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

Journal article

Stein DT, Reitsma MB, Geldsetzer P, Agoudavi K, Aryal KK, Bahendeka S, Brant LC, Farzadfar F, Gurung MS, Guwatudde D, Houehanou YCN, Malta DC, Martins JS, Moghaddam SS, Mwangi KJ, Norov B, Sturua L, Zhumadilov Z, Bärnighausen T, Davies JI, Flood D, Marcus ME, Theilmann M, Vollmer S, Manne-Goehler J, Atun R, Sudharsanan N, Verguet S
Nature Medicine, vol. 30, 2024, pp. 414–423

DOI: 10.1038/s41591-023-02769-8

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APA Click to copy
DT, S., MB, R., P, G., K, A., KK, A., S, B., … S, V. (2024). Hypertension care cascades and reducing inequities in cardiovascular disease in low- and middle-income countries. Nature Medicine, 30, 414–423. https://doi.org/10.1038/s41591-023-02769-8

Chicago/Turabian Click to copy
DT, Stein, Reitsma MB, Geldsetzer P, Agoudavi K, Aryal KK, Bahendeka S, Brant LC, et al. “Hypertension Care Cascades and Reducing Inequities in Cardiovascular Disease in Low- and Middle-Income Countries.” Nature Medicine 30 (2024): 414–423.

MLA Click to copy
DT, Stein, et al. “Hypertension Care Cascades and Reducing Inequities in Cardiovascular Disease in Low- and Middle-Income Countries.” Nature Medicine, vol. 30, 2024, pp. 414–23, doi:10.1038/s41591-023-02769-8.

BibTeX Click to copy

@article{stein2024a,
  title = {Hypertension care cascades and reducing inequities in cardiovascular disease in low- and middle-income countries},
  year = {2024},
  journal = {Nature Medicine},
  pages = {414–423},
  volume = {30},
  doi = {10.1038/s41591-023-02769-8},
  author = {DT, Stein and MB, Reitsma and P, Geldsetzer and K, Agoudavi and KK, Aryal and S, Bahendeka and LC, Brant and F, Farzadfar and MS, Gurung and D, Guwatudde and YCN, Houehanou and DC, Malta and JS, Martins and SS, Moghaddam and KJ, Mwangi and B, Norov and L, Sturua and Z, Zhumadilov and T, Bärnighausen and JI, Davies and D, Flood and ME, Marcus and M, Theilmann and S, Vollmer and J, Manne-Goehler and R, Atun and N, Sudharsanan and S, Verguet}
}

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.

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

Journal article

Cite

Abstract

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