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Care Cascades for Hypertension in Low-Income Settings: A Systematic Review and Meta-Analysis

Demetrio Lamloum1,2, Federico Fassio3, Brianna Osetinsky4,5

  • 1Department of Preventive, Restorative and Pediatric Dentistry, University of Bern, Bern, Switzerland.

International Journal of Public Health
|October 30, 2023
PubMed

Insights

Hypertension care cascade (HCC) is less effective in low-income countries (LICs). This review shows lower awareness, treatment, and control of high blood pressure in LICs, highlighting the need for tailored interventions.

Area of Science:

  • Cardiovascular Disease Epidemiology
  • Global Health Interventions
  • Health Systems Research

Background:

  • High blood pressure is a primary risk factor for cardiovascular disease globally.
  • The hypertension care cascade (HCC) framework assesses the continuum of care for hypertension management.
  • Evaluating HCC in low-income settings is crucial for improving cardiovascular health outcomes.

Approach:

  • Systematic review of studies published between January 2010 and April 2023.
  • Inclusion criteria focused on complete HCC data in adult populations, excluding reviews and studies on fragile patients.
  • Data extraction and quality assessment using MOOSE guidelines and JBI Critical Appraisal Tools.

Key Points:

  • Analyzed 95 articles, revealing an average hypertension prevalence of 33%, with lower rates in low-income countries (LICs) compared to lower-middle-income countries (LMICs).
  • Overall hypertension awareness was 48%, treatment 35%, and control 16%, with significantly lower percentages observed in LICs and Sub-Saharan Africa.
  • Performance across all stages of the HCC was notably poorer in LICs.

Conclusions:

  • Hypertension care cascade performance varies significantly across different countries.
  • Low-income settings demonstrate poorer outcomes in hypertension awareness, treatment, and control.
  • There is a critical need for developing and implementing interventions specifically designed for low-income settings to enhance hypertension care.

Keywords:
care cascadehypertension (HTN)low income country (LIC)lower-middle income country (LMIC)prevalence

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