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

Dorit Talia Stein, Marissa B. Reitsma, Pascal Geldsetzer, Kokou Agoudavi, Krishna Kumar Aryal, Silver Bahendeka, Luisa C.C. Brant, Farshad Farzadfar, Mongal Singh Gurung, David Guwatudde, Yessito Corine Nadège Houehanou, Deborah Carvalho Malta, João Soares Martins, Sahar Saeedi Moghaddam, Kibachio Joseph Mwangi, Bolormaa Norov, Lela Sturua, Zhaxybay Zhumadilov, Till Bärnighausen, Justine I. DaviesDavid Flood, Maja E. Marcus, Michaela Theilmann, Sebastian Vollmer, Jennifer Manne-Goehler, Rifat Atun, Nikkil Sudharsanan, Stéphane Verguet

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Improving hypertension control in low- and middle-income countries has uncertain implications across socioeconomic groups. In this study, we simulated improvements in the hypertension care cascade and evaluated the distributional benefits across wealth quintiles in 44 low- and middle-income countries using individual-level data from nationally representative, cross-sectional surveys. We raised diagnosis (diagnosis scenario) and treatment (treatment scenario) levels for all wealth quintiles to match the best-performing country quintile and estimated the change in 10-year cardiovascular disease (CVD) risk of individuals initiated on treatment. We observed greater health benefits among bottom wealth quintiles in middle-income countries and in countries with larger baseline disparities in hypertension management. Lower-middle-income countries would see the greatest absolute benefits among the bottom quintiles under the treatment scenario (29.1 CVD cases averted per 1,000 people living with hypertension in the bottom quintile (Q1) versus 17.2 in the top quintile (Q5)), and the proportion of total CVD cases averted would be largest among the lowest quintiles in upper-middle-income countries under both diagnosis (32.0% of averted cases in Q1 versus 11.9% in Q5) and treatment (29.7% of averted cases in Q1 versus 14.0% in Q5) scenarios. Targeted improvements in hypertension diagnosis and treatment could substantially reduce socioeconomic-based inequalities in CVD burden in low- and middle-income countries.

Original languageEnglish
Pages (from-to)414-423
Number of pages10
JournalNature Medicine
Volume30
Issue number2
DOIs
StatePublished - Feb 2024
Externally publishedYes

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