Standardized treatment to improve hypertension control in primary health care: The HEARTS in the Americas Initiative

DiPette, Donald J.; Goughnour, Kenneth; Zúñiga, Eduardo Contreras; Skeete, Jamario; Ridley, Emily; Angell, Sonia Y.; Brettler, Jeffrey W.; Campbell, Norm R.C.; Coca, Antionio; Connell, Kenneth; Doon, Rohit; Jaffe, Marc G.; López‐Jaramillo, Patricio; Moran, Andrew E.; Orías, Marcelo; Piñeiro, Daniel; Rosende, Andrés; González, Yamilé Valdés; Ordúñez, Pedro

doi:10.1111/jch.14072

Cited by 38 publications

(37 citation statements)

References 20 publications

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“…• In 2018, the evidence-based protocol module of the WHO HEARTS technical package was released and presented an algorithmic approach to managing hypertension in primary care settings. The module consists of a few possible algorithms endorsed by prominent societies including the World Heart Federation, International Society for Hypertension, and the World Hypertension League [50,51]. • In 2019, single-pill anti-hypertensive drug combinations were listed on the WHO Essential Medicine's list [24].…”

Section: New Guidelines and Recommendationsmentioning

confidence: 99%

“…In the future, this shift toward preferred antihypertensive medications has the potential to drive down medication prices across the region. In addition, the program successfully improved anti-hypertension formularies and established national pharmacologic treatment protocols [ 51 ]. The programme has already led to rapid and significant increases in hypertension control rates [ 130 ].…”

Section: Focus Areas Barriers and Enablers To Scale Up Recommendationsmentioning

confidence: 99%

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World Heart Federation Roadmap for Hypertension – A 2021 Update

et al. 2021

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screening and of out-of-office blood pressure measurements; the strengthening of primary care and a greater focus on task sharing and team-based care; the delivery of people-centred care and stronger patient and carer education; and the facilitation of adherence to treatment. All of the above are dependent upon the availability and effective distribution of good quality, evidencebased, inexpensive BP-lowering agents.

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Section: New Guidelines and Recommendationsmentioning

confidence: 99%

Section: Focus Areas Barriers and Enablers To Scale Up Recommendationsmentioning

confidence: 99%

World Heart Federation Roadmap for Hypertension – A 2021 Update

et al. 2021

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“…The HEARTS initiative in the Americas implements a population-based standardized hypertension treatment protocol with the use of two antihypertensive medications, preferably with a fixed-dose combination. 9 Also, the HOPE-4 study conducted in Colombia and Malaysia, included a community-based intervention on the education of the population and on improving the availability of antihypertensive medication. This achieved a doubling of BP control compared to standard management (69.0% vs. 30.0%; P < 0.0001).…”

Section: Discussionmentioning

confidence: 99%

“… 10 These two studies included excellent examples of feasible interventions that can be carried out in our countries. 9 , 10 Some limitations of the MMM study include the screenee recruitment method that was carried out by convenience, which is likely to generate a selection bias and a non-representative national sample. However, when compiling MMM Colombia data from the last 3 years, including more than 100 000 screenees the results are very consistent.…”

Section: Discussionmentioning

confidence: 99%

May Measurement Month 2019: an analysis of blood pressure screening results from Colombia

López‐Jaramillo¹,

López‐López²,

Otero³

et al. 2021

European Heart Journal Supplements

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Hypertension awareness and control is poor in low- and middle-income countries. Thus, implementing strategies to increase hypertension detection is needed. Colombia participated as one of the 92 countries involved in the third campaign of the May Measurement Month in 2019. Blood pressure (BP) was measured in 48 324 volunteers from 13 departments in Colombia. In total, 27.9% individuals were identified with hypertension. Of those with hypertension, 63.7% were aware of their condition, 60.0% were on antihypertensive medication, and 38.4% had controlled BP. These results showed low levels of awareness, treatment, and control of hypertension in this sample of subjects volunteered to participate, suggest the urgent necessity of implementing programmes to improve the diagnosis and management of hypertension in Colombia.

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“…Based on superior efficacy, treatment efficiency popularity among prescribers, availability and potential cost-effectiveness of SPCs, India may wish to consider inclusion of select antihypertensive SPCs in the national EML to extend their benefits to the public health system. Experiences from other parts of the world, such as the HEARTS in the Americas program in Latin America and the Caribbean, have demonstrated the acceptance and feasibility of standardized antihypertensive treatment protocols with the use of two-medication combination therapy in the initial treatment of newly diagnosed individuals with hypertension [ 12 13 ].…”

mentioning

confidence: 99%

Research Letter: Antihypertensive Drugs Market in India: An Insight on Size, Trends, and Prescribing Preferences in the Private Health Sector, 2016–2018

et al. 2021

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Background: India has a high burden of hypertension. While the private sector provides 70% of out-patient care in the country, a significant proportion of patients seeking care from the public sector buy drugs from private markets. This study aimed to describe India’s private sector antihypertensive drugs market at the national and state levels over 2016–2018. Methods: Antihypertensive drugs sales in India from 2016–2018 were analysed using a large nationally representative dataset for the private pharmaceuticals market. In addition, data for five states (Punjab, Madhya Pradesh, Kerala, Telangana, and Maharashtra) that were the foci of a large hypertension control program were studied. Results: The Indian hypertension drug market grew at a rate of 6.9% from 2016 to 2018 with a total of 21,066 million pills sales in 2018. Single-pill combinations (SPCs) contributed to 39.1% of total sale volumes. The market comprised of 182 different antihypertensive drugs including 134 SPCs. Total volume of sales covered a maximum of 26% of treatment need for the estimated population with hypertension. Two-drug SPCs had the highest market share (36%), followed by calcium channel blockers (18%), beta-blockers (16%) and angiotensin receptor blockers (14%). Among SPCs, amlodipine+atenolol had highest sales (9.8%). Twenty-five drugs, a mix of single drugs and SPCs, accounted for 80% of total sales. There were large state-to-state variations in sales per capita, preferred therapeutic classes and drugs. Conclusions: Despite the large antihypertensive drugs market, there exists a high unmet need for treatment in India. Inter-state differences in product sales indicate variable treatment practices, underscoring the need for private sector engagement to improve hypertension care practices aligned with national and international guidelines. SPCs contributed to a large share of the private market and inclusion of select antihypertensive SPCs in the national list of essential medications should be considered for the public health system.

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Standardized treatment to improve hypertension control in primary health care: The HEARTS in the Americas Initiative

Cited by 38 publications

References 20 publications

World Heart Federation Roadmap for Hypertension – A 2021 Update

World Heart Federation Roadmap for Hypertension – A 2021 Update

May Measurement Month 2019: an analysis of blood pressure screening results from Colombia

Research Letter: Antihypertensive Drugs Market in India: An Insight on Size, Trends, and Prescribing Preferences in the Private Health Sector, 2016–2018

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