Gaps in hypertension care and control: a population-based study in low-income urban Medellin, Colombia

Esteban Londoño Agudelo, Viviana Pérez Ospina, Tullia Battaglioli, Cecilia Taborda Pérez, Rubén Gómez-Arias, Patrick Van der Stuyft, Esteban Londoño Agudelo, Viviana Pérez Ospina, Tullia Battaglioli, Cecilia Taborda Pérez, Rubén Gómez-Arias, Patrick Van der Stuyft

Abstract

Objectives: To assess hypertension prevalence and the extent and associated factors of hypertension diagnosis, follow-up, treatment and control gaps in low-income urban Medellin, Colombia.

Methods: We randomly sampled 1873 adults aged 35 or older. Unaware hypertensive individuals were defined as those without previous diagnosis whose average blood pressure was equal to or above 140/90 mmHg. For aware hypertensive patients, control was delimited as average blood pressure below 140/90 if under 59 years old or diabetic, and as less than 150/90 otherwise. We used logistic regression to identify care gap-associated factors.

Results: Hypertension prevalence was 43.5% (95% CI 41.2-45.7). We found 28.2% aware and 15.3% unaware hypertensive individuals, which corresponds to a 35.1% (95% CI 31.9-38.5) underdiagnosis. This gap was determined by age, sex, education and lifestyle factors. 14.4% (95% CI 11.6-17.6) of aware hypertensive patients presented a follow-up gap, 93.4% (95% CI 90.9-95.2) were prescribed antihypertensive drugs, but 38.9% (95% CI 34.7-43.3) were not compliant. The latter was strongly associated with follow-up. The hypertension control gap in aware hypertensive patients, 39.0% (95% CI: 34.9-43.2), was associated with being older, having diabetes, weakly adhering to pharmacological treatment and receiving poor non-pharmacological advice. Overall, 60.4% (95% CI 57.0-63.8) of aware and unaware hypertensive participants had either diagnosed but uncontrolled or undiagnosed hypertension.

Conclusions: We found high hypertension prevalence coupled with, from an international perspective, encouraging awareness and control figures. Still, there remains ample room for improvement. Our findings can assist in designing integrated primary healthcare measures that further strengthen equitable and effective access to hypertension care and control.

Keywords: Colombia; Latin America; cascade of hypertension care; chronic diseases; health care gaps; hypertension awareness; hypertension control; primary health care.

© 2021 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

References

    1. Abbafati C, Machado DB, Cislaghi Bet al. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020: 396: 1223–1249.
    1. Ibrahim MM, Damasceno A. Hypertension in developing countries. Lancet 2012: 380: 611–619.
    1. Zhou B, Bentham J, Di Cesare Met al. Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population‐based measurement studies with 19·1 million participants. Lancet 2017: 389: 37–55.
    1. De Maio FG. Understanding chronic non‐communicable diseases in Latin America: towards an equity‐based research agenda. Global Health. 2011: 7: 36.
    1. Pan American Health Organization . Innovative Care for Chronic Conditions. Organizing and Delivering High Quality Care for Chronic Noncommunicable Diseases in the Americas. Washington D.C.; 2013. (Available from: ) [21 Oct 2020]
    1. Londoño Agudelo E, Rodríguez Salvá A, Díaz Piñera Aet al. Assessment of hypertension management and control: a registry‐based observational study in two municipalities in Cuba. BMC Cardiovasc Disord. 2019: 19: 29.
    1. Chow CK, Teo KK, Rangarajan Set al. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high‐, middle‐, and low‐income countries. JAMA 2013: 310: 959–968.
    1. Camacho PA, Gomez‐Arbelaez D, Molina DIet al. Social disparities explain differences in hypertension prevalence, detection and control in Colombia. J Hypertens. 2016: 34: 2344–2352.
    1. Mills KT, Bundy JD, Kelly TNet al. Global disparities of hypertension prevalence and control. Circulation 2016: 134: 441–450.
    1. Geldsetzer P, Manne‐Goehler J, Marcus MEet al. The state of hypertension care in 44 low‐income and middle‐income countries: a cross‐sectional study of nationally representative individual‐level data from 1·1 million adults. Lancet 2019: 394: 652–662.
    1. Khatib R, Schwalm J‐D, Yusuf Set al. Patient and healthcare provider barriers to hypertension awareness, treatment and follow up: a systematic review and meta‐analysis of qualitative and quantitative studies. PLoS One 2014: 9: e84238.
    1. Abadia CE, Oviedo DG. Bureaucratic Itineraries in Colombia. A theoretical and methodological tool to assess managed‐care health care systems. Soc Sci Med. 2009: 68: 1153–1160.
    1. The World Bank Data. (Available from: ) [23 Oct 2020]
    1. Congreso de la República de Colombia . Ley Número 100 de 1993. Por la cual se crea el sistema de seguridad social integral y se dictan otras disposiciones. Colombia; 1993. (Available from: ) [23 Oct 2020]
    1. Londoño Agudelo E, García Fariñas A, Pérez Ospina Vet al. Out‐of‐pocket expenditure for hypertension care: a population‐based study in low‐income urban Medellin, Colombia. Glob Health Action 2020: 13: 1806527.
    1. Proantioquia y demás instituciones privadas que conforman la iniciativa “Medellín Cómo Vamos.” Informe de Calidad de Vida de Medellín, 2017. Medellín, Colombia; 2018. (Available from: ) [25 Oct 2020]
    1. Alcaldía de Medellín. Perfil sociodemográfico por barrio. Comuna 2 Santa Cruz 2005‐2015. Medellín, Colombia; 2011. (Available from: ) [25 Oct 2020]
    1. Alcaldía de Medellín. Secretaría de Salud. Indicadores Básicos. Situación de Salud en Medellín 2015. Medellín, Colombia; 2015. (Available from: ) [26 Oct 2020]
    1. Ministerio de Salud y Protección Social . Análisis de Situación de Salud. Colombia, 2013. Bogotá, D.C., Colombia; 2014. (Available from: ) [28 Oct 2020]
    1. Alcaldía de Medellín. Perfil Demográfico 2016 ‐ 2020. Medellín, Colombia; 2015. (Available from: Demográfico2016‐2020TotalMedellin.pdf). [28 Oct 2020]
    1. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self‐reported measure of medication adherence. Med Care. 1986: 24: 67–74.
    1. Luepker RV, Evans A, McKeigue P, Reddy KS. Cardiovascular survey methods. Geneva, Switzerland; 2004. (Available from: ) [03 Nov 2020]
    1. Tolonen HEHES Manual Part B. Fieldwork Procedures. Helsinki; 2016. (Available from: ) [03 Nov 2020]
    1. Chobanian AV, Bakris GL, Black HRet al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003: 42: 1206–1252.
    1. James PA, Oparil S, Carter BLet al. Evidence‐based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014: 311: 507–520.
    1. Culig J, Leppée M. From Morisky to Hill‐bone; self‐reports scales for measuring adherence to medication. Coll Antropol. 2014: 38: 55–62.
    1. Lam WY, Fresco P. Medication adherence measures: an overview. Biomed Res Int 2015: 2015: 1–12.
    1. Ben AJ, Neumann CR, Mengue SS. The Brief Medication Questionnaire and Morisky‐Green test to evaluate medication adherence. Rev Saude Publica. 2012: 46: 279–289.
    1. Rodríguez J, Ruiz F, Peñaloza Eet al. Encuesta Nacional de Salud 2007. Resultados Nacionales. Bogotá, Colombia. 2009. (Available from: ) [04 Nov 2020]
    1. Ordunez P, Martinez R, Niebylski ML, Campbell NR. Hypertension prevention and control in Latin America and the Caribbean. J Clin Hypertens 2015: 17: 499–502.
    1. Rubinstein AL, Irazola VE, Calandrelli Met al. Prevalence, awareness, treatment, and control of hypertension in the Southern Cone of Latin America. Am J Hypertens 2016: 29: 1343.
    1. Ruilope LM, Chagas ACP, Brandão AAet al. Hipertensión en América Latina: perspectivas actuales de las tendencias y características. Hipertens y Riesgo Vasc 2017: 34: 50–56.
    1. Zhou B, Danaei G, Stevens GAet al. Long‐term and recent trends in hypertension awareness, treatment, and control in 12 high‐income countries: an analysis of 123 nationally representative surveys. Lancet 2019: 394: 639–651.
    1. Gobierno de Colombia . Ministerio de Salud y Protección Social . Analisis De Situación De Salud (ASIS) Colombia, 2017. 2018. (Available from: ) [12 Nov 2020]
    1. Everett B, Zajacova A. Gender differences in hypertension and hypertension awareness among young adults. Biodemography Soc Biol. 2015: 61: 1–17.
    1. Ofman D, Silvia PG, Iris C, Cófreces P, Stefani D. Estudio de las representaciones sociales de la hipertensión arterial según género. Liberabit. 2015: 21: 59–70.
    1. Ministerio de Salud de Colombia y Profamilia . Encuesta Nacional de Demografía y Salud. Tomo 1. Bogotá, Colombia; 2015. (Available from: ) [12 Nov 2020]
    1. Slama M, Susic D, Frohlich ED. Prevention of hypertension. Curr Opin Cardiol 2002: 17: 531–536.
    1. Olsen MH, Angell SY, Asma Set al. A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: the Lancet Commission on hypertension. Lancet 2016: 388: 2665–2712.
    1. Chadachan VM, Ye MT, Tay JC, Subramaniam K, Setia S. Understanding short‐term blood‐pressure‐variability phenotypes: from concept to clinical practice. Int J Gen Med 2018: 11: 241–254.
    1. Nelson SAE, Dresser GK, Vandervoort MKet al. Barriers to blood pressure control: a STITCH substudy. J Clin Hypertens. 2011: 13: 73–80.
    1. Chowdhury EK, Owen A, Krum Het al. Barriers to achieving blood pressure treatment targets in elderly hypertensive individuals. J Hum Hypertens 2013: 27: 545–551.
    1. Grossman A, Grossman E. Blood pressure control in type 2 diabetic patients. Cardiovasc Diabetol 2017: 16: 3.
    1. Legido‐Quigley H, Camacho Lopez PA, Balabanova Det al. Patients’ knowledge, attitudes, behaviour and health care experiences on the prevention, detection, management and control of hypertension in colombia: a qualitative study. PLoS One 2015: 10: e0122112.
    1. Rodríguez‐López MR, Varela MT, Rincón‐Hoyos VMM, Caicedo DM, Méndez FGO. Prevalencia y factores asociados a la adherencia al tratamiento no farmacológico en pacientes con hipertensión y diabetes en servicios de baja complejidad. Rev Fac Nac Salud Pública 2015: 33: 192–199.
    1. Nulu S. Neglected chronic disease: the WHO framework on non‐communicable diseases and implications for the global poor. Glob. Public Health 2017: 12: 396–415.
    1. Clark J. Medicalization of global health 1: Has the global health agenda become too medicalized? Glob Health Action. 2014: 7(SUPP.1): 23998.
    1. Hedayati SS, Elsayed EF, Reilly RF. Non‐pharmacological aspects of blood pressure management: what are the data? Kidney Int 2011: 79: 1061–1070.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner