Longitudinal evidence on treatment discontinuation, adherence, and loss of hypertension control in four middle-income countries
Managing hypertension is a highly dynamic process, yet current evidence on hypertension control in middle-income countries (MICs) is largely based on cross-sectional data. Using multiple waves of population-based cohort data from four MICs (China, Indonesia, Mexico, and South Africa), we undertook a...
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| Main Authors: | , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
6 July 2022
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| In: |
Science translational medicine
Year: 2022, Volume: 14, Issue: 652, Pages: 1-12 |
| ISSN: | 1946-6242 |
| DOI: | 10.1126/scitranslmed.abi9522 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1126/scitranslmed.abi9522 Verlag, lizenzpflichtig, Volltext: https://www.science.org/doi/10.1126/scitranslmed.abi9522 
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| Author Notes: | Nicole Mauer, Pascal Geldsetzer, Jennifer Manne-Goehler, Justine I. Davies, Andrew C. Stokes, Margaret McConnell, Mohammed K. Ali, Volker Winkler, Nikkil Sudharsanan |
| Summary: | Managing hypertension is a highly dynamic process, yet current evidence on hypertension control in middle-income countries (MICs) is largely based on cross-sectional data. Using multiple waves of population-based cohort data from four MICs (China, Indonesia, Mexico, and South Africa), we undertook a longitudinal investigation into how individuals with hypertension move through care over time. We classified adults aged 40 years and over (N = 8527) into care stages at both baseline and follow-up waves and estimated the probability of transitioning between stages using Poisson regression models. Over a 5- to 9-year follow-up period, only around 30% of undiagnosed individuals became diagnosed [Mexico, 27% (95% confidence interval: 23%, 31%); China, 30% (26%, 33%); Indonesia, 30% (28%, 32%); and South Africa, 36% (31%, 41%)], and one in four untreated individuals became treated [Indonesia, 11% (10%, 12%); Mexico, 24% (20%, 28%); China, 26% (23%, 29%); and South Africa, 33% (29%, 38%)]. The probability of reaching blood pressure (BP) control was lower [Indonesia, 2% (1%, 2%); China, 9% (7%, 11%); Mexico, 12% (9%, 14%); and South Africa, 24% (20%, 28%)] regardless of treatment status. A substantial proportion of individuals discontinued treatment [Indonesia, 70% (67%, 73%); China, 36% (32%, 40%); Mexico, 34% (29%, 39%); and South Africa, 20% (15%, 25%)], and most individuals lost BP control by follow-up [Indonesia, 92% (89%, 96%); Mexico, 77% (71%, 83%); China, 76% (69%, 83%); and South Africa 45% (36%, 54%)]. Our results highlight that policies solely aimed at improving diagnosis or initiating treatment may not lead to long-term hypertension control improvements in MICs. |
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| Item Description: | Gesehen am 21.02.2023 |
| Physical Description: | Online Resource |
| ISSN: | 1946-6242 |
| DOI: | 10.1126/scitranslmed.abi9522 |