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Progress, stasis, and regression through the hypertension care continuum: Longitudinal evidence from population-based cohort data in four populous middle-income countries

Nicole Mauer, Heidelberg Institute of Global Health
Pascal Geldsetzer, Stanford University
Jennifer Manne, Harvard University
Justine Davies, University of Birmingham
Andrew Stokes, Boston University
Margaret McConnell, Harvard School of Public Health
Mohammed Ali, Emory University
Volker Winkler, Heidelberg Institute of Global Health
Nikkil Sudharsanan, Heidelberg University

Improving hypertension control is a major population challenge in middle-income countries (MICs). While managing hypertension is a highly dynamic process, current evidence on hypertension control gaps used for informing policy in MICs is largely based on cross-sectional data. Using multiple waves of population-based cohort data from China, Indonesia, Mexico, South Africa, we provide the first longitudinal investigation of hypertension care gaps in MICs. We classified adults aged 40+ (N=8359) into 4 care stages (undiagnosed; diagnosed and untreated; diagnosed, treated, but uncontrolled; diagnosed, treated, and controlled) and estimated the probability of transitioning between stages over time using Poisson regression models. Over a 5- to 9-year follow-up, fewer than 33% of individuals became diagnosed and those that were diagnosed were unlikely to initiate treatment. Importantly, there were very high probabilities of regressing backwards through care stages: up to three in four individuals discontinued treatment and nearly all previously controlled individuals lost blood pressure control. Adopting a dynamic perspective reveals that policies solely aimed at improving diagnosis or initiating treatment may not lead to long-term hypertension control improvements in MICs. Our results call attention to improving retention in care and adherence to therapy as necessary first steps for achieving population-wide hypertension control.

Keywords: Cross-country comparative analyses, Longitudinal studies, Panel studies, Policy

See paper.

  Presented in Session 181. Trajectories in Multimorbidity