Addressing the diagnostic gap in hypertension through possible interventions and scale-up: A microsimulation study

Area of Science:

• Public Health
• Epidemiology
• Health Economics

Background:

• Cardiovascular diseases (CVDs) are the leading global cause of mortality, with 80% of deaths occurring in low- and middle-income countries (LMICs).
• Hypertension (HTN) is the primary modifiable risk factor for CVD, yet its diagnosis and management remain suboptimal in LMICs.
• The comparative effectiveness of interventions to improve HTN screening accuracy, reach, and completion has not been fully estimated.

Purpose of the Study:

• To estimate the impact of different hypertension screening strategies on HTN-induced morbidity and mortality in LMICs.
• To compare the effectiveness of improved diagnostic accuracy, increased screening coverage, and enhanced screening completion using digital tools.
• To provide evidence for optimizing public health interventions for hypertension management in resource-limited settings.

Main Methods:

• A microsimulation study using nationally representative individual-level data and global burden of disease data.
• Modeling four scenarios: lower diagnostic accuracy (S1), improved diagnostic accuracy (S2), increased screening reach (S3), and enhanced screening completion with digital tools (S4), compared to standard care (S0).
• Investigating the impact on morbidity and mortality over a 10-year period for a population with 31% HTN prevalence, 60% undiagnosed.

Main Results:

• Improving diagnostic accuracy alone could prevent 0.6% of HTN-induced deaths over 10 years.
• Increasing screening coverage and completion could prevent approximately 40 million (12.7%) HTN-induced deaths within the same timeframe.
• Doubling screening coverage alone could prevent over 3.3 million (12.1%) CVD events in 10 years.

Conclusions:

• While improving diagnostic accuracy is beneficial, enhancing screening coverage and completion is significantly more impactful for reducing HTN-related deaths in LMICs.
• Emphasis should be placed on implementation strategies that increase the reach and completion rates of blood pressure screening.
• Wider adoption of user-friendly tools, like automated digital blood pressure devices, can facilitate better screening completion.