Tackling High Blood Pressure in Kenya and Other Low- and Middle-Income
                        Countries: Why Now and What Can We Do?

Abstract Hypertension is the leading risk factor for global disease burden. Self-management of high blood pressure (BP) through self-monitoring and self-titration of medications, has proved to be one successful and cost-effective tool to achieve better BP control in many high-income countries but not much is known about its potential in low- and middle-income countries (LMICs). We used semi-structured questionnaires and focus groups in three LMICs; Peru, Cameroon and Malawi to examine perceptions and attitudes of patients diagnosed with essential hypertension towards living with hypertension, BP measurement and treatment, patient–physician relationship and opinions about self-management of high blood pressure. Results in all three countries were comparable. Patients showed varied levels of health literacy related to hypertension. BP measurement habits were mostly affected by resources available and caregiver support. Treatment and adherence to it were primarily affected by cost. Most patients were welcoming of the idea of self-management but skeptical about the ability to do self-monitoring accurately and the safety involving self-titration of medications.

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Effects of lifestyle-related interventions on blood pressure in the low and middle income countries: systematic review and meta-analysis

European Heart Journal ◽

10.1093/eurheartj/eht308.p1423 ◽

2013 ◽

Vol 34 (suppl 1) ◽

pp. P1423-P1423

Author(s):

C. Baena ◽

M. Olandoski ◽

J. O. Younge ◽

D. A. Buitrago-Lopez ◽

S. Darweesh ◽

...

Keyword(s):

Systematic Review ◽

Blood Pressure ◽

Meta Analysis ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

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Telemedicine interventions for hypertension management in low- and middle-income countries: A scoping review

PLoS ONE ◽

10.1371/journal.pone.0254222 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0254222

Author(s):

Michael Hoffer-Hawlik ◽

Andrew Moran ◽

Lillian Zerihun ◽

John Usseglio ◽

Jennifer Cohn ◽

...

Keyword(s):

Blood Pressure ◽

Clinical Outcomes ◽

Scoping Review ◽

Intervention Group ◽

Small Sample ◽

Current Evidence ◽

Middle Income ◽

Middle Income Countries ◽

The Impact ◽

Low And Middle Income

Hypertension remains the leading cause of cardiovascular disease worldwide and disproportionately impacts patients living in low- and middle-income countries (LMICs). Telemedicine offers a potential solution for improving access to health care for vulnerable patients in LMICs. Objectives The purpose of this scoping review was to summarize the evidence for telemedicine interventions for blood pressure management in LMICs and assess the relationships between the telemedicine intervention characteristics and clinical outcomes. Design Published studies were identified from the following databases (from their inception to May 2020): PubMed, Scopus, and Embase. Search terms related to “Low and Middle Income Countries,” “Telemedicine,” and “Hypertension” were used, and clinical outcomes were extracted from the screened articles. Results Our search resulted in 530 unique articles, and 14 studies were included in this review. Five studies assessed telemedicine interventions for patient-provider behavioral counseling, four assessed patient-provider medical management, and five assessed provider-provider consultation technologies. Out of fourteen individual studies, eleven demonstrated a significant improvement in systolic or diastolic blood pressure in the intervention group. Of the eight studies that reported difference-in-differences changes in systolic blood pressure, between-arm differences ranged from 13.2 mmHg to 0.4 mmHg. Conclusions The majority of the studies in this review demonstrated a significant reduction in blood pressure with use of the telemedicine intervention, though the magnitude of benefit was not consistently large. Limitations of the studies included small sample sizes, short duration, and intervention heterogeneity. Current evidence suggests that telemedicine may provide a promising approach to increase access to care and improve outcomes for hypertension in LMICs, especially during events that limit access to in-person care, such as the COVID-19 pandemic. However, high-quality clinical trials of sufficient size and duration are needed to establish the impact and role of telemedicine in hypertension care. The protocol for this review was not registered.

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Hypertension in Low- and Middle-Income Countries

Circulation Research ◽

10.1161/circresaha.120.318729 ◽

2021 ◽

Vol 128 (7) ◽

pp. 808-826

Author(s):

Aletta E. Schutte ◽

Nikhil Srinivasapura Venkateshmurthy ◽

Sailesh Mohan ◽

Dorairaj Prabhakaran

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Health Care ◽

Cost Effective ◽

Care Staff ◽

Health Care Staff ◽

Significant Shift ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

In recent decades low- and middle-income countries (LMICs) have been witnessing a significant shift toward raised blood pressure; yet in LMICs, only 1 in 3 are aware of their hypertension status, and ≈8% have their blood pressure controlled. This rising burden widens the inequality gap, contributes to massive economic hardships of patients and carers, and increases costs to the health system, facing challenges such as low physician-to-patient ratios and lack of access to medicines. Established risk factors include unhealthy diet (high salt and low fruit and vegetable intake), physical inactivity, tobacco and alcohol use, and obesity. Emerging risk factors include pollution (air, water, noise, and light), urbanization, and a loss of green space. Risk factors that require further in-depth research are low birth weight and social and commercial determinants of health. Global actions include the HEARTS technical package and the push for universal health care. Promising research efforts highlight that successful interventions are feasible in LMICs. These include creation of health-promoting environments by introducing salt-reduction policies and sugar and alcohol tax; implementing cost-effective screening and simplified treatment protocols to mitigate treatment inertia; pooled procurement of low-cost single-pill combination therapy to improve adherence; increasing access to telehealth and mHealth (mobile health); and training health care staff, including community health workers, to strengthen team-based care. As the blood pressure trajectory continues creeping upward in LMICs, contextual research on effective, safe, and cost-effective interventions is urgent. New emergent risk factors require novel solutions. Lowering blood pressure in LMICs requires urgent global political and scientific priority and action.

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Effects of lifestyle-related interventions on blood pressure in low and middle-income countries

Journal of Hypertension ◽

10.1097/hjh.0000000000000136 ◽

2014 ◽

Vol 32 (5) ◽

pp. 961-973 ◽

Cited By ~ 22

Author(s):

Cristina P. Baena ◽

Marcia Olandoski ◽

John O. Younge ◽

Adriana Buitrago-Lopez ◽

Sirwan K.L. Darweesh ◽

...

Keyword(s):

Blood Pressure ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

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Socioeconomic Status and Its Relation to Hypertension in Rural Nepal

International Journal of Hypertension ◽

10.1155/2021/5542438 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Sanju Bhattarai ◽

Birgit Tandstad ◽

Archana Shrestha ◽

Biraj Karmacharya ◽

Abhijit Sen

Keyword(s):

Blood Pressure ◽

Socioeconomic Status ◽

Socioeconomic Factors ◽

Low Income ◽

Lifestyle Factors ◽

High Income ◽

Middle Income ◽

Middle Income Countries ◽

Rural Nepal ◽

Low And Middle Income

Introduction. Hypertension and its association with socioeconomic positions are well established. However, the gradient of these relationships and the mediating role of lifestyle factors among rural population in low- and middle-income countries such as Nepal are not fully understood. We sought to assess the association between socioeconomic factors (education, income, and employment status) and hypertension. Also, we assessed whether the effect of education and income level on hypertension was mediated by lifestyle factors. Methods. This cross-sectional study was conducted among 260 participants aged ≥18 years attending a rural health center in Dolakha, Nepal. Self-reported data on demographic, socioeconomic, and lifestyle factors were collected, and blood pressure, weight, and height were measured for all study participants. Those with systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg or administrating high blood pressure-lowering medicines were regarded as hypertensives. Poisson regression models were used to estimate the prevalence ratios and corresponding 95% confidence intervals to assess the association between socioeconomic factors and hypertension. We explored mediation, using the medeff command in Stata for causal mediation analysis of nonlinear models. Results. Of the 50 hypertensive participants, sixty percent were aware of their status. The age-standardized prevalence of hypertension was two times higher for those with higher education or high-income category. Compared to low-income and unemployed groups, the prevalence ratio of hypertension was 1.33 and 2.26 times more for those belonging to the high-income and employed groups, respectively. No evidence of mediation by lifestyle factors was observed between socioeconomic status and hypertension. Conclusions. Socioeconomic positions were positively associated with hypertension prevalence in rural Nepal. Further studies using longitudinal settings are necessary to validate our findings especially in low- and middle-income countries such as Nepal.

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