Implementation of a community‐based hypertension control program in Matanzas, Cuba

Abstract

Increased blood pressure is a leading risk factor for death worldwide, and improving the control of hypertension is a major health goal to reduce non‐communicable disease. Thus, in 2016, as part of a regional effort between the Pan American Health Organization and Cuban Ministry of Public Health to reduce cardiovascular risk and disease, a community demonstration project was implemented to enhance hypertension control. The intervention project was in a population of 25 868 people served by the Carlos Verdugo Martínez Polyclinic in Matanzas, Cuba. The project implemented interventions currently recommended in the World Health Organization HEARTS modules, including a standardized clinical training program with certification for blood pressure measurement, routine screening for hypertension in clinics and in the community, a simple directive pharmacologic treatment algorithm, and a registry with performance reporting and feedback. Qualitative and quantitative program monitoring and evaluation was established. In a 2010 national survey, the prevalence of hypertension and the rate of hypertension control were estimated to be 31% and 36%, respectively. Following less than one year of the full implementation of the program, the prevalence of hypertension, proportion of the hypertensive population registered as having hypertension, proportion of those drug‐treated who were controlled, and estimated population rate of control were 30%, 90%, 68%, and 58%, respectively. Based on these positive results, the program has been expanded to include another demonstration program initiated in a second region. In addition, preliminary efforts to disseminate and scale‐up aspects of the program to the full Cuban population have started.

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“…Along with theses key interventions, this Region and particularly its most vulnerable economies can benefit significantly with more aggressive measures to reduce tobacco use and to overturn the obesity epidemic. Indeed, 12 countries of the Americas, supported by PAHO/WHO, CDC, RTSL, and World Hypertension League among other partners, are already implementing HEARTS, an innovative model which seeks to integrate effective public policies and interventions smoothly and progressively into already existing health delivery services to promote the adoption of global best practices in the prevention and control of CVD and improve the performance of the services through better control of hypertension and the promotion of CVD secondary prevention with emphasis on primary health care 40,41 …”

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“…26,34 Implementation of the interventions in HEARTS has been associated with hypertension control rates as high as 90% in clinics and in Cuba a doubling of population hypertension control in just 1 year. 32,35 Canadian health care professionals, and specifically pharmacists, working collaboratively with other health care providers can play a critical role in enhancing hypertension control, especially in older women. There are more than 10,000 pharmacies and 43,000 pharmacists in Canadian communities.…”

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“…In addition, preliminary efforts to disseminate and scale-up aspects of the program to the full Cuban population have started. 40 Since blood pressure is the intermediate phenotype of the hypertensive individual and most treatment decisions according to all hypertension guidelines is based on the blood pressure level, the accurate measurement of the blood pressure is critical. Patient preparation and the proper blood pressure technique is essential.…”