Insufficient high blood pressure treatment in the Global South

Health care systems in low and middle-income countries are insufficiently prepared for the increasing number of high blood pressure disorders. More than two-thirds of all people affected are without treatment, a recent study discovered.

Hypertension diagnosed only in 50% of cases

Health care systems in low and middle-income countries are insufficiently prepared for the increasing number of high blood pressure disorders. More than two-thirds of all people affected are without treatment. Researchers led by the Harvard T.H. Chan School of Public Health, USA, the University of Göttingen, Germany, and the Medical Faculty of Heidelberg University, Germany have discovered this.

The research team analyzed health care indicators of high blood pressure in 44 countries in the Global South. Using a waterfall model, they determined how well the health systems of different countries are adapted. First, the researchers determined how many people suffer from high blood pressure. On this basis, they determined how many patients were examined, diagnosed and treated. Finally, they analyzed how many patients successfully controlled the disease with medication.

"High blood pressure is already most prevalent in regions belonging to the Global South, especially sub-Saharan Africa and Central and South Asia," says Pascal Geldsetzer, a postdoctoral fellow at Harvard T.H. Chan School of Public Health and lead author of the study. "Our study shows not only that the care for hypertension in these countries is severely inadequate, but also where exactly patients get lost in the process of hypertension treatment. 

Only a tenth of patients have high blood pressure under control

The result: less than half of those affected are diagnosed with high blood pressure. Only 30% of these patients are treated and only one-tenth have the disease under control. "Hypertension can be treated relatively well and cheaply," says Sebastian Vollmer, Professor of Development Economics at the University of Göttingen. "Undiagnosed or untreated high blood pressure, on the other hand, is a considerable risk for the people affected and can lead to serious complications or even death. 

Till Bärnighausen, Professor of Global Health at the University Hospital and Faculty of Medicine Heidelberg and study co-author, adds: "Hypertension is already one of the major widespread diseases in the Global South and is becoming more common as the population of these countries ages. This study provides important insights for policymakers to determine where in the chain of treatment for hypertension the biggest problems currently exist. 

In order to improve the health systems of the countries concerned, the authors take a look at the success stories of well-adapted health systems. Costa Rica, Bangladesh, Brazil, Ecuador, Kyrgyzstan, and Peru are good examples. The analysis was based, among other things, on STEPS data from the World Health Organization.

Sources:
1. Pascal Geldsetzer et al. The state of hypertension care in 44 low- and middle-income countries: a cross-sectional study of individual-level nationally representative data from 1.1 million adults. The Lancet (2019). Doi: http://doi.org/10.1016/S0140-6736(19)30955-9
2. Georg-August-University Göttingen

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