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Hypertension Care Cascades and Reducing Inequities in Cardiovascular Disease in Low- and Middle-Income Countries Publisher Pubmed



Stein DT1 ; Reitsma MB2 ; Geldsetzer P3, 4 ; Agoudavi K5 ; Aryal KK6, 7 ; Bahendeka S8, 9 ; Brant LCC10 ; Farzadfar F11 ; Gurung MS12 ; Guwatudde D13 ; Houehanou YCN14 ; Malta DC15 ; Martins JS16 ; Saeedi Moghaddam S17, 18 Show All Authors
Authors
  1. Stein DT1
  2. Reitsma MB2
  3. Geldsetzer P3, 4
  4. Agoudavi K5
  5. Aryal KK6, 7
  6. Bahendeka S8, 9
  7. Brant LCC10
  8. Farzadfar F11
  9. Gurung MS12
  10. Guwatudde D13
  11. Houehanou YCN14
  12. Malta DC15
  13. Martins JS16
  14. Saeedi Moghaddam S17, 18
  15. Mwangi KJ19, 20
  16. Norov B21
  17. Sturua L22, 23
  18. Zhumadilov Z24
  19. Barnighausen T25, 26, 27
  20. Davies JI28, 29
  21. Flood D30, 31
  22. Marcus ME32, 33
  23. Theilmann M25, 34
  24. Vollmer S35
  25. Mannegoehler J36, 37
  26. Atun R1, 38
  27. Sudharsanan N25, 34
  28. Verguet S1

Source: Nature Medicine Published:2024


Abstract

Improving hypertension control in low- and middle-income countries has uncertain implications across socioeconomic groups. In this study, we simulated improvements in the hypertension care cascade and evaluated the distributional benefits across wealth quintiles in 44 low- and middle-income countries using individual-level data from nationally representative, cross-sectional surveys. We raised diagnosis (diagnosis scenario) and treatment (treatment scenario) levels for all wealth quintiles to match the best-performing country quintile and estimated the change in 10-year cardiovascular disease (CVD) risk of individuals initiated on treatment. We observed greater health benefits among bottom wealth quintiles in middle-income countries and in countries with larger baseline disparities in hypertension management. Lower-middle-income countries would see the greatest absolute benefits among the bottom quintiles under the treatment scenario (29.1 CVD cases averted per 1,000 people living with hypertension in the bottom quintile (Q1) versus 17.2 in the top quintile (Q5)), and the proportion of total CVD cases averted would be largest among the lowest quintiles in upper-middle-income countries under both diagnosis (32.0% of averted cases in Q1 versus 11.9% in Q5) and treatment (29.7% of averted cases in Q1 versus 14.0% in Q5) scenarios. Targeted improvements in hypertension diagnosis and treatment could substantially reduce socioeconomic-based inequalities in CVD burden in low- and middle-income countries. © The Author(s), under exclusive licence to Springer Nature America, Inc. 2024.
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