccaldo R, Rodrigues D, Rodríguez-Artalejo F, del Cristo Rodriguez-Perez M, Rodríguez-Villamizar LA, Rodríguez AY, Roggenbuck U, Rohloff P, Rohner F, Rojas-Martinez R, Rojroongwasinkul N, Romaguera D, Romeo EL, Rosario RV, Rosengren A, Rouse I, Rouzier V, Roy JGR, Ruano MH, Rubinstein A, Rühli FJ, Ruidavets JB, Ruiz-Betancourt BS, Ruiz-Castell M, Moreno ER, Rusakova IA, Jonsson KR, Russo P, Rust P, Rutkowski M, Saamel M, Sabanayagam C, Sabbaghi H, Sacchini E, Sachdev HS, Sadjadi A, Safarpour AR, Safi S, Safiri S, Saghi MH, Saidi O, Saki N, Šalaj S, Salanave B, Martinez ES, Saleva C, Salmerón D, Salomaa V, Salonen JT, Salvetti M, Samoutian M, Sánchez-Abanto J, Rodríguez IS, Sandjaja, Sans S, Marina LS, Santacruz E, Santos DA, Santos IS, Santos LC, Santos MP, Santos O, Santos R, Santos TR, Saramies JL, Sardinha LB, Sarrafzadegan N, Sathish T, Saum KU, Savva S, Savy M, Sawada N, Sbaraini M, Scazufca M, Schaan BD, Rosario AS, Schargrodsky H, Schienkiewitz A, Schindler K, Schipf S, Schmidt CO, Schmidt IM, Schneider A, Schnohr P, Schöttker B, Schramm S, Schramm S, Schröder H, Schultsz C, Schulze MB, Schutte AE, Sebert S, Sedaghattalab M, Selamat R, Sember V, Sen A, Senbanjo IO, Sepanlou SG, Sequera G, Serra-Majem L, Servais J, Ševčíková Ľ, Shalnova S, Shamah-Levy T, Shamshirgaran SM, Shanthirani CS, Sharafkhah M, Sharma SK, Shaw JE, Shayanrad A, Shayesteh AA, Shengelia L, Shi Z, Shibuya K, Shimizu-Furusawa H, Shimony T, Shiri R, Shrestha N, Si-Ramlee K, Siani A, Siantar R, Sibai AM, Sidossis LS, Silitrari N, Silva AM, de Moura Silva CR, Silva DAS, Silva KS, Sim X, Simon M, Simons J, Simons LA, Sjöberg A, Sjöström M, Skoblina NA, Skodje G, Slazhnyova T, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, So HK, Soares FC, Sobek G, Sobngwi E, Sodemann M, Söderberg S, Soekatri MYE, Soemantri A, Sofat R, Solfrizzi V, Somi MH, Sonestedt E, Song Y, Soofi S, Sørensen TIA, Sørgjerd EP, Jérome CS, Soto-Rojas VE, Soumaré A, Sousa-Poza A, Sovic S, Sparboe-Nilsen B, Sparrenberger K, Spencer PR, Spinelli A, Spiroski I, Staessen JA, Stamm H, Staub K, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Stergiou GS, Stessman J, Stevanović R, Stieber J, Stöckl D, Stokwiszewski J, Stoyanova E, Stratton G, Stronks K, Strufaldi MW, Sturua L, Suárez-Medina R, Suka M, Sun CA, Sun L, Sundström J, Sung YT, Sunyer J, Suriyawongpaisal P, Sweis NWG, Swinburn BA, Sy RG, Sylva RC, Szklo M, Szponar L, Tabone L, Tai ES, Tambalis KD, Tammesoo ML, Tamosiunas A, Tan EJ, Tang X, Tanrygulyyeva M, Tanser F, Tao Y, Tarawneh MR, Tarp J, Tarqui-Mamani CB, Braunerová RT, Taylor A, Taylor J, Tchibindat F, Te Velde S, Tebar WR, Tell GS, Tello T, Tham YC, Thankappan KR, Theobald H, Theodoridis X, Thomas N, Thorand B, Thuesen BH, Tichá Ľ, Timmermans EJ, Tjandrarini DH, Tjonneland A, Tolonen HK, Tolstrup JS, Topbas M, Topór-Mądry R, Torheim LE, Tormo MJ, Tornaritis MJ, Torrent M, Torres-Collado L, Toselli S, Touloumi G, Traissac P, Tran TTH, Tremblay MS, Triantafyllou A, Trichopoulos D, Trichopoulou A, Trinh OTH, Trivedi A, Tsao YH, Tshepo L, Tsigga M, Tsintavis P, Tsugane S, Tuitele J, Tuliakova AM, Tulloch-Reid MK, Tullu F, Tuomainen TP, Tuomilehto J, Turley ML, Twig G, Tynelius P, Tzala E, Tzotzas T, Tzourio C, Ueda P, Ugel E, Ukoli FAM, Ulmer H, Unal B, Usupova Z, Uusitalo HMT, Uysal N, Vaitkeviciute J, Valdivia G, Vale S, Valvi D, van Dam RM, van den Born BJ, Van der Heyden J, van der Schouw YT, Van Herck K, Van Lippevelde W, Van Minh H, Van Schoor NM, van Valkengoed IGM, Vanderschueren D, Vanuzzo D, Varbo A, Varela-Moreiras G, Vargas LN, Varona-Pérez P, Vasan SK, Vasques DG, Vega T, Veidebaum T, Velasquez-Melendez G, Velika B, Verloigne M, Veronesi G, Verschuren WMM, Victora CG, Viegi G, Viet L, Vik FN, Vilar M, Villalpando S, Vioque J, Virtanen JK, Visvikis-Siest S, Viswanathan B, Vladulescu M, Vlasoff T, Vocanec D, Vollenweider P, Völzke H, Voutilainen A, Vrijheid M, Vrijkotte TGM, Wade AN, Waldhör T, Walton J, Wambiya EOA, Bebakar WMW, Mohamud WNW, de Souza Wanderley Júnior R, Wang MD, Wang N, Wang Q, Wang X, Wang YX, Wang YW, Wannamethee SG, Wareham N, Weber A, Webster-Kerr K, Wedderkopp N, Weghuber D, Wei W, Weres A, Werner B, Westbury LD, Whincup PH, Wickramasinghe K, Widhalm K, Widyahening IS, Więcek A, Wild PS, Wilks RJ, Willeit J, Willeit P, Williams J, Wilsgaard T, Wojciech R, Wojtyniak B, Wolf K, Wong-McClure RA, Wong A, Wong EB, Wong JE, Wong TY, Woo J, Woodward M, Wu FC, Wu HY, Wu J, Wu LJ, Wu S, Wyszyńska J, Xu H, Xu L, Yaacob NA, Yamborisut U, Yan W, Yang L, Yang X, Yang Y, Yardim N, Yasuharu T, García MY, Yiallouros PK, Yngve A, Yoosefi M, Yoshihara A, You QS, You SL, Younger-Coleman NO, Yu YL, Yu Y, Yusof SM, Yusoff AF, Zaccagni L, Zafiropulos V, Zainuddin AA, Zakavi SR, Zamani F, Zambon S, Zampelas A, Zamrazilová H, Zapata ME, Zargar AH, Zaw KK, Zayed AA, Zdrojewski T, Żegleń M, Zejglicova K, Vrkic TZ, Zeng Y, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhao W, Zhecheva YV, Zhen S, Zheng W, Zheng Y, Zholdin B, Zhou M, Zhu D, Zins M, Zitt E, Zocalo Y, Zoghlami N, Cisneros JZ, Zuziak M, Bhutta ZA, Black RE, Ezzati M. Diminishing benefits of urban living for children and adolescents' growth and development. Nature 2023; 615:874-883. [PMID: 36991188 PMCID: PMC10060164 DOI: 10.1038/s41586-023-05772-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 01/30/2023] [Indexed: 03/31/2023]
Abstract
Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1-6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5-19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m-2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.
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Ordunez P, Lombardi C, Picone DS, Brady TM, Campbell NRC, Moran AE, Padwal R, Rosende A, Whelton PK, Sharman JE. HEARTS in the Americas: a global example of using clinically validated automated blood pressure devices in cardiovascular disease prevention and management in primary health care settings. J Hum Hypertens 2023; 37:126-129. [PMID: 35273326 PMCID: PMC9957723 DOI: 10.1038/s41371-022-00659-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/17/2022] [Accepted: 01/26/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Pedro Ordunez
- 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
| | - Dean S Picone
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Tammy M Brady
- Department of Pediatrics, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Norm R C Campbell
- Departments of Medicine, Physiology and Pharmacology and Community Health Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | | | - Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Andres Rosende
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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Luciani S, Nederveen L, Martinez R, Caixeta R, Chavez C, Sandoval RC, Severini L, Cerón D, Gomes AB, Malik S, Gomez F, Ordunez P, Maza M, Monteiro M, Hennis A. Noncommunicable diseases in the Americas: a review of the Pan American Health Organization's 25-year program of work. Rev Panam Salud Publica 2023; 47:e13. [PMID: 37114168 PMCID: PMC10128884 DOI: 10.26633/rpsp.2023.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 10/30/2022] [Indexed: 04/29/2023] Open
Abstract
This article describes progress in tackling noncommunicable diseases (NCDs) in the Americas since the Pan American Health Organization (PAHO) started its NCD program 25 years ago. Changes in the epidemiology of NCDs, NCD policies, health service capacity, and surveillance are discussed. PAHO's NCD program is guided by regional plans of action on specific NCDs and risk factors, as well as a comprehensive NCD plan. Its work involves implementing evidence-based World Health Organization technical packages on NCDs and their risk factors with the aim of achieving the Sustainable Development Goal target of a one third reduction in premature mortality caused by NCDs by 2030. Important advances have been made in the past 25 years in implementation of: policies on NCD risk factors; interventions to improve NCD diagnosis and treatment; and NCD surveillance. Premature mortality from NCDs decreased by 1.7% a year between 2000 and 2011 and 0.77% a year between 2011 and 2019. However, policies on risk factor prevention and health promotion need to be strengthened to ensure more countries are on track to achieving the NCD-related health goals of the Sustainable Development Goals by 2030. Actions are recommended for governments to raise the priority of NCDs by: making NCDs a core pillar of primary care services, using revenues from health taxes to invest more in NCD prevention and control; and implementing policies, laws, and regulations to reduce the demand for and availability of tobacco, alcohol, and ultra-processed food products.
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Affiliation(s)
- Silvana Luciani
- Department of Noncommunicable Diseases and Mental HealthPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America.
- Silvana Luciani,
| | - Leendert Nederveen
- Department of Noncommunicable Diseases and Mental HealthPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America.
| | - Ramon Martinez
- Department of Noncommunicable Diseases and Mental HealthPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America.
| | - Roberta Caixeta
- Department of Noncommunicable Diseases and Mental HealthPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America.
| | - Carolina Chavez
- Department of Noncommunicable Diseases and Mental HealthPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America.
| | - Rosa C. Sandoval
- Department of Noncommunicable Diseases and Mental HealthPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America.
| | - Luciana Severini
- Department of Noncommunicable Diseases and Mental HealthPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America.
| | - Diana Cerón
- Department of Noncommunicable Diseases and Mental HealthPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America.
| | - Adriana B. Gomes
- Department of Noncommunicable Diseases and Mental HealthPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America.
| | - Sehr Malik
- Department of Noncommunicable Diseases and Mental HealthPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America.
| | - Fabio Gomez
- Department of Noncommunicable Diseases and Mental HealthPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America.
| | - Pedro Ordunez
- Department of Noncommunicable Diseases and Mental HealthPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America.
| | - Mauricio Maza
- Department of Noncommunicable Diseases and Mental HealthPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America.
| | - Maristela Monteiro
- Department of Noncommunicable Diseases and Mental HealthPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America.
| | - Anselm Hennis
- Department of Noncommunicable Diseases and Mental HealthPan American Health OrganizationWashington, DCUnited States of AmericaDepartment of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America.
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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 en las Américas: innovaciones para mejorar el manejo de la hipertensión y del riesgo cardiovascular en la atención primaria. Rev Panam Salud Publica 2022; 46:e197. [PMID: 36284552 PMCID: PMC9578652 DOI: 10.26633/rpsp.2022.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [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
La Iniciativa Mundial HEARTS. es la iniciativa emblemática de la Organización Mundial de la Salud para reducir la carga de las enfermedades cardiovasculares, la principal causa de muerte y discapacidad en todo el mundo. La Iniciativa HEARTS en las Américas es la adaptación regional que propone usar HEARTS como modelo para el manejo del riesgo de enfermedades cardiovasculares, incluida la hipertensión, y la diabetes en la atención primaria de salud en la Región de las Américas para el año 2025. Esta iniciativa está iniciando su sexto año de aplicación y ya incluye a 22 países y 1 380 centros de atención primaria de salud. Este informe tiene tres objetivos. En primer lugar, describir cómo surgió la Iniciativa HEARTS en las Américas y cuáles son sus principales elementos. En segundo lugar, resumir las principales innovaciones logradas para catalizar la iniciativa y mantener su aplicación. Entre estas innovaciones se encuentran: a) la introducción de factores impulsores del control de la hipertensión; b) el desarrollo de una vía clínica integral y práctica; c) la elaboración de una estrategia para mejorar la precisión de la medición de la presión arterial; d) la creación de un marco de seguimiento y evaluación; y e) la elaboración de un conjunto estandarizado de recursos de capacitación y formación. En tercer lugar, en este informe se examinan las futuras prioridades de la iniciativa. El objetivo de poner en marcha estas soluciones innovadoras y pragmáticas es crear un sistema de salud más efectivo y trasladar el enfoque de los programas cardiovasculares y de hipertensión del nivel de atención altamente especializada a la atención primaria de salud. Además, HEARTS en las Américas puede servir como modelo para unas prácticas más integrales, efectivas y sostenibles en la prevención y el tratamiento de las enfermedades no transmisibles.
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Affiliation(s)
- Pedro Ordunez
- Departamento 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 Comunidad, Instituto Cardiovascular Libin de Alberta, Universidad de Calgary, Calgary, Canadá
| | - Gloria P. Giraldo Arcila
- Departamento 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 Hopkins, Baltimore, Estados Unidos de América
| | - Cintia Lombardi
- Departamento 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 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 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 Hill, Universidad de las Indias Occidentales, St Michael, Barbados
| | - Angelo Gamarra
- Departamento 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 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 Mental, Organización Panamericana de la Salud, Washington, DC (Estados Unidos). Washington, D. C., Estados Unidos de América
| | - Marc G. Jaffe
- Departamento de Endocrinología, Centro Médico Kaiser Permanente de San Francisco, San Francisco, Estados Unidos de América
| | - Libardo Rodríguez
- Departamento 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 Aires, Buenos Aires, Argentina
| | - Ramón Martínez
- Departamento 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 Médica, Universidad de Tasmania, Hobart, Australia
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Prado P, Gamarra A, Rodriguez L, Brettler J, Farrell M, Girola ME, Malcolm T, Martinez R, Molina V, Moran AE, Neupane D, Rosende A, González YV, Mukhtar Q, Ordunez P. Monitoring and evaluation platform for HEARTS in the Americas: improving population-based hypertension control programs in primary health care. Rev Panam Salud Publica 2022; 46:e161. [PMID: 36133432 PMCID: PMC9484330 DOI: 10.26633/rpsp.2022.161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/15/2022] [Indexed: 02/07/2023] Open
Abstract
ABSTRACT
HEARTS in the Americas is the Pan American Health Organization flagship program to accelerate the reduction of the cardiovascular disease (CVD) burden by improving hypertension control and CVD secondary prevention in primary health care. A monitoring and evaluation (M&E) platform is needed for program implementation, benchmarking, and informing policy-makers. This paper describes the conceptual bases of the HEARTS M&E platform including software design principles, contextualization of data collection modules, data structure, reporting, and visualization. The District Health Information Software 2 (DHIS2) web-based platform was chosen to implement aggregate data entry of CVD outcome, process, and structural risk factor indicators. In addition, PowerBI was chosen for data visualization and dashboarding for the analysis of performance and trends above the health care facility level. The development of this new information platform was focused on primary health care facility data entry, timely data reporting, visualizations, and ultimately active use of data to drive decision-making for equitable program implementation and improved quality of care. Additionally, lessons learnt and programmatic considerations were assessed through the experience of the M&E software development. Building political will and support is essential to developing and deploying a flexible platform in multiple countries which is contextually specific to the needs of various stakeholders and levels of the health care system. The HEARTS M&E platform supports program implementation and reveals structural and managerial limitations and care gaps. The HEARTS M&E platform will be central to monitoring and driving further population-level improvements in CVD and other noncommunicable disease-related health.
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Affiliation(s)
- Patric Prado
- Pan American Health Organization. Washington, DC, USA
| | | | | | - Jeffrey Brettler
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, United States of America
| | | | | | - Taraleen Malcolm
- Pan American Health Organization, Port of Spain, Trinidad and Tobago
| | | | | | | | - Dinesh Neupane
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | | | - Yamilé Valdés González
- University Hospital General Calixto García, National Technical Advisory Committee on Hypertension, Havana, Cuba
| | - Qaiser Mukhtar
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Pedro Ordunez
- Pan American Health Organization. Washington, DC, USA
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17
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Martinez R, Soliz P, Campbell NRC, Lackland DT, Whelton PK, Ordunez P. Association between population hypertension control and ischemic heart disease and stroke mortality in 36 countries of the Americas, 1990-2019: an ecological study. Rev Panam Salud Publica 2022; 46:e143. [PMID: 36133429 PMCID: PMC9484333 DOI: 10.26633/rpsp.2022.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/06/2022] [Indexed: 11/24/2022] Open
Abstract
ABSTRACT
Objective.
To quantify the association between the prevalence of population hypertension control and ischemic heart disease (IHD) and stroke mortality in 36 countries of the Americas from 1990 to 2019.
Methods.
This ecologic study uses the prevalence of hypertension, awareness, treatment, and control from the NCD-RisC and IHD and stroke mortality from the Global Burden of Disease Study 2019. Regression analysis was used to assess time trends and the association between population hypertension control and mortality.
Results.
Between 1990 and 2019, age-standardized death rates due to IHD and stroke declined annually by 2.2% (95% confidence intervals: –2.4 to –2.1) and 1.8% (–1.9 to –1.6), respectively. The annual reduction rate in IHD and stroke mortality deaccelerated to –1% (–1.2 to –0.8) during 2000-2019. From 1990 to 2019, the prevalence of hypertension controlled to a systolic/diastolic blood pressure ≤140/90 mmHg increased by 3.2% (3.1 to 3.2) annually. Population hypertension control showed an inverse association with IHD and stroke mortality, respectively, regionwide and in all but 3 out of 36 countries. Regionwide, for every 1% increase in population hypertension control, our data predicted a reduction of 2.9% (–2.94 to –2.85) in IHD deaths per 100 000 population, equivalent to an averted 25 639 deaths (2.5 deaths per 100 000 population) and 2.37% (–2.41 to –2.33) in stroke deaths per 100 000 population, equivalent to an averted 9 650 deaths (1 death per 100 000 population).
Conclusion.
There is a strong ecological negative association between IHD and stroke mortality and population hypertension control. Countries with the best performance in hypertension control showed better progress in reducing CVD mortality. Prediction models have implications for hypertension management in most populations in the Region of the Americas and other parts of the world.
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Affiliation(s)
- Ramon Martinez
- Pan American Health Organization, Washington, D.C., United States of America. ORCID 0000-0003-0641-0206
| | - Patricia Soliz
- Pan American Health Organization, Washington, D.C., United States of America. ORCID 0000-0001-5788-225X
| | | | - Daniel T. Lackland
- The Medical University of South Carolina, Charleston, United States of America. ORCID 0000-0001-5733-6283
| | - Paul K. Whelton
- Tulane University, New Orleans, United States of America. ORCID 0000-0002-2225-383X
| | - Pedro Ordunez
- Pan American Health Organization, Washington, D.C., United States of America. ORCID 0000-0002-9871-6845
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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: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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20
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Rosende A, DiPette D, Brettler J, Rodríguez G, Zuniga E, Connell K, Ordunez P. HEARTS in the Americas appraisal checklist and clinical pathway for comprehensive hypertension management in primary care. Rev Panam Salud Publica 2022; 46:e125. [PMID: 36071921 PMCID: PMC9440731 DOI: 10.26633/rpsp.2022.125] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/16/2022] [Indexed: 01/10/2023] Open
Abstract
ABSTRACT
Cardiovascular diseases are the leading cause of mortality and morbidity in the Region of the Americas, and hypertension represents its main risk factor. However, population hypertension control rates in the Region are poor. Global Hearts is the World Health Organization's flagship initiative to reduce the burden of cardiovascular diseases. HEARTS in the Americas Initiative is its regional adaptation that seeks to be the cardiovascular disease risk management model, including hypertension and diabetes, in primary health care throughout the Americas by 2025.
HEARTS in the Americas is being implemented in 22 countries and over 2 095 primary care centers. All implementing countries have defined their treatment protocols, and HEARTS in the Americas has supported continuous improvement. Because WHO recently released the 2021 Guideline for the Pharmacological Treatment of Hypertension in Adults and HEARTS in the Americas introduced the key drivers for hypertension control, the initiative generated a methodology to help countries update and strengthen their treatment protocols.
This article describes the process of developing the treatment protocol appraisal checklist and defines the resulting clinical pathway. This tool can help countries and primary care centers to improve their protocols by identifying the improvement points and upgrading clinical pathways.
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Affiliation(s)
- Andres Rosende
- Pan American Health Organization, Washington, D.C., United States of America
| | - Donald DiPette
- University of South Carolina, Columbia, United States of America
| | - Jeffrey Brettler
- Southern California Permanente Medical Group, Los Angeles, United States of America
| | | | - Eric Zuniga
- University of Antofagasta, Antofagasta, Chile
| | | | - Pedro Ordunez
- Pan American Health Organization, Washington, D.C., United States of America
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21
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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: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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22
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Ordunez P, Tajer C, Gaziano T, Rodriguez YA, Rosende A, Jaffe MG. Authors’ response to the letter “Concerning The HEARTS app: a clinical tool for cardiovascular risk and hypertension management in primary health care”. Rev Panam Salud Publica 2022; 46:e91. [PMID: 35795158 PMCID: PMC9250130 DOI: 10.26633/rpsp.2022.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Pedro Ordunez
- Pan American Health Organization, Washington DC, United States of America. ORCID 0000-0002-9871-6845
| | - Carlos Tajer
- Hospital El Cruce Néstor Kirchner, Buenos Aires, Argentina. ORCID 0000-0002-6787-6651
| | - Thomas Gaziano
- Harvard T.H. Chan School of Public Health, Boston, United States of America. ORCID 0000-0002-5985-345X
| | - Yenny A. Rodriguez
- Pan American Health Organization, Washington DC, United States of America. ORCID 0000-0003-2026-572X
| | - Andres Rosende
- Pan American Health Organization, Washington DC, United States of America. ORCID 0000-0001-8173-0686
| | - Marc G. Jaffe
- Kaiser Permanente San Francisco Medical Center, San Francisco, United States of America. ORCID 0000-0002-5049-7815
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23
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Ordunez P, Lombardi C, Picone DS, Brady TM, Campbell NRC, Moran AE, Padwal R, Rosende A, Whelton PK, Sharman JE. HEARTS en las Américas: un ejemplo mundial del uso de dispositivos automatizados de medición de la presión arterial validados clínicamente en la prevención y el manejo de las enfermedades cardiovasculares en entornos de atención primaria de salud. Rev Panam Salud Publica 2022; 46:e50. [PMID: 35573113 PMCID: PMC9097929 DOI: 10.26633/rpsp.2022.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/26/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- 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. Orcid: https://orcid.org/0000-0002-9871-6845
| | - Cintia Lombardi
- 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. Orcid: https://orcid.org/0000-0001-7376-7243
| | - Dean S Picone
- Instituto Menzies de Investigación Médica Universidad de Tasmania Hobart Australia Instituto Menzies de Investigación Médica, Universidad de Tasmania, Hobart, Australia. Orcid: https://orcid.org/0000-0002-4760-1634
| | - Tammy M Brady
- Departamento de Pediatría División de Nefrología Escuela de Medicina de la Universidad Johns Hopkins Baltimore Estados Unidos de América Departamento de Pediatría, División de Nefrología, Escuela de Medicina de la Universidad Johns Hopkins, Baltimore, Estados Unidos de América. Orcid: https://orcid.org/0000-0002-1315-6747
| | - Norm R C Campbell
- Departamentos de Medicina Fisiología y Farmacología y Ciencias de la Salud Comunitaria Instituto Cardiovascular Libin de Alberta Canadá Departamentos de Medicina, Fisiología y Farmacología y Ciencias de la Salud Comunitaria, Instituto Cardiovascular Libin de Alberta, Canadá. Orcid: https://orcid.org/0000-0002-1093-4742
| | - Andrew E Moran
- Resolve to Save Lives Nueva York Estados Unidos de América Resolve to Save Lives, Nueva York, Estados Unidos de América. Orcid: https://orcid.org/0000-0003-3554-0085
| | - Raj Padwal
- Departamento de Medicina Universidad de Alberta Edmonton Canadá Departamento de Medicina, Universidad de Alberta, Edmonton, Canadá. Orcid: https://orcid.org/0000-0003-3541-2817
| | - Andrés 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. Orcid: https://orcid.org/0000-0001-8173-0686
| | - 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. Orcid: https://orcid.org/0000-0002-2225-383X
| | - James E Sharman
- Instituto Menzies de Investigación Médica Universidad de Tasmania Hobart Australia Instituto Menzies de Investigación Médica, Universidad de Tasmania, Hobart, Australia. Orcid: https://orcid.org/0000-0003-2792-0811
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24
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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25
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Brettler JW, Giraldo Arcila GP, Aumala T, Best A, Campbell NR, Cyr S, Gamarra A, Jaffe MG, De la Rosa MJ, Maldonado J, Neira Ojeda C, Haughton M, Malcolm T, Perez V, Rodriguez G, Rosende A, Valdes Gonzalez Y, Wood PW, Zuniga E, Ordunez P. [Drivers and scorecards to improve hypertension control in primary care practice: Recommendations from the HEARTS in the Americas Innovation GroupFactores impulsores y métodos de puntuación para mejorar el control de la hipertensión en la práctica clínica de la atención primaria: recomendaciones del grupo de innovación de HEARTS en las Américas]. Rev Panam Salud Publica 2022; 46:e68. [PMID: 35573115 PMCID: PMC9097925 DOI: 10.26633/rpsp.2022.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Fundamentos. As doenças cardiovasculares (DCV) são as principais causas de morbimortalidade nas Américas, e a hipertensão arterial (HÁ) é o fator de risco modificável mais importante. Porém, as taxas de controle da HA continuam baixas, e a mortalidade por DCV está estagnada ou aumentando após décadas de redução contínua. Em 2016, a Organização Mundial da Saúde (OMS) lançou o pacote de medidas técnicas HEARTS para melhorar o controle da HA. A Organização Pan-Americana da Saúde (OPAS) criou a iniciativa HEARTS nas Américas para melhorar a gestão do risco cardiovascular (RCV), com ênfase no controle da HA. Até agora, essa iniciativa foi implementada em 21 países. Métodos. Para impulsionar a implementação, recrutou-se um grupo multidisciplinar de profissionais para selecionar impulsionadores-chave do controle da HA com base em evidências e elaborar um scorecard completo para monitorar sua implementação em unidades de atenção primária à saúde (APS). O grupo estudou sistemas de saúde com alto desempenho que haviam conseguido atingir um alto nível de controle da HA por meio de programas de melhoria da qualidade focados em medidas específicas de processo, com feedback regular para os profissionais das unidades de saúde. Resultados. Os oito fatores impulsionadores incluídos na seleção final foram categorizados em cinco domínios principais: (1) diagnóstico (exatidão da medição da pressão arterial e avaliação do RCV); (2) tratamento (protocolo padronizado de tratamento e intensificação do tratamento); (3) continuidade do cuidado e acompanhamento; (4) modelo de atenção (atendimento baseado em equipe, renovação da prescrição); e (5) sistema de avaliação do desempenho. Em seguida, os fatores impulsionadores e as recomendações foram transformados em medidas de processo, gerando dois scorecards inter-relacionados integrados ao sistema de monitoramento e avaliação da Iniciativa HEARTS nas Américas. Interpretação. O foco nesses impulsionadores-chave da HA e nos scorecards resultantes orientará o processo de melhoria da qualidade para atingir as metas de controle, a nível populacional, dos centros de saúde participantes nos países que estão implementando a iniciativa HEARTS.
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Affiliation(s)
- Jeffrey W Brettler
- Southern California Permanente Medical Group Los Angeles EUA Southern California Permanente Medical Group, Los Angeles, EUA.,Departamento de Ciências de Sistemas de Saúde Kaiser Permanente Bernard J. Tyson School of Medicine Pasadena EUA Departamento de Ciências de Sistemas de Saúde, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, EUA
| | - Gloria P Giraldo Arcila
- Departamento de Doenças Não Transmissíveis e Saúde Mental Organização Pan-Americana da Saúde Washington, DC EUA Departamento de Doenças Não Transmissíveis e Saúde Mental, Organização Pan-Americana da Saúde, Washington, DC, EUA
| | - Teresa Aumala
- Centro de Atenção Primária à Saúde Ministério da Saúde, Centro de Salud Conocoto Quito Equador Centro de Atenção Primária à Saúde, Ministério da Saúde, Centro de Salud Conocoto, Quito, Equador
| | - Allana Best
- Ministério da Saúde Porto de Espanha Trinidad e Tobago Ministério da Saúde, Porto de Espanha, Trinidad e Tobago
| | - Norm Rc Campbell
- Departamento de Medicina Fisiologia e Farmacologia e Ciências da Saúde Comunitária Libin Cardiovascular Institute of Alberta Calgary Canadá Departamento de Medicina, Fisiologia e Farmacologia e Ciências da Saúde Comunitária, Libin Cardiovascular Institute of Alberta, Calgary, Canadá
| | - Shana Cyr
- Ministério da Saúde Bem-Estar e Idosos Castries Santa Lúcia Ministério da Saúde, Bem-Estar e Idosos, Castries, Santa Lúcia
| | - Angelo Gamarra
- Departamento de Doenças Não Transmissíveis e Saúde Mental Organização Pan-Americana da Saúde Washington, DC EUA Departamento de Doenças Não Transmissíveis e Saúde Mental, Organização Pan-Americana da Saúde, Washington, DC, EUA
| | - Marc G Jaffe
- Departamento de Endocrinologia The Permanente Medical Group Kaiser San Francisco Medical Center San Francisco EUA Departamento de Endocrinologia, The Permanente Medical Group, Kaiser San Francisco Medical Center, San Francisco, EUA
| | - Mirna Jimenez De la Rosa
- Escola de Saúde Pública Faculdade de Ciências da Saúde Universidad Autónoma de Santo Domingo República Dominicana Escola de Saúde Pública, Faculdade de Ciências da Saúde, Universidad Autónoma de Santo Domingo, República Dominicana.,Oficina Escuela de Salud Publica Ciudad Universitaria Universidad Autónoma de Santo Domingo Distrito Nacional República Dominicana Oficina Escuela de Salud Publica, Ciudad Universitaria, Universidad Autónoma de Santo Domingo, Distrito Nacional, República Dominicana
| | - Javier Maldonado
- Organização Pan-Americana da Saúde Bogotá Colômbia Organização Pan-Americana da Saúde, Bogotá, Colômbia
| | - Carolina Neira Ojeda
- Departamento de Doenças Não Transmissíveis Ministério da Saúde Santiago do Chile Chile Departamento de Doenças Não Transmissíveis, Ministério da Saúde, Santiago do Chile, Chile
| | - Modesta Haughton
- Organização Pan-Americana da Saúde Ancón Panamá Organização Pan-Americana da Saúde, Ancón, Panamá
| | - Taraleen Malcolm
- Organização Pan-Americana da Saúde Porto de Espanha Trinidad e Tobago Organização Pan-Americana da Saúde, Porto de Espanha, Trinidad e Tobago
| | - Vivian Perez
- Organização Pan-Americana da Saúde Lima Peru Organização Pan-Americana da Saúde, Lima, Peru
| | - Gonzalo Rodriguez
- Organização Pan-Americana da Saúde Ciudad Autónoma de Buenos Aires Buenos Aires Argentina Organização Pan-Americana da Saúde, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Andres Rosende
- Departamento de Doenças Não Transmissíveis e Saúde Mental Organização Pan-Americana da Saúde Washington, DC EUA Departamento de Doenças Não Transmissíveis e Saúde Mental, Organização Pan-Americana da Saúde, Washington, DC, EUA
| | - Yamile Valdes Gonzalez
- Comitê Técnico Consultivo Nacional de Hipertensão Arterial Hospital Universitário "General Calixto García" Havana Cuba Comitê Técnico Consultivo Nacional de Hipertensão Arterial, Hospital Universitário "General Calixto García", Havana, Cuba
| | - Peter W Wood
- Departamento de Medicina Divisão de Medicina Interna Geral University of Alberta Edmonton Canadá Departamento de Medicina, Divisão de Medicina Interna Geral, University of Alberta, Edmonton, Canadá
| | - Eric Zuniga
- Servicio de Salud Antofagasta Universidad de Antofagasta Antofagasta Chile Servicio de Salud Antofagasta, Universidad de Antofagasta, Antofagasta, Chile
| | - Pedro Ordunez
- Departamento de Doenças Não Transmissíveis e Saúde Mental Organização Pan-Americana da Saúde Washington, DC EUA Departamento de Doenças Não Transmissíveis e Saúde Mental, Organização Pan-Americana da Saúde, Washington, DC, 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 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Ordunez P, Tajer C, Gaziano T, Rodríguez YA, Rosende A, Jaffe MG. [The HEARTS app: a clinical tool for cardiovascular risk and hypertension management in primary health careO aplicativo HEARTS: uma ferramenta clínica para o gerenciamento de risco cardiovascular e hipertensão na atenção primária à saúde]. Rev Panam Salud Publica 2022; 46:e46. [PMID: 35573118 PMCID: PMC9097924 DOI: 10.26633/rpsp.2022.46] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 01/06/2022] [Indexed: 11/25/2022] Open
Abstract
HEARTS en las Américas es la adaptación regional de la iniciativa Global HEARTS de la Organización Mundial de la Salud, que será el modelo para el manejo del riesgo de las enfermedades cardiovasculares (ECV) en la atención primaria de salud en la Región de las Américas para el año 2025. Ya se ha implementado en 21 países y 1045 centros de atención primaria de salud en toda América Latina y el Caribe. Se ha adoptado un enfoque de salud pública y de sistemas de salud para introducir sistemáticamente intervenciones simplificadas en el nivel de la atención primaria de salud que se centran en el control de la hipertensión como punto de entrada clínico. En este artículo se presenta una aplicación nueva y mejorada cuyo componente principal es la calculadora de riesgo de ECV y de manejo de la hipertensión. Se resume el enfoque de evaluación del riesgo y la metodología utilizada por la Organización Mundial de la Salud para actualizar sus tablas de riesgo cardiovascular del 2019; se describe la aplicación, su uso, su funcionalidad y su proceso de validación; y se presenta un conjunto de recomendaciones prácticas para optimizar el manejo del riesgo de ECV y de la hipertensión, mediante el uso de la aplicación en la práctica clínica. La aplicación HEARTS es una herramienta sólida para mejorar la calidad de la atención prestada en los centros de atención primaria. La creación y difusión de la aplicación HEARTS es un paso esencial en el camino hacia la eliminación de las ECV prevenibles en la Región de las Américas.
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Affiliation(s)
- Pedro Ordunez
- Organización Panamericana de la Salud Washington D.C. Estados Unidos de América Organización Panamericana de la Salud, Washington D.C., Estados Unidos de América. ORCID 0000-0002-9871-6845; ORCID 0000-0003-2026-572X; ORCID 0000-0001-8173-0686
| | - Carlos Tajer
- Hospital El Cruce Néstor Kirchner Buenos Aires Argentina Hospital El Cruce Néstor Kirchner, Buenos Aires, Argentina ORCID 0000-0002-6787-66511
| | - Thomas Gaziano
- Harvard T.H. Chan School of Public Health Boston Estados Unidos de América Harvard T.H. Chan School of Public Health, Boston, Estados Unidos de América. ORCID 0000-0002-5985-345X
| | - Yenny A Rodríguez
- Organización Panamericana de la Salud Washington D.C. Estados Unidos de América Organización Panamericana de la Salud, Washington D.C., Estados Unidos de América. ORCID 0000-0002-9871-6845; ORCID 0000-0003-2026-572X; ORCID 0000-0001-8173-0686
| | - Andrés Rosende
- Organización Panamericana de la Salud Washington D.C. Estados Unidos de América Organización Panamericana de la Salud, Washington D.C., Estados Unidos de América. ORCID 0000-0002-9871-6845; ORCID 0000-0003-2026-572X; ORCID 0000-0001-8173-0686
| | - Marc G Jaffe
- Kaiser Permanente San Francisco Medical Center San Francisco Estados Unidos de América Kaiser Permanente San Francisco Medical Center, San Francisco, Estados Unidos de América. ORCID 0000-0002-5049-7815
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Brettler JW, Giraldo Arcila GP, Aumala T, Best A, Campbell NR, Cyr S, Gamarra A, Jaffe MG, De la Rosa MJ, Maldonado J, Neira Ojeda C, Haughton M, Malcolm T, Perez V, Rodriguez G, Rosende A, Valdes Gonzalez Y, Wood PW, Zuñiga E, Ordunez P. [Drivers and scorecards to improve hypertension control in primary care practice: Recommendations from the HEARTS in the Americas Innovation GroupFatores impulsionadores e scorecards para melhorar o controle da hipertensão arterial na atenção primária: recomendações do Grupo de Inovação da Iniciativa HEARTS nas Américas]. Rev Panam Salud Publica 2022; 46:e56. [PMID: 35573117 PMCID: PMC9097922 DOI: 10.26633/rpsp.2022.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Antecedentes. Las enfermedades cardiovasculares (ECV) son la principal causa de morbilidad y mortalidad en la Región de las Américas y la hipertensión es el factor de riesgo modificable asociado más importante. Sin embargo, las tasas de control de la hipertensión siguen siendo bajas y la mortalidad por ECV está estancada o en aumento después de décadas de reducción continua. En el 2016, la Organización Mundial de la Salud (OMS) presentó el paquete técnico HEARTS para mejorar el control de la hipertensión. La Organización Panamericana de la Salud (OPS) diseñó la iniciativa HEARTS en las Américas para mejorar el control del riesgo de ECV, que hace hincapié en el control de la hipertensión y que, hasta la fecha, se ha implementado en 21 países. Métodos. Para avanzar en la implementación, se creó un grupo interdisciplinario de profesionales de la salud con el objetivo de seleccionar los factores impulsores claves del control de la hipertensión basados en la evidencia y diseñar un método de puntuación integral para dar seguimiento a su implementación en los centros de atención de salud primaria (APS). El grupo estudió los sistemas de salud de alto desempeño que logran un control elevado de la hipertensión mediante programas de mejora de la calidad que se centran en medidas específicas con respecto a los procesos, con retroalimentación regular a los prestadores en los centros de salud. Resultados. Los ocho factores impulsores finales seleccionados se clasificaron en cinco dominios principales: 1) diagnóstico (exactitud de la medición de la presión arterial y evaluación del riesgo de ECV); 2) tratamiento (protocolo de tratamiento e intensificación del tratamiento estandarizados); 3) continuidad de la atención y seguimiento; 4) sistema de prestación del tratamiento (atención basada en un trabajo en equipo, reposición de la medicación) y 5) sistema para la evaluación del desempeño. Los factores impulsores y las recomendaciones se tradujeron en medidas con respecto a los procesos, lo que llevó a dos métodos de puntuación integrados e interconectados en el sistema de seguimiento y evaluación del programa HEARTS en las Américas. Conclusiones. El enfoque que se centra en estos factores impulsores clave de la hipertensión y los métodos de puntuación resultantes servirá de guía para el proceso de mejora de la calidad con objeto de alcanzar los objetivos de control a nivel poblacional en los centros de salud participantes de los países que implementan el programa HEARTS.
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Affiliation(s)
- Jeffrey W Brettler
- Kaiser Permanente del Sur de California Los Ángeles Estados Unidos de América Kaiser Permanente del Sur de California, Los Ángeles, Estados Unidos de América.,Departamento de Ciencias de Sistemas de Salud Facultad de Medicina Bernard J. Tyson de Kaiser Permanente Pasadena Estados Unidos de América Departamento de Ciencias de Sistemas de Salud, Facultad de Medicina Bernard J. Tyson de Kaiser Permanente, Pasadena, Estados Unidos de América
| | - Gloria P Giraldo Arcila
- Departamento de Enfermedades no Transmisibles y Salud Mental Organización Panamericana de Salud Washington Estados Unidos de América Departamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de Salud, Washington, Estados Unidos de América
| | - Teresa Aumala
- Centro de Atención Primaria de Salud Ministerio de Salud Centro de Salud Conocoto Quito Ecuador Centro de Atención Primaria de Salud, Ministerio de Salud, Centro de Salud Conocoto, Quito, Ecuador
| | - Allana Best
- Ministerio de Salud Puerto España Trinidad y Tabago Ministerio de Salud, Puerto España, Trinidad y Tabago
| | - Norm Rc Campbell
- Departamento de Medicina Fisiología y Farmacología y Ciencias de Salud Comunitaria Instituto Cardiovascular Libin de Alberta Calgary Canadá Departamento de Medicina, Fisiología y Farmacología y Ciencias de Salud Comunitaria, Instituto Cardiovascular Libin de Alberta, Calgary, Canadá
| | - Shana Cyr
- Ministerio de Salud Bienestar y Asuntos de la Tercera Edad Castries Santa Lucía Ministerio de Salud, Bienestar y Asuntos de la Tercera Edad, Castries, Santa Lucía
| | - Angelo Gamarra
- Departamento de Enfermedades no Transmisibles y Salud Mental Organización Panamericana de Salud Washington Estados Unidos de América Departamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de Salud, Washington, Estados Unidos de América
| | - Marc G Jaffe
- Departamento de Endocrinología Grupo Médico Permanente Centro Médico de San Francisco Kaiser San Francisco Estados Unidos de América Departamento de Endocrinología, Grupo Médico Permanente, Centro Médico de San Francisco Kaiser, San Francisco, Estados Unidos de América
| | - Mirna Jimenez De la Rosa
- Escuela de Salud Pública Facultad de Ciencias de la Salud Universidad Autónoma de Santo Domingo Santo Domingo Dominican Republic Escuela de Salud Pública, Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, República Dominicana.,Oficina Escuela de Salud Pública Ciudad Universitaria Universidad Autónoma de Santo Domingo Santo Domingo República Dominicana Oficina Escuela de Salud Pública, Ciudad Universitaria, Universidad Autónoma de Santo Domingo, Santo Domingo, República Dominicana
| | - Javier Maldonado
- Organización Panamericana de Salud Bogotá Colombia Organización Panamericana de Salud, Bogotá, Colombia
| | - Carolina Neira Ojeda
- Departamento de Enfermedades no Transmisibles Ministerio de Salud Santiago de Chile Chile Departamento de Enfermedades no Transmisibles, Ministerio de Salud, Santiago de Chile, Chile
| | - Modesta Haughton
- Organización Panamericana de Salud Ancon Panamá Organización Panamericana de Salud, Ancon, Panamá
| | - Taraleen Malcolm
- Organización Panamericana de la Salud Puerto España Trinidad y Tabago Organización Panamericana de la Salud, Puerto España, Trinidad y Tabago
| | - Vivian Perez
- Organización Panamericana de Salud Lima Perú Organización Panamericana de Salud, Lima, Perú
| | - Gonzalo Rodriguez
- Organización Panamericana de la Salud Ciudad Autónoma de Buenos Aires Argentina Organización Panamericana de la Salud, Ciudad Autónoma de Buenos Aires, Argentina
| | - Andres Rosende
- Departamento de Enfermedades no Transmisibles y Salud Mental Organización Panamericana de Salud Washington Estados Unidos de América Departamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de Salud, Washington, Estados Unidos de América
| | - Yamile Valdes Gonzalez
- Comité Técnico Asesor Nacional sobre Hipertensión Hospital Universitario "General Calixto García" La Habana Cuba Comité Técnico Asesor Nacional sobre Hipertensión, Hospital Universitario "General Calixto García", La Habana, Cuba
| | - Peter W Wood
- Departamento de Medicina División de Medicina Interna General Universidad de Alberta Edmonton Canadá Departamento de Medicina, División de Medicina Interna General, Universidad de Alberta, Edmonton, Canadá
| | - Eric Zuñiga
- Servicios de Salud Antofagasta Universidad de Antofagasta Antofagasta Chile Servicios de Salud Antofagasta, Universidad de Antofagasta, Antofagasta, Chile
| | - Pedro Ordunez
- Departamento de Enfermedades no Transmisibles y Salud Mental Organización Panamericana de Salud Washington Estados Unidos de América Departamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de Salud, Washington, 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 Americas. Lancet Reg Health Am 2022; 9:None. [PMID: 35711684 PMCID: PMC9107389 DOI: 10.1016/j.lana.2022.100219] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [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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Brettler JW, Arcila GPG, Aumala T, Best A, Campbell NR, Cyr S, Gamarra A, Jaffe MG, la Rosa MJD, Maldonado J, Ojeda CN, Haughton M, Malcolm T, Perez V, Rodriguez G, Rosende A, González YV, Wood PW, Zúñiga E, Ordunez P. Drivers and scorecards to improve hypertension control in primary care practice: Recommendations from the HEARTS in the Americas Innovation Group. Lancet Reg Health Am 2022; 9:None. [PMID: 35711685 PMCID: PMC9121401 DOI: 10.1016/j.lana.2022.100223] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the Americas, and hypertension is the most significant modifiable risk factor. However, hypertension control rates remain low, and CVD mortality is stagnant or rising after decades of continuing reduction. In 2016, the World Health Organization (WHO) launched the HEARTS technical package to improve hypertension control. The Pan American Health Organization (PAHO) designed the HEARTS in the Americas Initiative to improve CVD risk management, emphasizing hypertension control, to date implemented in 21 countries. Methods To advance implementation, an interdisciplinary group of practitioners was engaged to select the key evidence-based drivers of hypertension control and to design a comprehensive scorecard to monitor their implementation at primary care health facilities (PHC). The group studied high-performing health systems that achieve high hypertension control through quality improvement programs focusing on specific process measures, with regular feedback to providers at health facilities. Findings The final selected eight drivers were categorized into five main domains: (1) diagnosis (blood pressure measurement accuracy and CVD risk evaluation); (2) treatment (standardized treatment protocol and treatment intensification); (3) continuity of care and follow-up; (4) delivery system (team-based care, medication refill), and (5) system for performance evaluation. The drivers and recommendations were then translated into process measures, resulting in two interconnected scorecards integrated into the HEARTS in the Americas monitoring and evaluation system. Interpretation Focus on these key hypertension drivers and resulting scorecards, will guide the quality improvement process to achieve population control goals at the participating health centers in HEARTS implementing countries. Funding No funding to declare.
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Affiliation(s)
- Jeffrey W Brettler
- Southern California Permanente Medical Group, Los Angeles, CA, USA.,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Gloria P Giraldo Arcila
- Department of Non-Communicable Diseases and Mental Health. Pan American Health Organization (PAHO), Washington, DC, USA
| | - Teresa Aumala
- Primary Health Care Center, Ministry of Health, Centro de Salud Conocoto, Quito, Ecuador
| | - Allana Best
- Ministry of Health, Park Street, Port of Spain, Trinidad and Tobago
| | - Norm Rc Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Shana Cyr
- Ministry of Health, Wellness & Elderly Affairs, Sir Stanislaus James Building, Waterfront, Castries, Saint Lucia
| | - Angelo Gamarra
- Department of Non-Communicable Diseases and Mental Health. Pan American Health Organization (PAHO), Washington, DC, USA
| | - Marc G Jaffe
- Department of Endocrinology, The Permanente Medical Group, Kaiser San Francisco Medical Center, San Francisco, CA, USA
| | - Mirna Jimenez De la Rosa
- School of Public Health, Faculty of Health Sciences, Universidad Autónoma de Santo Domingo, Dominican Republic.,Oficina Escuela de Salud Pública, Ciudad Universitaria, Universidad Autónoma de Santo Domingo, Distrito Nacional, Dominican Republic
| | | | - Carolina Neira Ojeda
- Department of Noncommunicable Diseases, Ministry of Health, Santiago de Chile, Chile
| | | | - Taraleen Malcolm
- Pan American Health Organization (PAHO), Port of Spain, Trinidad and Tobago
| | - Vivian Perez
- Pan American Health Organization,(PAHO), Lima, Peru
| | - Gonzalo Rodriguez
- Pan American Health Organization, (PAHO), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Andres Rosende
- Department of Non-Communicable Diseases and Mental Health. Pan American Health Organization (PAHO), Washington, DC, USA
| | - Yamilé Valdés González
- National Technical Advisory Committee on Hypertension, University Hospital "General Calixto García", Havana, Cuba
| | - Peter W Wood
- Department of Medicine, Division of General Internal Medicine, University of Alberta, Edmonton, AB, Canada
| | - Eric Zúñiga
- Health Services Antofagasta, Servicio de Salud Antofagasta, Universidad de Antofagasta, Antofagasta, Chile
| | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health. Pan American Health Organization (PAHO), Washington, DC, USA
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Cohn J, Bygrave H, Roberts T, Khan T, Ojji D, Ordunez P. Addressing Failures in Achieving Hypertension Control in Low- and Middle-Income Settings through Simplified Treatment Algorithms. Glob Heart 2022; 17:28. [PMID: 35586744 PMCID: PMC9009360 DOI: 10.5334/gh.1082] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/29/2021] [Indexed: 01/13/2023] Open
Abstract
Hypertension is the most important risk factor for cardiovascular diseases (CVDs), which are the leading global cause of death. Hypertension is under-diagnosed and under-treated in most low- and middle-income countries (LMICs). Current algorithms for hypertension treatment are complex for the healthcare worker, limit decentralization, complicate procurement and often translate to a large pill burden for the person with hypertension. We summarize evidence supporting implementation of simple, algorithmic, accessible, non-toxic and effective (SAANE) algorithms to provide a feasible way to access and maintain quality care for hypertension. Implementation of these algorithms will enable task shifting to less specialised health care workers and lay cadres, provision of fixed dose combinations, consolidation of the market while retaining generic competition, simplification of laboratory requirements, and lowering costs for health systems and people who incur out of pocket expenses.
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Affiliation(s)
| | - Helen Bygrave
- International AIDS Society, Geneva, CH
- Médecins Sans Frontierès Access Campaign, Geneva, CH
| | | | - Taskeen Khan
- Department of Public Health Medicine, University of Pretoria, Pretoria, ZA
- World Health Organization, Geneva, CH
| | - Dike Ojji
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja, Abuja, NG
| | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington DC, US
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Ordunez P, Tajer C, Gaziano T, Rodriguez YA, Rosende A, Jaffe MG. The HEARTS app: a clinical tool for cardiovascular risk and hypertension management in primary health care. Rev Panam Salud Publica 2022; 46:e12. [PMID: 35355690 PMCID: PMC8959249 DOI: 10.26633/rpsp.2022.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 01/06/2022] [Indexed: 12/14/2022] Open
Abstract
HEARTS in the Americas is the regional adaptation of the World Health Organization’s Global Hearts Initiative, which will be the model for risk management for cardiovascular disease (CVD) in primary health care in the Region of the Americas by 2025. It has already been implemented in 21 countries and 1045 primary health care centers throughout Latin America and the Caribbean. It takes a public health and health systems approach to systematically introduce simplified interventions at the primary health care level and focuses on hypertension as a clinical entry point. This paper introduces a new, improved application (app), the main component of which is the calculator for CVD risk and hypertension management. The paper summarizes the risk assessment approach and the methodology used by the World Health Organization to update its cardiovascular risk charts in 2019; describes the app, its use, functionality and validation process; and provides a set of practical recommendations for optimizing CVD risk and hypertension management by using the app in clinical practice. The HEARTS app is a powerful tool to improve the quality of care provided in primary health settings. The creation and dissemination of the HEARTS app is an essential step in the journey towards eliminating preventable CVD in the Americas.
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Affiliation(s)
- Pedro Ordunez
- Pan American Health Organization Washington, DC United States of America ORCID 0000-0002-9871-6845 ORCID 0000-0003-2026-572X ORCID 0000-0001-8173-0686 Pan American Health Organization, Washington, DC, United States of America; ORCID 0000-0002-9871-6845; ORCID 0000-0003-2026-572X; ORCID 0000-0001-8173-0686
| | - Carlos Tajer
- Hospital El Cruce Néstor Kirchner Buenos Aires Argentina ORCID 0000-0002-6787-6651 Hospital El Cruce Néstor Kirchner, Buenos Aires, Argentina; ORCID 0000-0002-6787-6651
| | - Thomas Gaziano
- Harvard T.H. Chan School of Public Health Boston United States of America ORCID 0000-0002-5985-345X Harvard T.H. Chan School of Public Health, Boston, United States of America; ORCID 0000-0002-5985-345X
| | - Yenny A Rodriguez
- Pan American Health Organization Washington, DC United States of America ORCID 0000-0002-9871-6845 ORCID 0000-0003-2026-572X ORCID 0000-0001-8173-0686 Pan American Health Organization, Washington, DC, United States of America; ORCID 0000-0002-9871-6845; ORCID 0000-0003-2026-572X; ORCID 0000-0001-8173-0686
| | - Andres Rosende
- Pan American Health Organization Washington, DC United States of America ORCID 0000-0002-9871-6845 ORCID 0000-0003-2026-572X ORCID 0000-0001-8173-0686 Pan American Health Organization, Washington, DC, United States of America; ORCID 0000-0002-9871-6845; ORCID 0000-0003-2026-572X; ORCID 0000-0001-8173-0686
| | - Marc G Jaffe
- Kaiser Permanente San Francisco Medical Center San Francisco United States of America ORCID 0000-0002-5049-7815 Kaiser Permanente San Francisco Medical Center, San Francisco, United States of America; ORCID 0000-0002-5049-7815
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Abstract
This study uses data from the publicly available Medaval database to determine the number of upper arm cuff and wrist cuff blood pressure measuring devices sold globally as well as the percentages of those devices that have been clinically validated for accuracy.
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Affiliation(s)
- Dean S. Picone
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | | | - Aletta E. Schutte
- School of Population Health, University of New South Wales, Sydney, Australia
| | | | - Pedro Ordunez
- Department of Non-communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC
| | - Paul K. Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - James E. Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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Martinez R, Morsch P, Soliz P, Hommes C, Ordunez P, Vega E. Life expectancy, healthy life expectancy, and burden of disease in older people in the Americas, 1990-2019: a population-based study. Rev Panam Salud Publica 2021; 45:e114. [PMID: 34621302 PMCID: PMC8489742 DOI: 10.26633/rpsp.2021.114] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/23/2021] [Indexed: 12/24/2022] Open
Abstract
Objective. To describe the life expectancy, healthy life expectancy, disease burden, and leading causes of mortality and disability in adults aged 65 years and older in the Region of the Americas from 1990 to 2019. Methods. We used estimates from the Global Burden of Disease Study 2019 to examine the level and trends of life expectancy, healthy life expectancy, years of life lost, years lived with disability, and disability-adjusted life years (DALYs). Results. Across the Region, life expectancy at 65 years increased from 17.1 years (95% uncertainty intervals (UI): 17.0–17.1) in 1990 to 19.2 years (95% UI: 18.9–19.4) in 2019 while healthy life expectancy increased from 12.2 years (95% UI: 10.9–12.4) to 13.6 years (95% UI: 12.2–14.9). All-cause DALY rates decreased in each older persons’ age group; however, absolute proportional DALYs increased from 22% to 32%. Ischemic heart disease, stroke, and chronic obstructive pulmonary disease were the leading causes of premature mortality. Diabetes mellitus, age-related and other hearing loss, and lower back pain were the leading causes of disability. Conclusion. The increase in life expectancy and decrease of DALYs indicate the positive effect of improvements in social conditions and health policies. However, the smaller increase in healthy life expectancy suggests that, despite living longer, people spend a substantial amount of time in their old age with disability and illness. Preventable and controllable diseases account for most of the disease burden in older adults in the Americas. Society-wide and life-course approaches, and adequate health services are needed to respond to the health needs of older people in the Region.
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Affiliation(s)
- Ramon Martinez
- Pan American Health Organization Washington D.C. United States of America Pan American Health Organization, Washington D.C., United States of America
| | - Patricia Morsch
- Pan American Health Organization Washington D.C. United States of America Pan American Health Organization, Washington D.C., United States of America
| | - Patricia Soliz
- Pan American Health Organization Washington D.C. United States of America Pan American Health Organization, Washington D.C., United States of America
| | - Carolina Hommes
- Pan American Health Organization Washington D.C. United States of America Pan American Health Organization, Washington D.C., United States of America
| | - Pedro Ordunez
- Pan American Health Organization Washington D.C. United States of America Pan American Health Organization, Washington D.C., United States of America
| | - Enrique Vega
- Pan American Health Organization Washington D.C. United States of America Pan American Health Organization, Washington D.C., United States of America
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Zhou B, Carrillo-Larco RM, Danaei G, Riley LM, Paciorek CJ, Stevens GA, Gregg EW, Bennett JE, Solomon B, Singleton RK, Sophiea MK, Iurilli MLC, Lhoste VPF, Cowan MJ, Savin S, Woodward M, Balanova Y, Cifkova R, Damasceno A, Elliott P, Farzadfar F, He J, Ikeda N, Kengne AP, Khang YH, Kim HC, Laxmaiah A, Lin HH, Margozzini Maira P, Miranda JJ, Neuhauser H, Sundström J, Varghese C, Widyahening IS, Zdrojewski T, Abarca-Gómez L, Abdeen ZA, Abdul Rahim HF, Abu-Rmeileh NM, Acosta-Cazares B, Adams RJ, Aekplakorn W, Afsana K, Afzal S, Agdeppa IA, Aghazadeh-Attari J, Aguilar-Salinas CA, Agyemang C, Ahmad NA, Ahmadi A, Ahmadi N, Ahmadi N, Ahmadizar F, Ahmed SH, Ahrens W, Ajlouni K, Al-Raddadi R, Alarouj M, AlBuhairan F, AlDhukair S, Ali MM, Alkandari A, Alkerwi A, Allin K, Aly E, Amarapurkar DN, Amougou N, Amouyel P, Andersen LB, Anderssen SA, Anjana RM, Ansari-Moghaddam A, Ansong D, Aounallah-Skhiri H, Araújo J, Ariansen I, Aris T, Arku RE, Arlappa N, Aryal KK, Aspelund T, Assah FK, Assunção MCF, Auvinen J, Avdićová M, Azevedo A, Azimi-Nezhad M, Azizi F, Azmin M, Babu BV, Bahijri S, Balakrishna N, Bamoshmoosh M, Banach M, Banadinović M, Bandosz P, Banegas JR, Baran J, Barbagallo CM, Barceló A, Barkat A, Barreto M, Barros AJD, Barros MVG, Bartosiewicz A, Basit A, Bastos JLD, Bata I, Batieha AM, Batyrbek A, Baur LA, Beaglehole R, Belavendra A, Ben Romdhane H, Benet M, Benson LS, Berkinbayev S, Bernabe-Ortiz A, Bernotiene G, Bettiol H, Bezerra J, Bhagyalaxmi A, Bhargava SK, Bia D, Biasch K, Bika Lele EC, Bikbov MM, Bista B, Bjerregaard P, Bjertness E, Bjertness MB, Björkelund C, Bloch KV, Blokstra A, Bo S, Bobak M, Boeing H, Boggia JG, Boissonnet CP, Bojesen SE, Bongard V, Bonilla-Vargas A, Bopp M, Borghs H, Bovet P, Boyer CB, Braeckman L, Brajkovich I, Branca F, Breckenkamp J, Brenner H, Brewster LM, Briceño Y, Brito M, Bruno G, Bueno-de-Mesquita HB, Bueno G, Bugge A, Burns C, Bursztyn M, Cabrera de León A, Cacciottolo J, Cameron C, Can G, Cândido APC, Capanzana MV, Čapková N, Capuano E, Capuano V, Cardoso VC, Carlsson AC, Carvalho J, Casanueva FF, Censi L, Cervantes-Loaiza M, Chadjigeorgiou CA, Chamukuttan S, Chan AW, Chan Q, Chaturvedi HK, Chaturvedi N, Chee ML, Chen CJ, Chen F, Chen H, Chen S, Chen Z, Cheng CY, Cheraghian B, Cherkaoui Dekkaki I, Chetrit A, Chien KL, Chiolero A, Chiou ST, Chirita-Emandi A, Chirlaque MD, Cho B, Christensen K, Christofaro DG, Chudek J, Cinteza E, Claessens F, Clarke J, Clays E, Cohen E, Concin H, Cooper C, Coppinger TC, Costanzo S, Cottel D, Cowell C, Craig CL, Crampin AC, Crujeiras AB, Cruz JJ, Csilla S, Cui L, Cureau FV, Cuschieri S, D'Arrigo G, d'Orsi E, Dallongeville J, Dankner R, Dantoft TM, Dauchet L, Davletov K, De Backer G, De Bacquer D, De Curtis A, de Gaetano G, De Henauw S, de Oliveira PD, De Ridder D, De Smedt D, Deepa M, Deev AD, DeGennaro VJ, Delisle H, Demarest S, Dennison E, Deschamps V, Dhimal M, Di Castelnuovo AF, Dias-da-Costa JS, Diaz A, Dickerson TT, Dika Z, Djalalinia S, Do HTP, Dobson AJ, Donfrancesco C, Donoso SP, Döring A, Dorobantu M, Dörr M, Doua K, Dragano N, Drygas W, Duante CA, Duboz P, Duda RB, Dulskiene V, Dushpanova A, Džakula A, Dzerve V, Dziankowska-Zaborszczyk E, Eddie R, Eftekhar E, Eggertsen R, Eghtesad S, Eiben G, Ekelund U, El-Khateeb M, El Ati J, Eldemire-Shearer D, Eliasen M, Elosua R, Erasmus RT, Erbel R, Erem C, Eriksen L, Eriksson JG, Escobedo-de la Peña J, Eslami S, Esmaeili A, Evans A, Faeh D, Fakhretdinova AA, Fall CH, Faramarzi E, Farjam M, Fattahi MR, Fawwad A, Felix-Redondo FJ, Felix SB, Ferguson TS, Fernandes RA, Fernández-Bergés D, Ferrante D, Ferrao T, Ferrari M, Ferrario MM, Ferreccio C, Ferreira HS, Ferrer E, Ferrieres J, Figueiró TH, Fink G, Fischer K, Foo LH, Forsner M, Fouad HM, Francis DK, Franco MDC, Frikke-Schmidt R, Frontera G, Fuchs FD, Fuchs SC, Fujita Y, Fumihiko M, Furdela V, Furer A, Furusawa T, Gaciong Z, Galbarczyk A, Galenkamp H, Galvano F, Gao J, Gao P, Garcia-de-la-Hera M, Garcia P, Gareta D, Garnett SP, Gaspoz JM, Gasull M, Gazzinelli A, Gehring U, Geleijnse JM, George R, Ghanbari A, Ghasemi E, Gheorghe-Fronea OF, Ghimire A, Gialluisi A, Giampaoli S, Gieger C, Gill TK, Giovannelli J, Gironella G, Giwercman A, Gkiouras K, Goldberg M, Goldsmith RA, Gomez LF, Gomula A, Gonçalves H, Gonçalves M, Gonçalves Cordeiro da Silva B, Gonzalez-Chica DA, Gonzalez-Gross M, González-Rivas JP, González-Villalpando C, González-Villalpando ME, Gonzalez AR, Gorbea MB, Gottrand F, Graff-Iversen S, Grafnetter D, Grajda A, Grammatikopoulou MG, Gregor RD, Grodzicki T, Grosso G, Gruden G, Gu D, Guan OP, Gudmundsson EF, Gudnason V, Guerrero R, Guessous I, Guimaraes AL, Gulliford MC, Gunnlaugsdottir J, Gunter MJ, Gupta PC, Gupta R, Gureje O, Gurzkowska B, Gutierrez L, Gutzwiller F, Ha S, Hadaegh F, Haghshenas R, Hakimi H, Halkjær J, Hambleton IR, Hamzeh B, Hange D, Hanif AAM, Hantunen S, Hao J, Hardman CM, Hari Kumar R, Hashemi-Shahri SM, Hata J, Haugsgjerd T, Hayes AJ, He Y, Heier M, Hendriks ME, Henrique RDS, Henriques A, Hernandez Cadena L, Herqutanto, Herrala S, Heshmat R, Hill AG, Ho SY, Ho SC, Hobbs M, Holdsworth M, Homayounfar R, Horasan Dinc G, Horimoto ARVR, Hormiga CM, Horta BL, Houti L, Howitt C, Htay TT, Htet AS, Htike MMT, Hu Y, Huerta JM, Huhtaniemi IT, Huiart L, Huisman M, Husseini AS, Huybrechts I, Hwalla N, Iacoviello L, Iannone AG, Ibrahim MM, Ibrahim Wong N, Ikram MA, Iotova V, Irazola VE, Ishida T, Isiguzo GC, Islam M, Islam SMS, Iwasaki M, Jackson RT, Jacobs JM, Jaddou HY, Jafar T, James K, Jamrozik K, Janszky I, Janus E, Jarvelin MR, Jasienska G, Jelaković A, Jelaković B, Jennings G, Jha AK, Jiang CQ, Jimenez RO, Jöckel KH, Joffres M, Johansson M, Jokelainen JJ, Jonas JB, Jørgensen T, Joshi P, Joukar F, Jóżwiak J, Juolevi A, Jurak G, Jureša V, Kaaks R, Kafatos A, Kajantie EO, Kalmatayeva Z, Kalpourtzi N, Kalter-Leibovici O, Kampmann FB, Kannan S, Karaglani E, Kårhus LL, Karki KB, Katibeh M, Katz J, Kauhanen J, Kaur P, Kavousi M, Kazakbaeva GM, Keil U, Keinan Boker L, Keinänen-Kiukaanniemi S, Kelishadi R, Kemper HCG, Keramati M, Kerimkulova A, Kersting M, Key T, Khader YS, Khalili D, Khaw KT, Kheiri B, Kheradmand M, Khosravi A, Kiechl-Kohlendorfer U, Kiechl S, Killewo J, Kim DW, Kim J, Klakk H, Klimek M, Klumbiene J, Knoflach M, Kolle E, Kolsteren P, Kontto JP, Korpelainen R, Korrovits P, Kos J, Koskinen S, Kouda K, Kowlessur S, Koziel S, Kratenova J, Kriaucioniene V, Kristensen PL, Krokstad S, Kromhout D, Kruger HS, Kubinova R, Kuciene R, Kujala UM, Kulaga Z, Kumar RK, Kurjata P, Kusuma YS, Kutsenko V, Kuulasmaa K, Kyobutungi C, Laatikainen T, Lachat C, Laid Y, Lam TH, Landrove O, Lanska V, Lappas G, Larijani B, Latt TS, Le Coroller G, Le Nguyen Bao K, Le TD, Lee J, Lee J, Lehmann N, Lehtimäki T, Lemogoum D, Levitt NS, Li Y, Lilly CL, Lim WY, Lima-Costa MF, Lin X, Lin YT, Lind L, Lingam V, Linneberg A, Lissner L, Litwin M, Lo WC, Loit HM, Lopez-Garcia E, Lopez T, Lotufo PA, Lozano JE, Lukačević Lovrenčić I, Lukrafka JL, Luksiene D, Lundqvist A, Lundqvist R, Lunet N, Lustigová M, Luszczki E, Ma G, Ma J, Machado-Coelho GLL, Machado-Rodrigues AM, Macia E, Macieira LM, Madar AA, Maggi S, Magliano DJ, Magriplis E, Mahasampath G, Maire B, Majer M, Makdisse M, Malekzadeh F, Malekzadeh R, Malhotra R, Mallikharjuna Rao K, Malyutina SK, Maniego LV, Manios Y, Mann JI, Mansour-Ghanaei F, Manzato E, Marcil A, Mårild SB, Marinović Glavić M, Marques-Vidal P, Marques LP, Marrugat J, Martorell R, Mascarenhas LP, Matasin M, Mathiesen EB, Mathur P, Matijasevich A, Matlosz P, Matsha TE, Mavrogianni C, Mbanya JCN, Mc Donald Posso AJ, McFarlane SR, McGarvey ST, McLachlan S, McLean RM, McLean SB, McNulty BA, Mediene Benchekor S, Medzioniene J, Mehdipour P, Mehlig K, Mehrparvar AH, Meirhaeghe A, Meisinger C, Mendoza Montano C, Menezes AMB, Menon GR, Mereke A, Meshram II, Metspalu A, Meyer HE, Mi J, Michels N, Mikkel K, Milkowska K, Miller JC, Minderico CS, Mini GK, Mirjalili MR, Mirrakhimov E, Mišigoj-Duraković M, Modesti PA, Moghaddam SS, Mohajer B, Mohamed MK, Mohamed SF, Mohammad K, Mohammadi MR, Mohammadi Z, Mohammadifard N, Mohammadpourhodki R, Mohan V, Mohanna S, Mohd Yusoff MF, Mohebbi I, Mohebi F, Moitry M, Møllehave LT, Molnár D, Momenan A, Mondo CK, Monterrubio-Flores E, Monyeki KDK, Moon JS, Moosazadeh M, Moreira LB, Morejon A, Moreno LA, Morgan K, Moschonis G, Mossakowska M, Mostafa A, Mostafavi SA, Mota J, Motlagh ME, Motta J, Moura-dos-Santos MA, Mridha MK, Msyamboza KP, Mu TT, Muhihi AJ, Muiesan ML, Müller-Nurasyid M, Murphy N, Mursu J, Musa KI, Musić Milanović S, Musil V, Mustafa N, Nabipour I, Naderimagham S, Nagel G, Naidu BM, Najafi F, Nakamura H, Námešná J, Nang EEK, Nangia VB, Narake S, Ndiaye NC, Neal WA, Nejatizadeh A, Nenko I, Neovius M, Nguyen CT, Nguyen ND, Nguyen QV, Nguyen QN, Nieto-Martínez RE, Niiranen TJ, Nikitin YP, Ninomiya T, Nishtar S, Njelekela MA, Noale M, Noboa OA, Noorbala AA, Norat T, Nordendahl M, Nordestgaard BG, Noto D, Nowak-Szczepanska N, Nsour MA, Nunes B, O'Neill TW, O'Reilly D, Ochimana C, Oda E, Odili AN, Oh K, Ohara K, Ohtsuka R, Olié V, Olinto MTA, Oliveira IO, Omar MA, Onat A, Ong SK, Ono LM, Ordunez P, Ornelas R, Ortiz PJ, Osmond C, Ostojic SM, Ostovar A, Otero JA, Overvad K, Owusu-Dabo E, Paccaud FM, Padez C, Pahomova E, Paiva KMD, Pająk A, Palli D, Palmieri L, Pan WH, Panda-Jonas S, Panza F, Paoli M, Papandreou D, Park SW, Park S, Parnell WR, Parsaeian M, Pasquet P, Patel ND, Pavlyshyn H, Pećin I, Pednekar MS, Pedro JM, Peer N, Peixoto SV, Peltonen M, Pereira AC, Peres KGDA, Peres MA, Peters A, Petkeviciene J, Peykari N, Pham ST, Pichardo RN, Pigeot I, Pikhart H, Pilav A, Pilotto L, Pitakaka F, Piwonska A, Pizarro AN, Plans-Rubió P, Polašek O, Porta M, Poudyal A, Pourfarzi F, Pourshams A, Poustchi H, Pradeepa R, Price AJ, Price JF, Providencia R, Puhakka SE, Puiu M, Punab M, Qasrawi RF, Qorbani M, Queiroz D, Quoc Bao T, Radić I, Radisauskas R, Rahimikazerooni S, Rahman M, Raitakari O, Raj M, Rakhimova EM, Ramachandra Rao S, Ramachandran A, Ramos E, Rampal L, Rampal S, Rangel Reina DA, Rarra V, Rech CR, Redon J, Reganit PFM, Regecová V, Revilla L, Rezaianzadeh A, Ribeiro R, Riboli E, Richter A, Rigo F, Rinke de Wit TF, Ritti-Dias RM, Robitaille C, Rodríguez-Artalejo F, Rodriguez-Perez MDC, Rodríguez-Villamizar LA, Roggenbuck U, Rojas-Martinez R, Romaguera D, Romeo EL, Rosengren A, Roy JGR, Rubinstein A, Ruidavets JB, Ruiz-Betancourt BS, Ruiz-Castell M, Rusakova IA, Russo P, Rutkowski M, Sabanayagam C, Sabbaghi H, Sachdev HS, Sadjadi A, Safarpour AR, Safi S, Safiri S, Saidi O, Sakarya S, Saki N, Salanave B, Salazar Martinez E, Salmerón D, Salomaa V, Salonen JT, Salvetti M, Sánchez-Abanto J, Sans S, Santos DA, Santos IS, Santos LC, Santos MP, Santos R, Saramies JL, Sardinha LB, Sarganas G, Sarrafzadegan N, Sathish T, Saum KU, Savva S, Sawada N, Sbaraini M, Scazufca M, Schaan BD, Schargrodsky H, Schipf S, Schmidt CO, Schnohr P, Schöttker B, Schramm S, Schultsz C, Schutte AE, Sebert S, Sein AA, Sen A, Senbanjo IO, Sepanlou SG, Servais J, Shalnova SA, Shamah-Levy T, Shamshirgaran M, Shanthirani CS, Sharafkhah M, Sharma SK, Shaw JE, Shayanrad A, Shayesteh AA, Shi Z, Shibuya K, Shimizu-Furusawa H, Shin DW, Shirani M, Shiri R, Shrestha N, Si-Ramlee K, Siani A, Siantar R, Sibai AM, Silva CRDM, Silva DAS, Simon M, Simons J, Simons LA, Sjöström M, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, So HK, Soares FC, Sobngwi E, Söderberg S, Soemantri A, Sofat R, Solfrizzi V, Somi MH, Sonestedt E, Song Y, Sørensen TIA, Sørgjerd EP, Sorić M, Sossa Jérome C, Soumaré A, Sparboe-Nilsen B, Sparrenberger K, Staessen JA, Starc G, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Stergiou GS, Stessman J, Stieber J, Stöckl D, Stocks T, Stokwiszewski J, Stronks K, Strufaldi MW, Suka M, Sun CA, Sung YT, Suriyawongpaisal P, Sy RG, Syddall HE, Sylva RC, Szklo M, Tai ES, Tammesoo ML, Tamosiunas A, Tan EJ, Tang X, Tanser F, Tao Y, Tarawneh MR, Tarqui-Mamani CB, Taylor A, Taylor J, Tebar WR, Tell GS, Tello T, Tham YC, Thankappan KR, Theobald H, Theodoridis X, Thijs L, Thinggaard M, Thomas N, Thorand B, Thuesen BH, Timmermans EJ, Tjandrarini DH, Tjonneland A, Toft U, Tolonen HK, Tolstrup JS, Topbas M, Topór-Madry R, Tormo MJ, Tornaritis MJ, Torrent M, Torres-Collado L, Touloumi G, Traissac P, Triantafyllou A, Trichopoulos D, Trichopoulou A, Trinh OTH, Trivedi A, Tshepo L, Tsugane S, Tuliakova AM, Tulloch-Reid MK, Tullu F, Tuomainen TP, Tuomilehto J, Turley ML, Twig G, Tynelius P, Tzourio C, Ueda P, Ugel E, Ulmer H, Uusitalo HMT, Valdivia G, Valvi D, van Dam RM, van den Born BJ, Van der Heyden J, van der Schouw YT, Van Herck K, Van Minh H, Van Schoor NM, van Valkengoed IGM, van Zutphen EM, Vanderschueren D, Vanuzzo D, Varbo A, Vasan SK, Vega T, Veidebaum T, Velasquez-Melendez G, Veronesi G, Verschuren WMM, Verstraeten R, Victora CG, Viet L, Villalpando S, Vineis P, Vioque J, Virtanen JK, Visvikis-Siest S, Viswanathan B, Vlasoff T, Vollenweider P, Voutilainen A, Wade AN, Walton J, Wambiya EOA, Wan Bebakar WM, Wan Mohamud WN, Wanderley Júnior RDS, Wang MD, Wang N, Wang Q, Wang X, Wang YX, Wang YW, Wannamethee SG, Wareham N, Wei W, Weres A, Werner B, Whincup PH, Widhalm K, Wiecek A, Wilks RJ, Willeit J, Willeit P, Williams EA, Wilsgaard T, Wojtyniak B, Wong-McClure RA, Wong A, Wong TY, Woo J, Wu FC, Wu S, Wyszynska J, Xu H, Xu L, Yaacob NA, Yan W, Yang L, Yang X, Yang Y, Yasuharu T, Ye X, Yiallouros PK, Yoosefi M, Yoshihara A, You SL, Younger-Coleman NO, Yusoff AF, Zainuddin AA, Zakavi SR, Zamani F, Zambon S, Zampelas A, Zapata ME, Zaw KK, Zejglicova K, Zeljkovic Vrkic T, Zeng Y, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhen S, Zheng Y, Zholdin B, Zhu D, Zins M, Zitt E, Zocalo Y, Zoghlami N, Zuñiga Cisneros J, Ezzati M. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet 2021; 398:957-980. [PMID: 34450083 PMCID: PMC8446938 DOI: 10.1016/s0140-6736(21)01330-1] [Citation(s) in RCA: 938] [Impact Index Per Article: 312.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. METHODS We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. FINDINGS The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. INTERPRETATION Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. FUNDING WHO.
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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: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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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: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Iurilli MLC, Zhou B, Bennett JE, Carrillo-Larco RM, Sophiea MK, Rodriguez-Martinez A, Bixby H, Solomon BD, Taddei C, Danaei G, Di Cesare M, Stevens GA, Riley LM, Savin S, Cowan MJ, Bovet P, Damasceno A, Chirita-Emandi A, Hayes AJ, Ikeda N, Jackson RT, Khang YH, Laxmaiah A, Liu J, Miranda JJ, Saidi O, Sebert S, Sorić M, Starc G, Gregg EW, Abarca-Gómez L, Abdeen ZA, Abdrakhmanova S, Ghaffar SA, Rahim HFA, Abu-Rmeileh NM, Garba JA, Acosta-Cazares B, Adams RJ, Aekplakorn W, Afsana K, Afzal S, Agdeppa IA, Aghazadeh-Attari J, Aguilar-Salinas CA, Agyemang C, Ahmad MH, Ahmad NA, Ahmadi A, Ahmadi N, Ahmed SH, Ahrens W, Aitmurzaeva G, Ajlouni K, Al-Hazzaa HM, Al-Lahou B, Al-Raddadi R, Alarouj M, AlBuhairan F, AlDhukair S, Ali MM, Alkandari A, Alkerwi A, Allin K, Alvarez-Pedrerol M, Aly E, Amarapurkar DN, Amiri P, Amougou N, Amouyel P, Bo Andersen L, Anderssen SA, Ängquist L, Anjana RM, Ansari-Moghaddam A, Aounallah-Skhiri H, Araújo J, Ariansen I, Aris T, Arku RE, Arlappa N, Aryal KK, Aspelund T, Assah FK, Assunção MCF, Aung MS, Auvinen J, Avdicová M, Avi S, Azevedo A, Azimi-Nezhad M, Azizi F, Azmin M, Babu BV, Jørgensen MB, Baharudin A, Bahijri S, Baker JL, Balakrishna N, Bamoshmoosh M, Banach M, Bandosz P, Banegas JR, Baran J, Barbagallo CM, Barceló A, Barkat A, Barros AJD, Barros MVG, Basit A, Bastos JLD, Bata I, Batieha AM, Batista RL, Battakova Z, Batyrbek A, Baur LA, Beaglehole R, Bel-Serrat S, Belavendra A, Romdhane HB, Benedics J, Benet M, Bergh IH, Berkinbayev S, Bernabe-Ortiz A, Bernotiene G, Bettiol H, Bezerra J, Bhagyalaxmi A, Bharadwaj S, Bhargava SK, Bhutta ZA, Bi H, Bi Y, Bia D, Lele ECB, Bikbov MM, Bista B, Bjelica DJ, Bjerregaard P, Bjertness E, Bjertness MB, Björkelund C, Bloch KV, Blokstra A, Bo S, Bobak M, Boddy LM, Boehm BO, Boeing H, Boggia JG, Bogova E, Boissonnet CP, Bojesen SE, Bonaccio M, Bongard V, Bonilla-Vargas A, Bopp M, Borghs H, Braeckevelt L, Braeckman L, Bragt MCE, Brajkovich I, Branca F, Breckenkamp J, Breda J, Brenner H, Brewster LM, Brian GR, Brinduse L, Brophy S, Bruno G, Bueno-de-Mesquita HB, Bugge A, Buoncristiano M, Burazeri G, Burns C, de León AC, Cacciottolo J, Cai H, Cama T, Cameron C, Camolas J, Can G, Cândido APC, Cañete F, Capanzana MV, Capková N, Capuano E, Capuano V, Cardol M, Cardoso VC, Carlsson AC, Carmuega E, Carvalho J, Casajús JA, Casanueva FF, Celikcan E, Censi L, Cervantes-Loaiza M, Cesar JA, Chamukuttan S, Chan AW, Chan Q, Chaturvedi HK, Chaturvedi N, Rahim NCA, Li Chee M, Chen CJ, Chen F, Chen H, Chen S, Chen Z, Cheng CY, Cheraghian B, Chetrit A, Chikova-Iscener E, Chiolero A, Chiou ST, Chirlaque MD, Cho B, Christensen K, Christofaro DG, Chudek J, Cifkova R, Cilia M, Cinteza E, Claessens F, Clarke J, Clays E, Cohen E, Concin H, Confortin SC, Cooper C, Coppinger TC, Corpeleijn E, Costanzo S, Cottel D, Cowell C, Craig CL, Crampin AC, Crujeiras AB, Csilla S, Cucu AM, Cui L, Cureau FV, Czenczek-Lewandowska E, D'Arrigo G, d'Orsi E, Dacica L, Re Saavedra MÁD, Dallongeville J, Damsgaard CT, Dankner R, Dantoft TM, Dasgupta P, Dastgiri S, Dauchet L, Davletov K, De Backer G, De Bacquer D, de Gaetano G, De Henauw S, de Oliveira PD, De Ridder D, De Ridder K, de Rooij SR, De Smedt D, Deepa M, Deev AD, Jr DeGennaro V, Dehghan A, Delisle H, Delpeuch F, Demarest S, Dennison E, Dereń K, Deschamps V, Dhimal M, Di Castelnuovo AF, Dias-da-Costa JS, Díaz-Sánchez ME, Diaz A, Dika Z, Djalalinia S, Djordjic V, Do HTP, Dobson AJ, Donati MB, Donfrancesco C, Donoso SP, Döring A, Dorobantu M, Dorosty AR, Doua K, Dragano N, Drygas W, Li Duan J, Duante CA, Duboz P, Duda RB, Duleva V, Dulskiene V, Dumith SC, Dushpanova A, Dzerve V, Dziankowska-Zaborszczyk E, Eddie R, Eftekhar E, Egbagbe EE, Eggertsen R, Eghtesad S, Eiben G, Ekelund U, El-Khateeb M, El Ati J, Eldemire-Shearer D, Eliasen M, Elliott P, Engle-Stone R, Enguerran M, Erasmus RT, Erbel R, Erem C, Eriksen L, Eriksson JG, la Peña JED, Eslami S, Esmaeili A, Evans A, Faeh D, Fakhretdinova AA, Fall CH, Faramarzi E, Farjam M, Sant'Angelo VF, Farzadfar F, Fattahi MR, Fawwad A, Felix-Redondo FJ, Ferguson TS, Fernandes RA, Fernández-Bergés D, Ferrante D, Ferrao T, Ferrari M, Ferrario MM, Ferreccio C, Ferrer E, Ferrieres J, Figueiró TH, Fijalkowska A, Fink G, Fischer K, Foo LH, Forsner M, Fouad HM, Francis DK, do Carmo Franco M, Frikke-Schmidt R, Frontera G, Fuchs FD, Fuchs SC, Fujiati II, Fujita Y, Fumihiko M, Furusawa T, Gaciong Z, Gafencu M, Galbarczyk A, Galenkamp H, Galeone D, Galfo M, Galvano F, Gao J, Garcia-de-la-Hera M, García-Solano M, Gareta D, Garnett SP, Gaspoz JM, Gasull M, Gaya ACA, Gaya AR, Gazzinelli A, Gehring U, Geiger H, Geleijnse JM, Ghanbari A, Ghasemi E, Gheorghe-Fronea OF, Giampaoli S, Gianfagna F, Gill TK, Giovannelli J, Gironella G, Giwercman A, Gkiouras K, Godos J, Gogen S, Goldberg M, Goldsmith RA, Goltzman D, Gómez SF, Gomula A, da Silva BGC, Gonçalves H, Gonzalez-Chica DA, Gonzalez-Gross M, González-Leon M, González-Rivas JP, González-Villalpando C, González-Villalpando ME, Gonzalez AR, Gottrand F, Graça AP, Graff-Iversen S, Grafnetter D, Grajda A, Grammatikopoulou MG, Gregor RD, Grodzicki T, Grøholt EK, Grøntved A, Grosso G, Gruden G, Gu D, Gualdi-Russo E, Guallar-Castillón P, Gualtieri A, Gudmundsson EF, Gudnason V, Guerrero R, Guessous I, Guimaraes AL, Gulliford MC, Gunnlaugsdottir J, Gunter MJ, Guo XH, Guo Y, Gupta PC, Gupta R, Gureje O, Gurzkowska B, Gutiérrez-González E, Gutierrez L, Gutzwiller F, Ha S, Hadaegh F, Hadjigeorgiou CA, Haghshenas R, Hakimi H, Halkjær J, Hambleton IR, Hamzeh B, Hange D, Hanif AAM, Hantunen S, Hao J, Kumar RH, Hashemi-Shahri SM, Hassapidou M, Hata J, Haugsgjerd T, He J, He Y, He Y, Heidinger-Felso R, Heinen M, Hejgaard T, Hendriks ME, dos Santos Henrique R, Henriques A, Cadena LH, Herrala S, Herrera VM, Herter-Aeberli I, Heshmat R, Hill AG, Ho SY, Ho SC, Hobbs M, Holdsworth M, Homayounfar R, Homs C, Hopman WM, Horimoto ARVR, Hormiga CM, Horta BL, Houti L, Howitt C, Htay TT, Htet AS, Htike MMT, Hu Y, Huerta JM, Huhtaniemi IT, Huiart L, Petrescu CH, 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SR, Zamani F, Zambon S, Zampelas A, Zamrazilová H, Zapata ME, Zargar AH, Ko Zaw K, Zdrojewski T, Zejglicova K, Vrkic TZ, Zeng Y, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhao W, Zhen S, Zheng W, Zheng Y, Zholdin B, Zhou M, Zhu D, Zins M, Zitt E, Zocalo Y, Cisneros JZ, Zuziak M, Ezzati M, Filippi S. Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight. eLife 2021; 10:e60060. [PMID: 33685583 PMCID: PMC7943191 DOI: 10.7554/elife.60060] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 01/07/2021] [Indexed: 02/05/2023] Open
Abstract
From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Nayu Ikeda
- National Institutes of Biomedical Innovation, Health and Nutrition
| | | | | | | | - Jing Liu
- Capital Medical University Beijing An Zhen Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Shoaib Afzal
- University of Copenhagen
- Copenhagen University Hospital
| | | | | | | | | | | | | | - Ali Ahmadi
- Shahrekord University of Medical Sciences
| | | | | | | | | | - Kamel Ajlouni
- National Center for Diabetes, Endocrinology and Genetics
| | | | | | | | | | | | | | | | | | | | | | | | - Eman Aly
- World Health Organization Regional Office for the Eastern Mediterranean
| | | | - Parisa Amiri
- Research Center for Social Determinants of Health
| | | | | | | | | | | | | | | | | | - Joana Araújo
- Institute of Public Health of the University of Porto
| | | | | | | | | | | | | | | | | | | | | | | | - Shina Avi
- Tel-Aviv University
- Hebrew University of Jerusalem
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Abdul Basit
- Baqai Institute of Diabetology and Endocrinology
| | | | | | | | | | | | | | | | | | | | | | | | - Judith Benedics
- Federal Ministry of Social Affairs, Health, Care and Consumer Protection
| | | | | | | | | | | | | | | | | | | | | | | | - Hongsheng Bi
- Shandong University of Traditional Chinese Medicine
| | - Yufang Bi
- Shanghai Jiao-Tong University School of Medicine
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - João Breda
- World Health Organization Regional Office for Europe
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- Council for Agricultural Research and Economics
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Angela Chetrit
- The Gertner Institute for Epidemiology and Health Policy Research
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- Canadian Fitness and Lifestyle Research Institute
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Rachel Dankner
- The Gertner Institute for Epidemiology and Health Policy Research
| | | | | | | | - Luc Dauchet
- University of Lille
- Lille University Hospital
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- Beijing Center for Disease Prevention and Control
| | | | | | | | | | | | | | - Anar Dushpanova
- Scuola Superiore Sant'Anna
- Al-Farabi Kazakh National University
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Günther Fink
- Swiss Tropical and Public Health Institute
- University of Basel
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- World Health Organization Regional Office for the Eastern Mediterranean
| | | | | | | | | | | | | | | | | | | | | | | | - Mihai Gafencu
- Victor Babes University of Medicine and Pharmacy Timisoara
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Marcel Goldberg
- Institut National de la Santé et de la Recherche Médicale
- Paris University
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Yin Guo
- Capital Medical University Beijing Tongren Hospital
| | | | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jie Hao
- Beijing Institute of Ophthalmology
| | | | | | | | | | | | | | - Yuan He
- National Research Institute for Health and Family Planning
| | - Yuna He
- Chinese Center for Disease Control and Prevention
| | | | | | | | | | | | - Ana Henriques
- Institute of Public Health of the University of Porto
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- Institute of Molecular and Clinical Ophthalmology Basel
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- French National Research Institute for Sustainable Development
| | | | | | | | | | | | | | | | | | - Joanne Katz
- Johns Hopkins Bloomberg School of Public Health
| | | | | | | | | | | | | | | | | | - Roya Kelishadi
- Research Institute for Primordial Prevention of Non-communicable Disease
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Slawomir Koziel
- PASs Hirszfeld Institute of Immunology and Experimental Therapy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Edwige Landais
- French National Research Institute for Sustainable Development
| | - Vera Lanska
- Institute for Clinical and Experimental Medicine
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- University of Chinese Academy of Sciences
| | | | | | | | | | | | - Lijuan Liu
- Capital Medical University Beijing Tongren Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Xu Ma
- National Research Institute for Health and Family Planning
| | | | | | | | | | - Stefania Maggi
- Institute of Neuroscience of the National Research Council
| | | | | | | | | | - Bernard Maire
- French National Research Institute for Sustainable Development
| | | | | | - Päivi Mäki
- Finnish Institute for Health and Welfare
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jaume Marrugat
- CIBERCV
- Institut Hospital del Mar d'Investigacions Mèdiques
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- Capital Institute of Pediatrics
| | | | | | | | | | | | | | - GK Mini
- Women’s Social and Health Studies Foundation
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- University of Strasbourg
- Strasbourg University Hospital
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- Instituto Conmemorativo Gorgas de Estudios de la Salud
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- Banska Bystrica Regional Authority of Public Health
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- National Institute for Health Development
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- National Institute for Health Development
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- SB RAS Federal Research Center Institute of Cytology and Genetics
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- Shanghai Jiao-Tong University School of Medicine
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- Institute of Neuroscience of the National Research Council
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- National Institute for Health Development
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- Korea Centers for Disease Control and Prevention
| | | | - Claes Ohlsson
- University of Gothenburg
- Sahlgrenska University Hospital
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- Institute for Cancer Research, Prevention and Clinical Network
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- IRCCS Ente Ospedaliero Specializzato in Gastroenterologia S. de Bellis
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- Korea Centers for Disease Control and Prevention
| | | | | | - Ionela M Pascanu
- University of Medicine, Pharmacy, Science and Technology of Târgu Mures
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- Leibniz Institute for Prevention Research and Epidemiology - BIPS
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- University of Medicine, Pharmacy, Science and Technology of Târgu Mures
| | | | - Miquel Porta
- Institut Hospital del Mar d'Investigacions Mèdiques
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- Victor Babes University of Medicine and Pharmacy Timisoara
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- Amrita Institute of Medical Sciences
| | | | | | - Ivo Rakovac
- World Health Organization Regional Office for Europe
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- Institut Universitari d'Investigació en Atenció Primària Jordi Gol
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- National Institute of Health Doutor Ricardo Jorge
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- Institute of Food Sciences of the National Research Council
| | | | | | | | | | | | | | | | | | - Nader Saki
- Ahvaz Jundishapur University of Medical Sciences
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- Research and Education Institute of Child Health
| | - Mathilde Savy
- French National Research Institute for Sustainable Development
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- University of New South Wales
- The George Institute for Global Health
| | | | | | | | - Abhijit Sen
- Center for Oral Health Services and Research Mid-Norway
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Alfonso Siani
- Institute of Food Sciences of the National Research Council
| | | | | | | | | | | | | | | | | | | | | | | | | | - Liam Smeeth
- London School of Hygiene & Tropical Medicine
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Igor Spiroski
- Institute of Public Health
- Ss. Cyril and Methodius University
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Lela Sturua
- National Center for Disease Control and Public Health
| | | | | | | | | | | | | | | | | | | | | | | | | | - Lucjan Szponar
- National Institute of Public Health – National Institute of Hygiene
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Pierre Traissac
- French National Research Institute for Sustainable Development
| | | | | | | | - Oanh TH Trinh
- University of Medicine and Pharmacy at Ho Chi Minh City
| | | | | | | | | | | | | | | | | | | | | | - Gilad Twig
- Tel-Aviv University
- Hebrew University of Jerusalem
| | | | | | | | | | - Eunice Ugel
- Universidad Centro-Occidental Lisandro Alvarado
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- Copenhagen University Hospital
- University of Copenhagen
| | | | | | | | - Tomas Vega
- Consejería de Sanidad Junta de Castilla y León
| | | | | | | | | | | | | | | | - Lucie Viet
- National Institute for Public Health and the Environment
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ningli Wang
- Capital Medical University Beijing Tongren Hospital
| | | | | | | | | | | | | | - Adelheid Weber
- Federal Ministry of Social Affairs, Health, Care and Consumer Protection
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Bogdan Wojtyniak
- National Institute of Public Health - National Institute of Hygiene
| | | | | | | | | | - Jean Woo
- The Chinese University of Hong Kong
| | | | | | - Jianfeng Wu
- Shandong University of Traditional Chinese Medicine
| | | | | | - Haiquan Xu
- Institute of Food and Nutrition Development of Ministry of Agriculture and Rural Affairs
| | - Liang Xu
- Beijing Institute of Ophthalmology
| | | | | | - Weili Yan
- Children's Hospital of Fudan University
| | | | | | - Yang Yang
- Shanghai Educational Development Co. Ltd
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- Peking University
- Duke University
| | | | | | - Dong Zhao
- Capital Medical University Beijing An Zhen Hospital
| | | | - Wenhua Zhao
- Chinese Center for Disease Control and Prevention
| | - Shiqi Zhen
- Jiangsu Provincial Center for Disease Control and Prevention
| | | | | | | | - Maigeng Zhou
- Chinese Center for Disease Control and Prevention
| | - Dan Zhu
- Inner Mongolia Medical University
| | - Marie Zins
- Institut National de la Santé et de la Recherche Médicale
- Paris University
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Campbell NR, Schutte AE, Varghese CV, Ordunez P, Zhang XH, Khan T, Sharman JE, Whelton PK, Parati G, Weber MA, Orías M, Jaffe MG, Moran AE, Plavnik FL, Ram VS, Brainin M, Owolabi MO, Ramirez AJ, Barbosa E, Bortolotto LA, Lackland DT. [São Paulo call to action for the prevention and control of high blood pressure: 2020Llamado a la acción de San Pablo para la prevención y el control de la hipertensión arterial, 2020]. Rev Panam Salud Publica 2021; 44:e27. [PMID: 33643393 PMCID: PMC7905737 DOI: 10.26633/rpsp.2021.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/05/2019] [Indexed: 11/24/2022] Open
Abstract
About 1/4th of adults have high blood pressure which is the single most important risk for death (including heart disease and stroke).There are effective policies that could facilitate people making healthy choices to prevent raised blood pressure, and if fully implemented, could largely prevent hypertension from occurring.Hypertension is easy to screen and treat for BUT only about 50% of adults with hypertension are aware of their condition and only about 1 in 7 is adequately treated.Preventing and controlling high blood pressure is the major mechanism for NCD prevention and control and a model for other NCD risks.Effective lifestyle and drug treatments could prevent and control hypertension in most individuals if systematically applied to the population, simple interventions are feasible in all settings, and can be used to enhance primary care.Urgent sustained action is needed is needed for effective public policies and health system changes to prevent and control hypertension.
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Affiliation(s)
- Norm Rc Campbell
- Departamento de Medicina, Departamento de Medicina, Fisiologia e Farmacologia e Ciências da Saúde da Comunidade, Instituto O'Brien de Saúde Pública e Instituto Cardiovascular Libin de Alberta, Universidade de Calgary Alberta Canadá Departamento de Medicina, Departamento de Medicina, Fisiologia e Farmacologia e Ciências da Saúde da Comunidade, Instituto O'Brien de Saúde Pública e Instituto Cardiovascular Libin de Alberta, Universidade de Calgary, Calgary, Alberta, Canadá
| | - Aletta E Schutte
- Unidade de Hipertensão e Doença Cardiovascular, Equipe de Pesquisa de Hipertensão na África (HART, na sigla em inglês), Universidade Noroeste Potchefstroom África do Sul Unidade de Hipertensão e Doença Cardiovascular, Equipe de Pesquisa de Hipertensão na África (HART, na sigla em inglês), Universidade Noroeste, Potchefstroom, África do Sul
| | - Cherian V Varghese
- Departamento de Doenças Não Transmissíveis, Organização Mundial da Saúde Genebra Suíça Departamento de Doenças Não Transmissíveis, Organização Mundial da Saúde, Genebra, Suíça
| | - Pedro Ordunez
- Departamento de Doenças Não Transmissíveis e Saúde Mental, Organização Pan-Americana da Saúde Washington, D.C. Estados Unidos Departamento de Doenças Não Transmissíveis e Saúde Mental, Organização Pan-Americana da Saúde, Washington, D.C., Estados Unidos
| | - Xin-Hua Zhang
- Instituto Liga de Hipertensão de Pequim Pequim China Instituto Liga de Hipertensão de Pequim, Pequim, China
| | - Taskeen Khan
- Departamento de Doenças Não Transmissíveis, Organização Mundial da Saúde Genebra Suíça Departamento de Doenças Não Transmissíveis, Organização Mundial da Saúde, Genebra, Suíça
| | - James E Sharman
- Instituto Menzies para Pesquisa Médica, Universidade da Tasmânia, Hobart Tasmânia Austrália Instituto Menzies para Pesquisa Médica, Universidade da Tasmânia, Hobart, Tasmânia, Austrália
| | - Paul K Whelton
- Departamento de Epidemiologia e Medicina, Centro de Ciências da Saúde da Universidade de Tulane Nova Orleans Estados Unidos Departamento de Epidemiologia e Medicina, Centro de Ciências da Saúde da Universidade de Tulane, Nova Orleans, Estados Unidos
| | - Gianfranco Parati
- Departamento de Medicina e Cirurgia, Universidade de Milão-Bicocca e Departamento de Ciências Cardiovasculares, Neurais e Metabólicas, e Instituto Auxológico Italiano, IRCCS, Hospital San Luca Milão Itália Departamento de Medicina e Cirurgia, Universidade de Milão-Bicocca e Departamento de Ciências Cardiovasculares, Neurais e Metabólicas, e Instituto Auxológico Italiano, IRCCS, Hospital San Luca, Milão, Itália
| | - Michael A Weber
- Divisão de Medicina Cardiovascular, Universidade Estadual de Nova York, Centro Médico Downstate, Brooklyn Nova York Estados Unidos Divisão de Medicina Cardiovascular, Universidade Estadual de Nova York, Centro Médico Downstate, Brooklyn, Nova York, Estados Unidos
| | - Marcelo Orías
- Sanatorio Allende, y Universidade Nacional de Córdoba Córdoba Argentina Sanatorio Allende, y Universidade Nacional de Córdoba, Córdoba, Argentina
| | - Marc G Jaffe
- Resolve to Save Lives, Uma Iniciativa da Vital Strategies, Nova York, Estados Unidos e Kaiser Permanente do Norte da Califórnia, South San Francisco Califórnia Estados Unidos Resolve to Save Lives, Uma Iniciativa da Vital Strategies, Nova York, Estados Unidos e Kaiser Permanente do Norte da Califórnia, South San Francisco, Califórnia, Estados Unidos
| | - Andrew E Moran
- Controle Mundial de Hipertensão, Resolve to Save Lives, Uma iniciativa da Vital Strategies Nova York Estados Unidos Controle Mundial de Hipertensão, Resolve to Save Lives, Uma iniciativa da Vital Strategies, Nova York, Estados Unidos
| | - Frida Liane Plavnik
- Grupo de Hipertensão, Hospital Alemão Oswaldo Cruz; Instituto do Coração (InCor); Sociedade Brasileira de Hipertensão São Paulo Brasil Grupo de Hipertensão, Hospital Alemão Oswaldo Cruz; Instituto do Coração (InCor); Sociedade Brasileira de Hipertensão, São Paulo, Brasil
| | - Venkata S Ram
- Escola de Medicina Sudoeste da Universidade do Texas, Dallas, Estados Unidos; Faculdade de Medicina e Hospitais Apollo Hyderabad Índia Escola de Medicina Sudoeste da Universidade do Texas, Dallas, Estados Unidos; Faculdade de Medicina e Hospitais Apollo, Hyderabad, Índia; Universidade Macquarie, Faculdade de Medicina e Ciências da Saúde, Sydney, Austrália; Liga Mundial de Hipertensão, Escritório Regional do Sudeste Asiático, Hyderabad, Índia
| | - Michael Brainin
- Universidade do Danúbio Krems Áustria Universidade do Danúbio, Krems, Áustria
| | - Mayowa O Owolabi
- Centro de Excelência para Doenças Não Transmissíveis da Aliança de Universidades de Pesquisa Africana Universidade de Ibadan Nigéria Centro de Excelência para Doenças Não Transmissíveis da Aliança de Universidades de Pesquisa Africana, Universidade de Ibadan, Nigéria
| | - Agustin J Ramirez
- Unidade de Hipertensão Arterial e Doenças Metabólicas, Hospital Universitário, Fundação Favaloro Buenos Aires Argentina Unidade de Hipertensão Arterial e Doenças Metabólicas, Hospital Universitário, Fundação Favaloro, Buenos Aires, Argentina
| | - Eduardo Barbosa
- Sociedade Latino-americana de Hipertensão Porto Alegre Brasil Sociedade Latino-americana de Hipertensão, Porto Alegre, Brasil
| | - Luiz Aparecido Bortolotto
- Hospital das Clínicas da Universidade de São Paulo; Instituto do Coração (InCor); e Sociedade Brasileira de Hipertensão São Paulo Brasil Hospital das Clínicas da Universidade de São Paulo; Instituto do Coração (InCor); e Sociedade Brasileira de Hipertensão, São Paulo, Brasil
| | - Daniel T Lackland
- Divisão de Neurociências Translacionais e Estudos Populacionais, Universidade de Medicina da Carolina do Sul Charleston Estados Unidos Divisão de Neurociências Translacionais e Estudos Populacionais, Universidade de Medicina da Carolina do Sul, Charleston, Estados Unidos
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Campbell NRC, Schutte AE, Varghese CV, Ordunez P, Zhang XH, Khan T, Sharman JE, Whelton PK, Parati G, Weber MA, Orías M, Jaffe MG, Moran AE, Plavnik FL, Ram VS, Brainin M, Owolabi MO, Ramirez AJ, Barbosa E, Bortolotto LA, Lackland DT. [São Paulo call to action for the prevention and control of high blood pressure: 2020Chamado à ação de São Paulo para prevenção e controle da hipertensão arterial: 2020]. Rev Panam Salud Publica 2021; 45:e26. [PMID: 33643404 PMCID: PMC7905751 DOI: 10.26633/rpsp.2021.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/05/2019] [Indexed: 11/24/2022] Open
Abstract
About 1/4th of adults have high blood pressure which is the single most important risk for death (including heart disease and stroke).There are effective policies that could facilitate people making healthy choices to prevent raised blood pressure, and if fully implemented, could largely prevent hypertension from occurring.Hypertension is easy to screen and treat for BUT only about 50% of adults with hypertension are aware of their condition and only about 1 in 7 is adequately treated.Preventing and controlling high blood pressure is the major mechanism for NCD prevention and control and a model for other NCD risks.Effective lifestyle and drug treatments could prevent and control hypertension in most individuals if systematically applied to the population, simple interventions are feasible in all settings, and can be used to enhance primary care.Urgent sustained action is needed is needed for effective public policies and health system changes to prevent and control hypertension.
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Affiliation(s)
- Norm RC Campbell
- Departamento de Medicina, Fisiología y Farmacología y Ciencias de la Salud de la Comunidad, Instituto O’Brien para Salud Pública e Instituto Cardiovascular Libin de Alberta, Universidad de CalgaryCalgary, AlbertaCanadáDepartamento de Medicina, Fisiología y Farmacología y Ciencias de la Salud de la Comunidad, Instituto O’Brien para Salud Pública e Instituto Cardiovascular Libin de Alberta, Universidad de Calgary, Calgary, Alberta, Canadá
| | - Aletta E Schutte
- Unidad para la Hipertensión y las Enfermedades Cardiovasculares, Equipo de Investigación de la Hipertensión en África (HART), Universidad NoroccidentalPotchefstroomSudáfricaUnidad para la Hipertensión y las Enfermedades Cardiovasculares, Equipo de Investigación de la Hipertensión en África (HART), Universidad Noroccidental, Potchefstroom, Sudáfrica
| | - Cherian V Varghese
- Departamento de Enfermedades no Transmisibles, Organización Mundial de la SaludGinebraSuizaDepartamento de Enfermedades no Transmisibles, Organización Mundial de la Salud, Ginebra, Suiza
| | - Pedro Ordunez
- Departamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la SaludWashington, D.C.Estados UnidosDepartamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, D.C., Estados Unidos
| | - Xin-Hua Zhang
- Instituto de la Liga de Beijing contra la HipertensiónBeijingChinaInstituto de la Liga de Beijing contra la Hipertensión, Beijing, China
| | - Taskeen Khan
- Departamento de Enfermedades no Transmisibles, Organización Mundial de la SaludGinebraSuizaDepartamento de Enfermedades no Transmisibles, Organización Mundial de la Salud, Ginebra, Suiza
| | - James E Sharman
- Instituto Menzies de Investigación Médica, Universidad de TasmaniaHobartTasmaniaAustraliaInstituto Menzies de Investigación Médica, Universidad de Tasmania, Hobart, Tasmania, Australia
| | - Paul K Whelton
- Departamentos de Epidemiología y Medicina, Centro de Ciencias Médicas de la Universidad de TulaneNueva OrleansEstados UnidosDepartamentos de Epidemiología y Medicina, Centro de Ciencias Médicas de la Universidad de Tulane, Nueva Orleans, Estados Unidos
| | - Gianfranco Parati
- Departamento de Medicina y Cirugía, Universidad de Milán-Bicocca, y Departamento de Ciencias Cardiovasculares, Neurales y Metabólicas, Instituto Auxológico Italiano, IRCCS, Hospital San LucaMilánItaliaDepartamento de Medicina y Cirugía, Universidad de Milán-Bicocca, y Departamento de Ciencias Cardiovasculares, Neurales y Metabólicas, Instituto Auxológico Italiano, IRCCS, Hospital San Luca, Milán, Italia
| | - Michael A Weber
- División de Medicina Cardiovascular, Universidad Estatal de Nueva York, Centro Médico DownstateBrooklynNueva YorkEstados UnidosDivisión de Medicina Cardiovascular, Universidad Estatal de Nueva York, Centro Médico Downstate, Brooklyn, Nueva York, Estados Unidos
| | - Marcelo Orías
- Sanatorio Allende, y Universidad Nacional de CórdobaCórdobaArgentinaSanatorio Allende, y Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Marc G Jaffe
- Resolve to Save Lives, una iniciativa de Vital Strategies, Nueva York, Estados Unidos y Kaiser Permanente de California del Norte, San Francisco meridionalCaliforniaEstados UnidosResolve to Save Lives, una iniciativa de Vital Strategies, Nueva York, Estados Unidos y Kaiser Permanente de California del Norte, San Francisco meridional, California, Estados Unidos
| | - Andrew E Moran
- Control Mundial de la Hipertensión, Resolve to Save Lives, una iniciativa de Vital StrategiesNueva YorkEstados UnidosControl Mundial de la Hipertensión, Resolve to Save Lives, una iniciativa de Vital Strategies, Nueva York, Estados Unidos
| | - Frida Liane Plavnik
- Grupo de Hipertensión, Hospital Alemão Oswaldo Cruz; e Instituto del Corazón (InCor); y Sociedad Brasileña de HipertensiónSan PabloBrasilGrupo de Hipertensión, Hospital Alemão Oswaldo Cruz; e Instituto del Corazón (InCor); y Sociedad Brasileña de Hipertensión, San Pablo, Brasil)
| | - Venkata S Ram
- Escuela de Medicina Sudoeste de la Universidad de Texas, Estados Unidos; Colegio Médico y Hospital ApolloHyderabadIndiaFacultad de Medicina y Ciencias de la Salud de la Universidad de MacquarieSydneyAustraliaOficina Regional de Asia Meridional de la Liga Mundial de la HipertensiónHyderabadIndiaEscuela de Medicina Sudoeste de la Universidad de Texas, Estados Unidos; Colegio Médico y Hospital Apollo, Hyderabad, India; Facultad de Medicina y Ciencias de la Salud de la Universidad de Macquarie, Sydney, Australia; Oficina Regional de Asia Meridional de la Liga Mundial de la Hipertensión, Hyderabad, India
| | - Michael Brainin
- Universidad del DanubioKremsAustriaUniversidad del Danubio, Krems, Austria
| | - Mayowa O Owolabi
- Centro de Excelencia de las Universidades Africanas de Investigación sobre las Enfermedades no TransmisiblesUniversidad de IbadanNigeriaCentro de Excelencia de las Universidades Africanas de Investigación sobre las Enfermedades no Transmisibles, Universidad de Ibadan, Nigeria
| | - Agustin J Ramirez
- Unidad de Hipertensión Arterial y Enfermedades Metabólicas, Hospital Universitario, Fundación FavaloroBuenos AiresArgentinaUnidad de Hipertensión Arterial y Enfermedades Metabólicas, Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina
| | - Eduardo Barbosa
- Sociedad Latinoamericana de la Hipertensión, Artery LatamPorto AlegreBrasilSociedad Latinoamericana de la Hipertensión, Artery Latam, Porto Alegre, Brasil
| | - Luiz Aparecido Bortolotto
- Hospital de Clínicas, Universidad de San Pablo; Instituto del Corazón; y Sociedad Brasileña de HipertensiónSan PabloBrasilHospital de Clínicas, Universidad de San Pablo; Instituto del Corazón; y Sociedad Brasileña de Hipertensión, San Pablo, Brasil
| | - Daniel T Lackland
- División de Neurociencias Aplicadas y Estudios de Población, Universidad Médica de Carolina del Sur, CharlestonCarolina del SurEstados UnidosDivisión de Neurociencias Aplicadas y Estudios de Población, Universidad Médica de Carolina del Sur, Charleston, Carolina del Sur, Estados Unidos
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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: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Lombardi C, Sharman JE, Padwal R, Picone D, Alcolea E, Ayala R, Gittens A, Lawrence‐Williams P, Malcolm T, Neira C, Perez V, Rosende A, Tesser J, Villacres N, Campbell NRC, Ordunez P. Weak and fragmented regulatory frameworks on the accuracy of blood pressure-measuring devices pose a major impediment for the implementation of HEARTS in the Americas. J Clin Hypertens (Greenwich) 2020; 22:2184-2191. [PMID: 33022866 PMCID: PMC8030047 DOI: 10.1111/jch.14058] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/18/2020] [Accepted: 09/04/2020] [Indexed: 12/28/2022]
Abstract
Global HEARTS is a WHO initiative for cardiovascular disease prevention and control. Accurate blood pressure (BP) measurement is an essential component of the initiative. This study aimed to determine the regulatory frameworks governing the accuracy of BPMDs in countries of the Americas participating in the HEARTS initiative. Quantitative and qualitative analysis of the laws and regulations relevant to ensuring the accuracy of BPMDs were determined from the Ministries of Health/Regulatory Agencies among 13 countries in Latin America and the Caribbean. Analysis included characterizing the scope of regulations (ie, pre-market approval, sales and promotion, labeling, cuff sizes, and procurement), information systems for monitoring the models of BPMDs used in primary health care (PHC), and systems to enforce compliance with regulations. Ten of the 13 countries had medical device laws, but regulations that specifically address BPMDs only existed in three countries. Only one country (Brazil) had regulations for mandatory accuracy validation testing and only two countries regulated internet sales of BPMDs. Labeling and cuff size regulations existed in four and two countries, respectively. Less than half the countries reported having a data repository on the BPMD models being used in PHC facilities (four countries) or sold (five countries). Weak and fragmented regulatory frameworks on the accuracy of BPMDs exist among countries of the Americas. This will adversely affect the accuracy of blood pressure assessment and hence poses a major impediment for successful implementation of HEARTS initiative.
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Affiliation(s)
- Cintia Lombardi
- Department of Non‐Communicable Diseases and Mental HealthPan American Health OrganizationWashingtonDCUSA
| | - James E. Sharman
- Menzies Institute for Medical ResearchUniversity of TasmaniaHobartTasAustralia
| | - Raj Padwal
- Department of MedicineUniversity of AlbertaEdmontonABCanada
| | - Dean Picone
- Menzies Institute for Medical ResearchUniversity of TasmaniaHobartTasAustralia
| | - Ernesto Alcolea
- Center for the Estate Control of Medicines and Medical Devices (CECMED)A WHO Collaborative CenterHavanaCuba
| | - Roberto Ayala
- National Center for Health Technology Excellence (CENETEC)Ministry of HealthMexico CityMexico
| | - Anselm Gittens
- Metrology DepartmentSaint Lucia Bureau of StandardsCastriesSaint Lucia
| | | | - Taraleen Malcolm
- Pan American Health OrganizationPort of SpainTrinidad and Tobago
| | - Carolina Neira
- Department of Noncommunicable DiseasesMinistry of HealthSantiagoChile
| | | | - Andres Rosende
- National Program of Prevention of Cardiovascular DiseasesMinistry of HealthBuenos AiresArgentina
| | - Juliano Tesser
- National Sanitary Surveillance Agency (ANVISA)BrasiliaBrazil
| | | | - 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
| | - Pedro Ordunez
- Department of Non‐Communicable Diseases and Mental HealthPan American Health OrganizationWashingtonDCUSA
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Litwin M, Liu J, Liu L, Lo WC, Loit HM, Long KQ, Lopes L, Lopes O, Lopez-Garcia E, Lopez T, Lotufo PA, Lozano JE, Lukrafka JL, Luksiene D, Lundqvist A, Lundqvist R, Lunet N, Lunogelo C, Lustigová M, Luszczki E, Ma G, Ma J, Ma X, Machado-Coelho GLL, Machado-Rodrigues AM, Machi S, Macieira LM, Madar AA, Maggi S, Magliano DJ, Magnacca S, Magriplis E, Mahasampath G, Maire B, Majer M, Makdisse M, Mäki P, Malekzadeh F, Malekzadeh R, Malhotra R, Mallikharjuna Rao K, Malyutina SK, Maniego LV, Manios Y, Mann JI, Mansour-Ghanaei F, Manzato E, Margozzini P, Markaki A, Markey O, Markidou Ioannidou E, Marques-Vidal P, Marques LP, Marrugat J, Martin-Prevel Y, Martin R, Martorell R, Martos E, Marventano S, Mascarenhas LP, Masoodi SR, Mathiesen EB, Mathur P, Matijasevich A, Matsha TE, Mavrogianni C, Mazur A, Mbanya JCN, McFarlane SR, McGarvey ST, McKee M, McLachlan S, McLean RM, McLean SB, McNulty BA, Mediene-Benchekor S, Medzioniene J, Mehdipour P, Mehlig K, Mehrparvar AH, Meirhaeghe A, Meisfjord J, Meisinger C, Menezes AMB, Menon GR, Mensink GBM, Menzano MT, Mereke A, Meshram II, Metspalu A, Mi J, Michaelsen KF, Michels N, Mikkel K, Milkowska K, Miller JC, Minderico CS, Mini GK, Miquel JF, Miranda JJ, Mirjalili MR, Mirkopoulou D, Mirrakhimov E, Mišigoj-Durakovic M, Mistretta A, Mocanu V, Modesti PA, Moghaddam SS, Mohajer B, Mohamed MK, Mohamed SF, Mohammad K, Mohammadi Z, Mohammadifard N, Mohammadpourhodki R, Mohan V, Mohanna S, Mohd Yusoff MF, Mohebbi I, Mohebi F, Moitry M, Molbo D, Møllehave LT, Møller NC, Molnár D, Momenan A, Mondo CK, Monroy-Valle M, Monterrubio-Flores E, Monyeki KDK, Moon JS, Moosazadeh M, Moreira LB, Morejon A, Moreno LA, Morgan K, Morin SN, Mortensen EL, Moschonis G, Mossakowska M, Mostafa A, Mota-Pinto A, Mota J, Motlagh ME, Motta J, Moura-dos-Santos MA, Mridha MK, Msyamboza KP, Mu TT, Muc M, Mugoša B, Muiesan ML, Mukhtorova P, Müller-Nurasyid M, Murphy N, Mursu J, Murtagh EM, Musa KI, Music Milanovic S, Musil V, Mustafa N, Nabipour I, Naderimagham S, 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D, Rodríguez-Artalejo F, Rodriguez-Perez MDC, Rodríguez-Villamizar LA, Roggenbuck U, Rojas-Martinez R, Rojroongwasinkul N, Romaguera D, Romeo EL, Rosario RV, Rosengren A, Rouse I, Roy JGR, Rubinstein A, Rühli FJ, Ruidavets JB, Ruiz-Betancourt BS, Ruiz Moreno E, Rusakova IA, Russell Jonsson K, Russo P, Rust P, Rutkowski M, Sabanayagam C, Sacchini E, Sachdev HS, Sadjadi A, Safarpour AR, Safi S, Safiri S, Saidi O, Saki N, Salanave B, Salazar Martinez E, Salmerón D, Salomaa V, Salonen JT, Salvetti M, Samoutian M, Sánchez-Abanto J, Sandjaja, Sans S, Santa Marina L, Santos DA, Santos IS, Santos LC, Santos MP, Santos O, Santos R, Santos Sanz S, Saramies JL, Sardinha LB, Sarrafzadegan N, Sathish T, Saum KU, Savva S, Savy M, Sawada N, Sbaraini M, Scazufca M, Schaan BD, Schaffrath Rosario A, Schargrodsky H, Schienkiewitz A, Schindler K, Schipf S, Schmidt CO, Schmidt IM, Schnohr P, Schöttker B, Schramm S, Schramm S, Schröder H, Schultsz C, Schutte AE, Sebert S, Sein AA, Selamat R, Sember V, Sen 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Strufaldi MW, Sturua L, Suárez-Medina R, Suka M, Sun CA, Sundström J, Sung YT, Sunyer J, Suriyawongpaisal P, Swinburn BA, Sy RG, Syddall HE, Sylva RC, Szklo M, Szponar L, Tai ES, Tammesoo ML, Tamosiunas A, Tan EJ, Tang X, Tanser F, Tao Y, Tarawneh MR, Tarp J, Tarqui-Mamani CB, Taxová Braunerová R, Taylor A, Taylor J, Tchibindat F, Tebar WR, Tell GS, Tello T, Thankappan KR, Theobald H, Theodoridis X, Thijs L, Thomas N, Thuesen BH, Tichá L, Timmermans EJ, Tjonneland A, Tolonen HK, Tolstrup JS, Topbas M, Topór-Madry R, Torheim LE, Tormo MJ, Tornaritis MJ, Torrent M, Torres-Collado L, Toselli S, Traissac P, Tran TTH, Trichopoulos D, Trichopoulou A, Trinh OTH, Trivedi A, Tshepo L, Tsigga M, Tsugane S, Tuliakova AM, Tulloch-Reid MK, Tullu F, Tuomainen TP, Tuomilehto J, Turley ML, Tynelius P, Tzotzas T, Tzourio C, Ueda P, Ugel E, Ukoli FAM, Ulmer H, Unal B, Usupova Z, Uusitalo HMT, Uysal N, Vaitkeviciute J, Valdivia G, Vale S, Valvi D, van Dam RM, Van der Heyden J, van der Schouw YT, Van Herck K, Van Minh H, van Valkengoed IGM, Vanderschueren D, Vanuzzo D, Varbo A, Varela-Moreiras G, Varona-Pérez P, Vasan SK, Vega T, Veidebaum T, Velasquez-Melendez G, Velika B, Veronesi G, Verschuren WMM, Victora CG, Viegi G, Viet L, Villalpando S, Vineis P, Vioque J, Virtanen JK, Visser M, Visvikis-Siest S, Viswanathan B, Vladulescu M, Vlasoff T, Vocanec D, Völzke H, Voutilainen A, Voutilainen S, Vrijheid M, Vrijkotte TGM, Wade AN, Wagner A, Waldhör T, Walton J, Wambiya EOA, Wan Bebakar WM, Wan Mohamud WN, Wanderley Júnior RDS, Wang MD, Wang N, Wang Q, Wang X, Wang YX, Wang YW, Wannamethee SG, Wareham N, Weber A, Wedderkopp N, Weerasekera D, Weghuber D, Wei W, Weres A, Werner B, Whincup PH, Widhalm K, Widyahening IS, Wiecek A, Wilks RJ, Willeit J, Willeit P, Williams J, Wilsgaard T, Wojtyniak B, Wong-McClure RA, Wong A, Wong JE, Wong TY, Woo J, Woodward M, Wu FC, Wu J, Wu LJ, Wu S, Xu H, Xu L, Yaacob NA, Yamborisut U, Yan W, Yang L, Yang X, Yang Y, Yardim N, Yaseri M, Yasuharu T, Ye X, Yiallouros PK, Yoosefi M, Yoshihara A, You QS, You SL, Younger-Coleman NO, Yusof SM, Yusoff AF, Zaccagni L, Zafiropulos V, Zainuddin AA, Zakavi SR, Zamani F, Zambon S, Zampelas A, Zamrazilová H, Zapata ME, Zargar AH, Zaw KK, Zdrojewski T, Zeljkovic Vrkic T, Zeng Y, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhao W, Zhen S, Zheng W, Zheng Y, Zholdin B, Zhou M, Zhu D, Zocalo Y, Zuñiga Cisneros J, Zuziak M, Ezzati M. Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants. Lancet 2020; 396:1511-1524. [PMID: 33160572 PMCID: PMC7658740 DOI: 10.1016/s0140-6736(20)31859-6] [Citation(s) in RCA: 171] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 08/03/2020] [Accepted: 08/19/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. METHODS For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5-19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. FINDINGS We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9-10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes-gaining too little height, too much weight for their height compared with children in other countries, or both-occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. INTERPRETATION The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks. FUNDING Wellcome Trust, AstraZeneca Young Health Programme, EU.
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Ordunez P. Letter by Ordunez Regarding Article, "Cardiometabolic Risk Factor Control During Times of Crises and Beyond". Circ Cardiovasc Qual Outcomes 2020; 13:e007129. [PMID: 33176468 PMCID: PMC7673635 DOI: 10.1161/circoutcomes.120.007129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington DC
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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 DOI: 10.1111/jch.14072] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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)
- Donald J DiPette
- School of Medicine, University of South Carolina, Columbia, SC, USA
| | - Kenneth Goughnour
- Women Influencing Health, Education and Rule of Law (WI-HER), Vienna, VA, USA
| | - Eric Zuniga
- Health Service of Antofagasta, University of Antofagasta, Antofagasta, Chile
| | - Jamario Skeete
- Department of Internal Medicine, Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | | | - Sonia Angell
- California Department of Public Health, California, IL, 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, AB, Canada
| | - Antionio Coca
- Department of Internal Medicine, Hypertension and Vascular Risk Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Kenneth Connell
- Faculty of Medical Sciences, The University of the West Indies, St Michael, Barbados
| | - Rohit Doon
- Ministry of Health, Port of Spain, Trinidad and Tobago
| | - Marc Jaffe
- Division of Endocrinology, Kaiser Permanente, San Francisco, CA, USA
| | | | - Andrew Moran
- Resolve to Save Lives, An initiative of Vital Strategies, New York, NY, USA.,Columbia University Irving Medical Center, New York, NY, USA
| | - Marcelo Orias
- Sanatorio Allende Córdoba, Universidad Nacional de Córdoba, Cordoba, Argentina
| | | | | | - Yamilé Valdés González
- National Technical Advisory Commission on Hypertension, Havana, Cuba.,University Hospital "General Calixto García", Havana, Cuba
| | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
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Picone DS, Padwal R, Campbell NRC, Boutouyrie P, Brady TM, Olsen MH, Delles C, Lombardi C, Mahmud A, Meng Y, Mokwatsi GG, Ordunez P, Phan HT, Pucci G, Schutte AE, Sung KC, Zhang XH, Sharman JE. How to check whether a blood pressure monitor has been properly validated for accuracy. J Clin Hypertens (Greenwich) 2020; 22:2167-2174. [PMID: 33017506 DOI: 10.1111/jch.14065] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/27/2020] [Accepted: 09/09/2020] [Indexed: 12/20/2022]
Abstract
Hypertension guidelines recommend that blood pressure (BP) should be measured using a monitor that has passed validation testing for accuracy. BP monitors that have not undergone rigorous validation testing can still be cleared by regulatory authorities for marketing and sale. This is the situation for most BP monitors worldwide. Thus, consumers (patients, health professionals, procurement officers, and general public) may unwittingly purchase BP monitors that are non-validated and more likely to be inaccurate. Without prior knowledge of these issues, it is extremely difficult for consumers to distinguish validated from non-validated BP monitors. For the above reasons, the aim of this paper is to provide consumers guidance on how to check whether a BP monitor has been properly validated for accuracy. The process involves making an online search of listings of BP monitors that have been assessed for validation status. Only those monitors that have been properly validated are recommended for BP measurement. There are numerous different online listings of BP monitors, several are country-specific and two are general (international) listings. Because monitors can be marketed using alternative model names in different countries, if a monitor is not found on one listing, it may be worthwhile cross-checking with a different listing. This information is widely relevant to anyone seeking to purchase a home, clinic, or ambulatory BP monitor, including individual consumers for use personally or policy makers and those procuring monitors for use in healthcare systems, and retailers looking to stock only validated BP monitors.
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Affiliation(s)
- Dean S Picone
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - 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, AB, Canada
| | - Pierre Boutouyrie
- Department of Pharmacology, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, Inserm UMR 970, Université de Paris, Paris, France
| | - Tammy M Brady
- Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Hecht Olsen
- Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark.,Centre for Individualized Medicine in Arterial Diseases, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Cintia Lombardi
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Azra Mahmud
- King Abdul Aziz Cardiac Center, King Abdul Aziz Medical City, Riyadh, Saudi Arabia.,National Guard Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Yaxing Meng
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Gontse G Mokwatsi
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Hoang T Phan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.,Pham Ngoc, Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Giacomo Pucci
- Unit of Internal Medicine at Terni University Hospital, Department of Medicine, University of Perugia, Perugia, Italy
| | - Aletta E Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.,School of Public Health and Community Medicine, University of New South Wales, The George Institute for Global Health, Sydney, Australia
| | - Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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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: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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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: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Martinez R, Lloyd-Sherlock P, Soliz P, Ebrahim S, Vega E, Ordunez P, McKee M. Trends in premature avertable mortality from non-communicable diseases for 195 countries and territories, 1990-2017: a population-based study. Lancet Glob Health 2020; 8:e511-e523. [PMID: 32199120 DOI: 10.1016/s2214-109x(20)30035-8] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/14/2020] [Accepted: 01/27/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND The reduction by a third of premature non-communicable disease (NCD) mortality by 2030 is the ambitious target of Sustainable Development Goal (SDG) 3.4. However, the indicator is narrowly defined, including only four major NCDs (cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases) and only for people aged 30-70 years. This study focuses on premature avertable mortality from NCDs-premature deaths caused by NCDs that could be prevented through effective public policies and health interventions or amenable to high-quality health care-to assess trends at global, regional, and national levels using estimates from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2017. METHODS We reviewed existing lists of NCD causes of death that are either preventable through public health policies and interventions or amenable to health care to create a list of avertable NCD causes of death, which was mapped to the GBD cause list. We estimated age-standardised years of life lost (YLL) per 100 000 population due to premature avertable mortality from NCDs, avertable NCD cause clusters, and non-avertable NCD causes by sex, location, and year and reported their 95% uncertainty intervals (UIs). We examined trends in age-standardised YLL due to avertable and non-avertable NCDs, assessed the progress of premature avertable mortality from NCDs in achieving SDG 3.4, and explored specific avertable NCD cause clusters that could make a substantial contribution to overall trends in premature mortality. FINDINGS Globally, premature avertable mortality from NCDs for both sexes combined declined -1·3% (95% UI -1·4 to -1·2) per year, from 12 855 years (11 809 to 14 051) in 1990 to 9008 years (8329 to 9756) in 2017. However, the absolute number of avertable NCD deaths increased 49·3% (95% UI 47·3 to 52·2) from 23·1 million (22·0-24·1) deaths in 1990 to 34·5 million (33·4 to 35·6) in 2017. Premature avertable mortality from NCDs reduced in every WHO region and in most countries and territories between 1990 and 2017. Despite these reductions, only the Western Pacific and European regions and 25 countries (most of which are high-income countries) are on track to achieve SDG target 3.4. Since 2017, there has been a global slowdown in the reduction of premature avertable mortality from NCDs. In 2017, high premature avertable mortality from NCDs was clustered in low-income and middle-income countries, mainly in the South-East Asia region, Eastern Mediterranean region, and African region. Most countries with large annual reductions in such mortality between 1990 and 2017 had achieved low levels of premature avertable mortality from NCDs by 2017. Some countries, the most populous examples being Afghanistan, the Central African Republic, Uzbekistan, Haiti, Mongolia, Turkmenistan, Pakistan, Ukraine, Laos, and Egypt, reported both an upward trend and high levels of premature avertable mortality from NCDs. Cardiovascular diseases, cancers, and chronic respiratory diseases have been the main drivers of the global and regional reduction in premature avertable mortality from NCDs, whereas premature mortality from substance use disorders, chronic kidney disease and acute glomerulonephritis, and diabetes have been increasing. INTERPRETATION Worldwide, there has been a substantial reduction in premature avertable mortality from NCDs, but progress has been uneven across populations. Countries vary substantially in current levels and trends and, hence, the extent to which they are on track to achieve SDG 3.4. By accounting for premature avertable mortality while avoiding arbitrary age cutoffs, premature avertable mortality from NCDs is a robust, comprehensive, and actionable indicator for quantifying and monitoring global and national progress towards NCD prevention and control. FUNDING None.
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Affiliation(s)
| | | | | | - Shah Ebrahim
- London School of Hygiene & Tropical Medicine, London, UK
| | - Enrique Vega
- Pan American Health Organization, Washington, DC, USA
| | - Pedro Ordunez
- Pan American Health Organization, Washington, DC, USA
| | - Martin McKee
- London School of Hygiene & Tropical Medicine, London, UK
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