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

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)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(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;. 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 eachyear. 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