Variation in the proportion of adults in need of BP-lowering medications by hypertension care guideline in low- and middle-income countries
A Cross-Sectional Study of 1037215 Individuals From 50 Nationally Representative Surveys
Current hypertension guidelines vary substantially in their definition of who should be offered blood pressure–lowering medications. Understanding the effect of guideline choice on the proportion of adults who require treatment is crucial for planning and scaling up hypertension care in low- and middle-income countries. We extracted cross-sectional data on age, sex, blood pressure, hypertension treatment and diagnosis status, smoking, and body mass index for adults 30 to 70 years of age from nationally representative surveys in 50 low- and middle-income countries (N = 1 037 215). We aimed to determine the effect of hypertension guideline choice on the proportion of adults in need of blood pressure–lowering medications. We considered 4 hypertension guidelines: the 2017 American College of Cardiology/American Heart Association guideline, the commonly used 140/90 mm Hg threshold, the 2016 World Health Organization HEARTS guideline, and the 2019 UK National Institute for Health and Care Excellence guideline. There was substantial variation in the proportion of adults in need of blood pressure–lowering medications depending on which hypertension guideline was used. Given the great implications of this choice for health system capacity, policy makers will need to carefully consider which guideline they should adopt when scaling up hypertension care in their country.
Sudharsanan, N., M. Theilmann, T. Kirschbaum, J. Manne-Goehler, S. Azadnajafabad, P. Bovet, S. Chen, A. Damasceno, J. De Neve, M. Dorobantu, C. Ebert, F. Farzadfar, G. Gathecha, M. Gurung, K. Jamshidi, J. Jorgensen, D. Labadarios, J. Lemp, N. Lunet, J. Mwangi, S. Moghaddam, S. Bahendeka, Z. Zhumadilov, T. Bärnighausen, S. Vollmer, R. Atun, J. Davies und P. Geldsetzer (2021), Variation in the proportion of adults in need of BP-lowering medications by hypertension care guideline in low- and middle-income countries: A Cross-Sectional Study of 1037215 Individuals From 50 Nationally Representative Surveys. Circulation, 143, 10, 991-1001