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. 2022 Mar;24(3):246-254.
doi: 10.1111/jch.14399. Epub 2022 Feb 24.

Hypertension continuum of care: Blood pressure screening, diagnosis, treatment, and control in a population-based cohort in Haiti

Miranda Metz  1 , Jean Lookens Pierre  2 , Lily Du Yan  1   3 , Vanessa Rouzier  2   3 , Stephano St-Preux  2 , Serfine Exantus  2 , Fabyola Preval  2 , Nicholas Roberts  1 , Olga Tymejczyk  4 , Rodolphe Malebranche  5 , Marie Marcelle Deschamps  2 , Jean W Pape  2 , Margaret L McNairy  1   3
Affiliations

Hypertension continuum of care: Blood pressure screening, diagnosis, treatment, and control in a population-based cohort in Haiti

Miranda Metz et al. J Clin Hypertens (Greenwich). 2022 Mar.

Abstract

Cardiovascular disease (CVD) is the number one cause of death in low-income countries including Haiti, with hypertension (HTN) being the leading risk factor. This study aims to identify gaps in the HTN continuum of screening, diagnosis, treatment, and blood pressure (BP) control. Sociodemographic and clinical data were collected from a population-based sample of adults ≥18 years in Port-au-Prince (PAP) from March 2019 to April 2021. HTN was defined as systolic BP ≥ 140 mmHg, diastolic BP ≥ 90 mmHg, or use of antihypertensive medication. Screening was defined as ever having had a BP measurement; diagnosis as previously being informed of a HTN diagnosis; treatment as having taken antihypertensives in the past 2 weeks; and controlled as taking antihypertensives and having BP < 140/90 mmHg. Factors associated with attaining each step in the continuum were assessed using Poisson multivariable regressions. Among 2737 participants, 810 (29% age-standardized) had HTN, of whom 97% had been screened, 72% diagnosed, 45% treated, and 13% controlled. There were no significant differences across age groups or sex. Obesity (BMI ≥ 30) was a significant factor associated with receiving treatment compared to normal weight (BMI < 25), with a prevalence ratio (PR) of 1.5 (95% CI 1.1-2.0). Having secondary or higher education was associated with higher likelihood of controlled BP (PR 1.9 [95% CI 1.1-3.3]). In this urban Haitian population, the greatest gaps in HTN care are treatment and control. Targeted interventions are needed to improve these steps, including broader access to affordable treatment, timely distribution of medications, and patient adherence to HTN medication.

Trial registration: ClinicalTrials.gov NCT03892265.

Keywords: Haiti; cardiovascular disease; continuum of care; hypertension.

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Conflict of interest statement

None.

Figures

FIGURE 1
FIGURE 1
Hypertension care continuum for Haitian adults in the Haiti CVD cohort. Percentage of participants who have been screened, diagnosed, treated, and controlled among all individuals with HTN (N = 810)
FIGURE 2
FIGURE 2
Conditional proportions of attaining each step in the hypertension care continuum among Haitian adults with hypertension (N = 810)
FIGURE 3
FIGURE 3
Cumulative hypertension care continuum by sex. Percentage of female (N = 516) and male (N = 294) participants with hypertension who have been screened, diagnosed, treated, and controlled
FIGURE 4
FIGURE 4
Cumulative hypertension care continuum by age category. Percentage of participants with hypertension (N = 810) who have been screened, diagnosed, treated, and controlled by age category
See this image and copyright information in PMC

References

    1. Davies JI, Reddiar SK, Hirschhorn LR, et al. Association between country preparedness indicators and quality clinical care for cardiovascular disease risk factors in 44 lower‐ and middle‐income countries: a multicountry analysis of survey data. PLoS Med. 2020;17(11):e1003268. - PMC - PubMed
    1. Odland ML, Bockarie T, Wurie H, et al. Prevalence and access to care for cardiovascular risk factors in older people in Sierra Leone: a cross‐sectional survey. BMJ Open. 2020;10(9):e038520. - PMC - PubMed
    1. Akl C, Akik C, Ghattas H, Obermeyer CM. The cascade of care in managing hypertension in the Arab world: a systematic assessment of the evidence on awareness, treatment and control. BMC Public Health. 2020;20(1):835. - PMC - PubMed
    1. Chow CK, Gupta R. Blood pressure control: a challenge to global health systems. Lancet. 2019;394(10199):613–615. - PubMed
    1. Attaei MW, Khatib R, Mckee M. Availability and affordability of blood pressure‐lowering medicines and the effect on blood pressure control in high‐income, middle‐income, and low‐income countries: an analysis of the PURE study data. Lancet Public Health. 2017;2(9):e411‐e419. - PubMed

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