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

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.

Prevalence of hypertension and possible risk factors of hypertension unawareness among individuals aged 30–75 years from two Panamanian provinces: Results from population-based cross-sectional studies, 2010 and 2019

“…Nevertheless, we found a decrease in the prevalence of hypertension between the PREFREC (2010) and ENSPA (2019) study, as opposed to other countries in the region, such as Peru, that reported an increasing prevalence of hypertension attributed to recent economic growth [ 10 ], whereas the prevalence in Brazil [ 37 ], Canada [ 7 ], and the United States [ 9 ] has remained unchanged. In agreement with our study, recent studies have reported a decrease in the prevalence of hypertension despite an increase in obesity [ 4 , 11 ]. Our results suggest that other risk factors associated with hypertension such as salt intake, smoking, and exposure to dietary fatty acids have improved [ 4 , 11 ].…”

“…In agreement with our study, recent studies have reported a decrease in the prevalence of hypertension despite an increase in obesity [ 4 , 11 ]. Our results suggest that other risk factors associated with hypertension such as salt intake, smoking, and exposure to dietary fatty acids have improved [ 4 , 11 ]. For example, in the case of smoking, in 2005, Panama adopted the WHO Framework Convention on Tobacco Control.…”

“…Studies from 2000-2010 have shown a substantial increase in hypertension awareness in high-income countries (HIC), whereas in LMICs the increase has been slight [6]. However, since 2010, a plateau and even a decrease in hypertension awareness has been identified in HIC [7][8][9], as well as in LMICs [10,11].…”

Chile’s public healthcare sector hypertension control rates before and during the pandemic and HEARTS implementation

“…A strength of using this strategy to obtain treatment and control rates is that centers are required to monitor this rate as obtained here. Second, it might be possible that the estimated group of people with hypertension is overestimated considering it was calculated using the prevalence reported on the last National Health Survey (2017), which shows a slight but significant decrease in the prevalence compared to the one in 2003 ( 10 ). This could underestimate the treatment and control rates calculated in this study.…”

Perceptions of the Doctor-Patient Relationship Among Patients in a Private, Secondary-Level Hospital in Southern India

“…Currently, there is a push to improve quality of care in primary care in LMICs, especially with growing rates of DM, HTN and chronic diseases ( 27 – 29 ). While quality has been measured using the cascade of care of care ( 30 – 33 ) and achievement of guideline-based management and counseling strategies ( 34 , 35 ), fewer studies in LMICs include the role of longitudinal primary care doctors, empanelment, and the doctor-patient relationship in quality-of-care assessments ( 36 ). Given that research has shown that continuity of care improves medication adherence and patient healthy lifestyle behaviors ( 37 – 39 ), more research is needed on the state of continuity of care in LMICs and the doctor-patient relationship.…”