¿Qué representa cambiar el umbral diagnóstico de la hipertensión arterial? Guías ACC/AHA 2017 y su aplicación en Perú

Hernández-Vasquéz, Akram; Rojas‐Roque, Carlos; Santero, Marilina; Maza, Juan Carlos Ruiz; Casas-Bendezú, Mixsi; Miranda, J. Jaime

doi:10.4067/s0034-98872019000500545

Cited by 19 publications

(14 citation statements)

References 23 publications

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“…This is in addition to the 1.5 million hypertensive adults currently untreated according to the current (JNC 7) guideline. The relative increase of about 55% in hypertension prevalence as a result of adopting the 2017 ACC/AHA guideline seems to be higher in Chile than those estimated (using similar methods) in the United States (27%), China (45%) and Spain (42%) [11,12], but lower than in Peru (130%) [26]. The definitions in the Peruvian study were based on high BP alone, however, and so is not strictly comparable with our findings.…”

Section: Discussioncontrasting

confidence: 91%

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

Passi-Solar

Margozzini

Mindell

et al. 2020

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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

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Section: Discussioncontrasting

confidence: 91%

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

Passi-Solar

Margozzini

Mindell

et al. 2020

Preprint

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“…Likewise, given the differences between the first and second blood pressure measurements in the ENDES, it would be important to have a third measurement. On the other hand, if the American College of Cardiology/American Heart Association 2017 guidelines are applied, it is expected that the prevalence of hypertension and undiagnosed hypertension will increase significantly [ 59 ]. However, the authors consider that the use of a nationally representative database allows the study of a highly prevalent problem such as hypertension, as well as identification of the factors associated with the non-diagnosis of this chronic condition, and consider these findings useful from the Peruvian and global perspective, to continue with the study of the non-diagnosis of hypertension and its related factors.…”

Section: Discussionmentioning

confidence: 99%

Undiagnosed hypertension in Peru: analysis of associated factors and socioeconomic inequalities, 2019

Guerrero-Díaz

Hernández-Vasquéz

Montoya-Rivera

et al. 2021

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To determine the factors associated and measure the socioeconomic inequalities in people with undiagnosed hypertension in Peru. Materials and methods: An observational, cross-sectional, analytical study was performed using data from the 2019 Demographic and Family Health Survey (ENDES, acronym in Spanish) database. The dependent variable was the presence of undiagnosed hypertension (mean systolic blood pressure !140 mmHg and/or mean diastolic blood pressure !90 mmHg in the two blood pressure measurements and with no prior diagnosis of hypertension by a health care professional). Adjusted prevalence ratios were estimated to determine the factors associated with undiagnosed hypertension. The socioeconomic inequality in undiagnosed hypertension was estimated using concentration curves and the Erreygers concentration index. Results: 67.2% of 3697 persons with hypertension had not been diagnosed. Non-diagnosis of hypertension was more prevalent in men who were residents of the Coast and in inhabitants residing at more than 3000 m above sea level. Being 50 years of age or older, having health insurance, being obese and having diabetes mellitus were associated with a lower prevalence of undiagnosed hypertension. Inequality of the non-diagnosis of hypertension was found to be concentrated in the poorest population. Conclusions: At least one out of every two adult Peruvians with hypertension have not been diagnosed with this condition. Socioeconomic inequality was found, as well as socio-demographic and health-related factors associated with undiagnosed hypertension. Our findings identify some population subgroups in which interventions for screening and treatment of hypertension should be prioritized in order to reduce both inequalities and complications of hypertension among the most vulnerable.

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“…A national report revealed that hypertension prevalence increased by 0.8 percentage points in the period 2017-2018 [7]. Moreover, the novel cut-off for diagnosis (ACC/AHA 2017, 130/80 mmHg) notably increases the prevalence of hypertension in 18.5 percentage points in comparison with the traditional cut-off (JNC 7, 140/90 mmHg) [8]. This LMIC presents worrying rates of disparities in socioeconomic determinants.…”

Section: Introductionmentioning

confidence: 99%

Socioeconomic determinants of hypertension and prehypertension in Peru: Evidence from the Peruvian Demographic and Health Survey

et al. 2021

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Background Peru is a Latin American country with a significant burden of hypertension that presents worrying rates of disparities in socioeconomic determinants. However, there is a lack of studies exploring the association between those determinants, hypertension and prehypertension in Peruvian population. Objective We aimed to assess the association betwgeen socioeconomic determinants, hypertension and prehypertension using a nationally representative survey of Peruvians. Methods We performed a cross-sectional analysis of the Peruvian Demographic and Health Survey (2018), which is a two-staged regional-level representative survey. We used data from 33,336 people aged 15 and older. The dependent variable was blood pressure classification (normal, prehypertension and hypertension) following the Seventh Report of the Joint National Committee (JNC-7) on hypertension management. Independent variables were socioeconomic: age, sex, marital status, wealth index, health insurance, education, region and area of residence. Due to the nature of the dependent variable (more than two categories), we opted to use the multinomial regression model, adjusting the effect of the multistage sample using the svy command. We tested interactions with the adjusted Wald test. Results The prevalence of prehypertension and hypertension was 33.68% and 19.77%, respectively. Awareness was higher in urban than in rural areas (9.61% vs. 8.31%, p = 0.008). Factors associated with a higher prevalence ratio of both prehypertension and hypertension were age (ratios rose with each age group), male sex (prehypertension aRPR 5.15, 95%CI 4.63–5.73; hypertension aRPR 3.85, 95% CI 3.37–4.40) and abdominal obesity (prehypertension aRPR 2.11, 95%CI 1.92–2.31; hypertension aRPR 3.04, 95% CI 2.69–3.43). Factors with a lower prevalence ratio of both diseases were secondary education (prehypertension aRPR 0.76, 95%CI 0.60–0.95; hypertension aRPR 0.75, 95% CI 0.58–0.97), higher education (prehypertension aRPR 0.78, 95%CI 0.61–0.99; hypertension aRPR 0.62, 95% CI 0.46–0.82), being married/cohabiting (prehypertension aRPR 0.87, 95%CI 0.79–0.95; hypertension aRPR 0.77, 95% CI 0.68–0.87), richest wealth index (only prehypertension aRPR 0.76, 95%CI 0.63–0.92) and living in cities different to Lima (rest of the Coastline, Highlands and Jungle). Having health insurance (only hypertension aRPR 1.26, 95%CI 1.03–1.53) and current drinking (only prehypertension aRPR 1.15, 95%CI 1.01–1.32) became significant factors in rural areas. Conclusions We evidenced socioeconomic disparities among people with hypertension and prehypertension. Better health policies on reducing the burden of risk factors are needed, besides, policy decision makers should focus on hypertension preventive strategies in Peru.

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¿Qué representa cambiar el umbral diagnóstico de la hipertensión arterial? Guías ACC/AHA 2017 y su aplicación en Perú

Cited by 19 publications

References 23 publications

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

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

Undiagnosed hypertension in Peru: analysis of associated factors and socioeconomic inequalities, 2019

Socioeconomic determinants of hypertension and prehypertension in Peru: Evidence from the Peruvian Demographic and Health Survey

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