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Review
. 2017 Feb;35(1):99-115.
doi: 10.1016/j.ccl.2016.08.010.

Innovative Approaches to Hypertension Control in Low- and Middle-Income Countries

Rajesh Vedanthan  1 , Antonio Bernabe-Ortiz  2 , Omarys I Herasme  3 , Rohina Joshi  4 , Patricio Lopez-Jaramillo  5 , Amanda G Thrift  6 , Jacqui Webster  4 , Ruth Webster  4 , Karen Yeates  7 , Joyce Gyamfi  8 , Merina Ieremia  9 , Claire Johnson  4 , Jemima H Kamano  10 , Maria Lazo-Porras  2 , Felix Limbani  11 , Peter Liu  12 , Tara McCready  13 , J Jaime Miranda  2 , Sailesh Mohan  14 , Olugbenga Ogedegbe  8 , Brian Oldenburg  15 , Bruce Ovbiagele  16 , Mayowa Owolabi  17 , David Peiris  4 , Vilarmina Ponce-Lucero  2 , Devarsetty Praveen  18 , Arti Pillay  19 , Jon-David Schwalm  13 , Sheldon W Tobe  20 , Kathy Trieu  4 , Khalid Yusoff  21 , Valentin Fuster  3
Affiliations
Review

Innovative Approaches to Hypertension Control in Low- and Middle-Income Countries

Rajesh Vedanthan et al. Cardiol Clin. 2017 Feb.

Abstract

Elevated blood pressure, a major risk factor for ischemic heart disease, heart failure, and stroke, is the leading global risk for mortality. Treatment and control rates are very low in low- and middle-income countries. There is an urgent need to address this problem. The Global Alliance for Chronic Diseases sponsored research projects focus on controlling hypertension, including community engagement, salt reduction, salt substitution, task redistribution, mHealth, and fixed-dose combination therapies. This paper reviews the rationale for each approach and summarizes the experience of some of the research teams. The studies demonstrate innovative and practical methods for improving hypertension control.

Keywords: Community engagement; Hypertension; Low- and middle-income countries; Polypill; Salt reduction; Salt substitution; Task redistribution; mHealth.

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Figures

Figure 1
Figure 1
Community engagement activities undertaken within GACD Projects. Participation activities denote the least level of engagement while empowerment activities denote the greatest level of engagement.
Figure 2
Figure 2
Framework for salt reduction strategies, including context, activities, outputs, and anticipated outcomes.
Figure 3
Figure 3
Launching a salt substitute to reduce blood pressure at the population level in Peru, divided into two phases.
Figure 4
Figure 4
The process of task-redistribution for the management of hypertension adapted from the WHO’s recommendations on task-shifting. From World Health Organization, PEPFAR, UNAIDS. Task shifting: rational redistribution of tasks among health workforce teams : global recommendations and guidelines. http://www.who.int/healthsystems/TTR-TaskShifting.pdf, 2016, with permission.
Figure 5
Figure 5
Proportion of participants adherent to combination therapy at end of study in patients either with established CVD or at high calculated risk. Adherence is defined as taking antiplatelet, statin and ≥ 2 BP-lowering drugs at least 4 days of the last 7 at end of study in UMPIRE, Kanyini-GAP and IMPACT. Adherence in the FOCUS trial was defined as pill count between 80 and 110% at end of study plus a score of 20/20 on the Morisky-Green questionnaire. Data from references , , , .
Figure 6
Figure 6
Schematic illustrating the potential for mHealth to connect clinicians, community health workers (CHWs), and patients. Blue arrows indicate direct interactions among individuals. Red arrows indicate interactions that are facilitated by mHealth.
See this image and copyright information in PMC

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