Addressing Failures in Achieving Hypertension Control in Low- and Middle-Income Settings through Simplified Treatment Algorithms

Abstract

Hypertension is the most important risk factor for cardiovascular diseases (CVDs), which are the leading global cause of death. Hypertension is under-diagnosed and under-treated in most low- and middle-income countries (LMICs). Current algorithms for hypertension treatment are complex for the healthcare worker, limit decentralization, complicate procurement and often translate to a large pill burden for the person with hypertension. We summarize evidence supporting implementation of simple, algorithmic, accessible, non-toxic and effective (SAANE) algorithms to provide a feasible way to access and maintain quality care for hypertension. Implementation of these algorithms will enable task shifting to less specialised health care workers and lay cadres, provision of fixed dose combinations, consolidation of the market while retaining generic competition, simplification of laboratory requirements, and lowering costs for health systems and people who incur out of pocket expenses.

HEARTS in the Americas: innovations for improving hypertension and cardiovascular disease risk management in primary care

“…To be more functional, the guidelines need an algorithm or standardized treatment protocol which has limited branches and fewer steps (simple, direct), and is composed of available and affordable medicines (always accessible), with good side-effect profiles (well-tolerated), once-a-day dosing (practical), and which lower blood pressure equally across a broad range of demographics and thus across populations (effective). Adopting simple algorithms and small, carefully managed, and standardized hypertension medication formularies, supported by the local legislative environment, might facilitate task shifting to less specialized health care workers, and the provision of fixed-dose combinations, thus simplifying laboratory requirements and lowering out-of-pocket expenses for people ( 26 ).…”

HEARTS en las Américas: innovaciones para mejorar el manejo de la hipertensión y del riesgo cardiovascular en la atención primaria

“…Para ser más funcionales, las directrices necesitan un algoritmo o protocolo de tratamiento estandarizado que tenga un número limitado de ramificaciones y menos pasos (sencillos, directos) y esté compuesto por medicamentos disponibles y asequibles (siempre accesibles), con buenos perfiles de efectos secundarios (bien tolerados), que sean administrados una vez al día (prácticos), y que disminuyan la presión arterial por igual en una amplia gama de grupos demográficos y, por tanto, en todos los grupos poblacionales (eficaces). La adopción de algoritmos simples y vademécums de medicamentos antihipertensivos reducidos, cuidadosamente administrados y estandarizados, respaldados por el marco legal local, podría facilitar la reasignación de tareas hacia trabajadores de salud menos especializados y la administración de combinaciones de dosis fijas, lo que simplificaría los requisitos de laboratorio y disminuiría los gastos corrientes de las personas ( 26 ).…”

Most Recent Trials and Advances in Hypertension

“…SAANE algorithms indicate clear titration steps but do not go as far as selecting a preferred algorithm or naming the preferred drug within a class. [ 21 ] This strategy facilitates successful management of hypertension treatment by less skilled health workers with little supervision. Similarly, SAANE algorithms facilitate not only the initiation of therapy, but also adjustment to reach hypertension control.…”