Cardiovascular risk assessment in low-resource settings: a consensus document of the European Society of Hypertension Working Group on Hypertension and Cardiovascular Risk in Low Resource Settings

Abstract

The Global Burden of Diseases, Injuries, and Risk Factors Study 2010 confirms ischemic heart disease and stroke as the leading cause of death and that hypertension is the main associated risk factor worldwide. How best to respond to the rising prevalence of hypertension in resource-deprived settings is a topic of ongoing public-health debate and discussion. In low-income and middle-income countries, socioeconomic inequality and cultural factors play a role both in the development of risk factors and in the access to care. In Europe, cultural barriers and poor communication between health systems and migrants may limit migrants from receiving appropriate prevention, diagnosis, and treatment. To use more efficiently resources available and to make treatment cost-effective at the patient level, cardiovascular risk approach is now recommended. In 2011, The European Society of Hypertension established a Working Group on 'Hypertension and Cardiovascular risk in low resource settings', which brought together cardiologists, diabetologists, nephrologists, clinical trialists, epidemiologists, economists, and other stakeholders to review current strategies for cardiovascular risk assessment in population studies in low-income and middle-income countries, their limitations, possible improvements, and future interests in screening programs. This report summarizes current evidence and presents highlights of unmet needs.

FIGURE 1

Diagnosis of hypertension (SBP ≥140 mmHg and/or diastolic blood pressure ≥90 mm Hg and/or self-reported use of antihypertensive drugs at the time of the interview) performed on the basis of measurements taken at the first visit (visit 1), at the second visit (visit 2), or both. The number of individuals with and without the condition and age-weighted rates are reported . CI, confidence interval.

FIGURE 2

Venn diagram showing the amount of overlap between hypertension, diabetes, and proteinuria separately for the individuals from the urban (n = 4390) and rural area (n = 4775). Data are expressed as percentage of urban or rural individuals, the absolute number being reported in brackets .