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

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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 P^{3, 4} ; Agoudavi K⁵ ; Aryal KK^{6, 7} ; Bahendeka S^{8, 9} ; Brant LCC¹⁰ ; Farzadfar F¹¹ ; Gurung MS¹² ; Guwatudde D¹³ ; Houehanou YCN¹⁴ ; Malta DC¹⁵ ; Martins JS¹⁶ ; Saeedi Moghaddam S^{17, 18} Show All Authors

Stein DT¹
Reitsma MB²
Geldsetzer P^{3, 4}
Agoudavi K⁵
Aryal KK^{6, 7}
Bahendeka S^{8, 9}
Brant LCC¹⁰
Farzadfar F¹¹
Gurung MS¹²
Guwatudde D¹³
Houehanou YCN¹⁴
Malta DC¹⁵
Martins JS¹⁶
Saeedi Moghaddam S^{17, 18}
Mwangi KJ^{19, 20}
Norov B²¹
Sturua L^{22, 23}
Zhumadilov Z²⁴
Barnighausen T^{25, 26, 27}
Davies JI^{28, 29}
Flood D^{30, 31}
Marcus ME^{32, 33}
Theilmann M^{25, 34}
Vollmer S³⁵
Mannegoehler J^{36, 37}
Atun R^{1, 38}
Sudharsanan N^{25, 34}
Verguet S¹

Show Affiliations

1. Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
2. Department of Health Policy, Stanford School of Medicine, Stanford University, Stanford, CA, United States
3. Division of Primary Care and Population Health, Stanford University, Stanford, CA, United States
4. Chan Zuckerberg Biohub, San Francisco, CA, United States
5. Noncommunicable Disease Program, Ministry of Health, Lome, Togo
6. Bergen Centre for Ethics and Priority Setting in Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
7. Public Health Promotion and Development Organization, Kathmandu, Nepal
8. MKPGMS-Uganda Martyrs University, Kampala, Uganda
9. St. Francis Hospital, Nsambya, Kampala, Uganda
10. Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
11. Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
12. Policy and Planning Division, Ministry of Health, Thimphu, Bhutan
13. Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
14. National School of Public Health, University of Parakou, Parakou, Benin
15. Department Maternal Child and Public Health, Nursing School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
16. Faculty of Medicine and Health Sciences, Universidade Nacional Timor Lorosaâ€™e, Dili, Timor-Leste
17. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
18. Kiel Institute for the World Economy, Kiel, Germany
19. World Health Organization, Pretoria, South Africa
20. Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
21. Nutrition Department, National Center for Public Health, Ulaanbaatar, Mongolia
22. National Center for Disease Control and Public Health, Tbilisi, Georgia
23. Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
24. School of Medicine, Nazarbayev University, Astana, Kazakhstan
25. Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
26. Harvard Center for Population and Development Studies, Cambridge, MA, United States
27. Africa Health Research Institute, KwaZulu-Natal, South Africa
28. Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
29. Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa
30. Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
31. Center for Indigenous Health Research, Wuquâ€™ Kawoq, Tecpan, Guatemala
32. Brigham and Womenâ€™s Hospital, Boston, MA, United States
33. Harvard Medical School, Boston, MA, United States
34. Professorship of Behavioral Science for Disease Prevention and Health Care, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
35. Department of Economics & Centre for Modern Indian Studies, University of Gottingen, Gottingen, Germany
36. Division of Infectious Diseases, Brigham and Womenâ€™s Hospital, Boston, MA, United States
37. Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
38. Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, United States

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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Style	Citing Format
MLA	Stein DT, et al.. "Hypertension Care Cascades and Reducing Inequities in Cardiovascular Disease in Low- and Middle-Income Countries." Nature Medicine, vol. 30, no. 2, 2024, pp. 414-423.
APA	Stein DT, Reitsma MB, Geldsetzer P, Agoudavi K, Aryal KK, Bahendeka S, Brant LCC, Farzadfar F, Gurung MS, Guwatudde D, Houehanou YCN, Malta DC, Martins JS, Saeedi Moghaddam S, Mwangi KJ, Norov B, Sturua L, Zhumadilov Z, Barnighausen T, ... Verguet S (2024). Hypertension Care Cascades and Reducing Inequities in Cardiovascular Disease in Low- and Middle-Income Countries. Nature Medicine, 30(2), 414-423.
Chicago	Stein DT, Reitsma MB, Geldsetzer P, Agoudavi K, Aryal KK, Bahendeka S, Brant LCC, et al.. "Hypertension Care Cascades and Reducing Inequities in Cardiovascular Disease in Low- and Middle-Income Countries." Nature Medicine 30, no. 2 (2024): 414-423.
Harvard	Stein DT et al. (2024) 'Hypertension Care Cascades and Reducing Inequities in Cardiovascular Disease in Low- and Middle-Income Countries', Nature Medicine, 30(2), pp. 414-423.
Vancouver	Stein DT, Reitsma MB, Geldsetzer P, Agoudavi K, Aryal KK, Bahendeka S, et al.. Hypertension Care Cascades and Reducing Inequities in Cardiovascular Disease in Low- and Middle-Income Countries. Nature Medicine. 2024;30(2):414-423.
BibTex	@article{ author = {Stein DT and Reitsma MB and Geldsetzer P and Agoudavi K and Aryal KK and Bahendeka S and Brant LCC and Farzadfar F and Gurung MS and Guwatudde D and Houehanou YCN and Malta DC and Martins JS and Saeedi Moghaddam S and Mwangi KJ and Norov B and Sturua L and Zhumadilov Z and Barnighausen T and Davies JI and Flood D and Marcus ME and Theilmann M and Vollmer S and Mannegoehler J and Atun R and Sudharsanan N and Verguet S}, title = {Hypertension Care Cascades and Reducing Inequities in Cardiovascular Disease in Low- and Middle-Income Countries}, journal = {Nature Medicine}, volume = {30}, number = {2}, pages = {414-423}, year = {2024} }
RIS	TY - JOUR AU - Stein DT AU - Reitsma MB AU - Geldsetzer P AU - Agoudavi K AU - Aryal KK AU - Bahendeka S AU - Brant LCC AU - Farzadfar F AU - Gurung MS AU - Guwatudde D AU - Houehanou YCN AU - Malta DC AU - Martins JS AU - Saeedi Moghaddam S AU - Mwangi KJ AU - Norov B AU - Sturua L AU - Zhumadilov Z AU - Barnighausen T AU - Davies JI AU - Flood D AU - Marcus ME AU - Theilmann M AU - Vollmer S AU - Mannegoehler J AU - Atun R AU - Sudharsanan N AU - Verguet S TI - Hypertension Care Cascades and Reducing Inequities in Cardiovascular Disease in Low- and Middle-Income Countries JO - Nature Medicine VL - 30 IS - 2 SP - 414 EP - 423 PY - 2024 ER -

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