Mean blood pressure according to the hypertension care cascade: Analysis of six national health surveys in Peru

Abstract Background Trend data on hypertension prevalence and attainment indicators at each step of the care cascade (awareness, treatment, control) are required in Chile. This study aims to quantify trends (2003–2017) in prevalence and in the proportion of individuals with hypertension attaining each step of the care cascade among adults aged 17 years or older, and to assess the impact of lowering the blood pressure (BP) thresholds used to define elevated BP on these indicators. Methods We used data from 2003, 2010, and 2017 Chilean national health surveys. Each year we assessed levels of (1) mean systolic (SBP) and diastolic (DBP) blood pressure, (2) hypertension prevalence (BP ≥ 140/90 mmHg or use of antihypertensive treatment), and (3) awareness, treatment, and control. Logistic regression on pooled data was used to assess trends in binary outcomes; linear regression was used to assess trends in continuous SBP and DBP. We compared levels of hypertension prevalence using two sources to ascertain antihypertensive treatment (self-reported versus medicine inventory). The 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines were used to re-define hypertension using lower thresholds (BP ≥ 130/80 mmHg). Results Hypertension prevalence was 34.0, 32.0 and 30.8% in 2003, 2010 and 2017, respectively. Levels of treated- and controlled-hypertension were significantly higher in 2017 than in 2003 (65% versus 41% for treatment, P < 0.001; 34% versus 14% for control, P < 0.001), while levels of awareness were stable (66% versus 59%, P = 0.130). Awareness, treatment, and control levels were higher among females in 2003, 2010, and 2017 (P < 0.001). Mean SBP and DBP decreased over the 15-year period, except for SBP among females on treatment. Adopting the 2017 ACC/AHA guidelines would increase hypertension prevalence by 17 and 55% in absolute and relative terms, respectively. Conclusions Chile has experienced a positive population-wide lowering in blood pressure distribution which may be explained partly by a significant rise in levels of treated- and controlled-hypertension since 2003. Lowering the thresholds used to define elevated BP would substantially increase the financial public health challenge of further improving attainment levels at each step of the care cascade. Innovative and collaborative strategies are needed to improve hypertension management, especially among males.

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Hypertension care cascade in Chile: a serial cross-sectional study from national health surveys 2003-2010-2017.

10.21203/rs.3.rs-16313/v1 ◽

2020 ◽

Author(s):

Alvaro Passi-Solar ◽

Paula Margozzini ◽

Jennifer S Mindell ◽

Milagros A Ruiz ◽

Carlos Valencia ◽

...

Keyword(s):

National Health ◽

Health Surveys ◽

Antihypertensive Treatment ◽

Universal Access ◽

Cross Sectional ◽

Hypertension Prevalence ◽

Care Cascade ◽

And Control ◽

The Impact ◽

National Health Surveys

Abstract Background: Data on trends in hypertension prevalence and indicators of attainment at each step of the care cascade are required in Chile. Aim : To quantify trends (2003-2017) in prevalence and in the proportion of individuals with hypertension attaining each step of the care cascade (awareness, treatment and control) among adults aged ≥17 years, and to assess the impact of lowering the blood pressure (BP) threshold on these indicators. Methods: We used data from three Chilean national health surveys (ENS 2003; 2010; 2017). Mean systolic (SBP) and diastolic (DBP) levels, hypertension prevalence (BP≥140/90 mmHg or use of antihypertensive treatment), and levels of awareness, treatment and control were assessed in each year. Logistic regression on pooled data was used to assess trends in hypertension prevalence and in its care cascade; linear regression was used to assess trends in SBP and DBP. We compared levels of hypertension prevalence using two sources to ascertain use of antihypertensive treatment (ATC codes from a detailed medicine inventory and self-reported use). The 2017 ACC/AHA guidelines were used to re-define hypertension using lower thresholds (BP≥130/80 mmHg or use of treatment). Results : Hypertension prevalence was 34.0%, 32.0% and 30.8% in 2003, 2010 and 2017, respectively. Mean SBP and DBP decreased over the 15-year period, except for SBP among females on treatment. Adopting the 2017 ACC/AHA guidelines would increase hypertension prevalence by 17% and 55% in absolute and relative terms, respectively. Levels of treated- and controlled-hypertension were significantly higher in 2017 than in 2003 (65% vs 41% for treatment; 34% vs 14% for control), while levels of awareness were stable (66% vs 59%). Gender disparities were evident, with higher awareness, treatment and control levels among females in 2003, 2010 and 2017. Conclusions: The introduction of universal access to care for hypertension in Chile in 2005 accounted partly for the rise in levels of treated- and controlled-hypertension since 2003. Lowering the BP threshold would substantially increase the financial public health challenge of further improving levels of attainment at each step of the care cascade. Innovative and collaborative strategies are needed to improve the management of hypertension, especially among males.

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P1948Socioeconomic inequalities in the prevalence and management of hypertension: analyses of the Chilean National Health Surveys 2003, 2010 and 2017

European Heart Journal ◽

10.1093/eurheartj/ehz748.0695 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Passi ◽

P Margozzini ◽

J Mindell ◽

M Ruiz ◽

S Scholes

Keyword(s):

Blood Pressure ◽

National Health ◽

Health Surveys ◽

Universal Access ◽

Hypertension Management ◽

Hypertension Prevalence ◽

Risk Of Death ◽

Cardiovascular Morbidity And Mortality ◽

And Control ◽

National Health Surveys

Abstract Hypertension is the highest attributable risk of death worldwide, causing 7.1million deaths annually, and it is the primary cause of cardiovascular morbidity and mortality. In Chile, around one-in-three adults are living with this chronic health condition. Chilean evidence has shown inequalities in hypertension prevalence by various measures of socioeconomic position (SEP). However, information on SEP inequalities in the three key aspects of hypertension management (awareness, treatment, and control of high blood pressure), is only partially known. Purpose To assess SEP inequalities in hypertension prevalence and management in Chilean adults. Methods Data came from the Chilean National Health Surveys (ENS) 2003, 2010 and 2017. Years of formal education was used as the SEP measure. Age-and gender-specific Slope and Relative Indices of Inequalities (SII and RII) were calculated for the prevalence of hypertension (mean SBP ≥140mmHg, DBP ≥90mmHg, or current medication use to lower blood pressure) and for each management outcome. Results Analytical sample comprised 3,426; 4,838 and 5,373 participants aged ≥17y with blood pressure measurements for years 2003, 2010 and 2017, respectively. Prevalence of hypertension was 32.4%, 32.2% and 30.8% for the years 2003, 2010 and 2017, respectively. According to the SII and RII, males and females aged <65y showed higher hypertension prevalence among those with fewer years of education in 2003, 2010 and 2017. Among those classed as hypertensive, levels of awareness increased from 59.4% in 2003 to 65.9% in 2017. Over the same time period, levels of treatment increased from 39.0% to 65.2%, and levels of control increased from 14.1% to 23.9%. SEP inequalities in hypertension management – with better outcomes for the most educated – were highest among females aged ≥65y. Conclusion Introduction of universal access to care for hypertension in Chile in 2005 accounted partly for the rise of hypertension management levels since 2003. According to local and international strategies for the prevention and control of noncommunicable diseases, there is room for improvement. However, improvements should have a specific focus on SEP inequalities. Acknowledgement/Funding Chilean Ministry of Health

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