Gaps in hypertension care and control: a population‐based study in low‐income urban Medellin, Colombia

Abstract

Objectives To assess hypertension prevalence and the extent and associated factors of hypertension diagnosis, follow‐up, treatment and control gaps in low‐income urban Medellin, Colombia. Methods We randomly sampled 1873 adults aged 35 or older. Unaware hypertensive individuals were defined as those without previous diagnosis whose average blood pressure was equal to or above 140/90 mmHg. For aware hypertensive patients, control was delimited as average blood pressure below 140/90 if under 59 years old or diabetic, and as less than 150/90 otherwise. We used logistic regression to identify care gap‐associated factors. Results Hypertension prevalence was 43.5% (95% CI 41.2–45.7). We found 28.2% aware and 15.3% unaware hypertensive individuals, which corresponds to a 35.1% (95% CI 31.9–38.5) underdiagnosis. This gap was determined by age, sex, education and lifestyle factors. 14.4% (95% CI 11.6–17.6) of aware hypertensive patients presented a follow‐up gap, 93.4% (95% CI 90.9–95.2) were prescribed antihypertensive drugs, but 38.9% (95% CI 34.7–43.3) were not compliant. The latter was strongly associated with follow‐up. The hypertension control gap in aware hypertensive patients, 39.0% (95% CI: 34.9–43.2), was associated with being older, having diabetes, weakly adhering to pharmacological treatment and receiving poor non‐pharmacological advice. Overall, 60.4% (95% CI 57.0–63.8) of aware and unaware hypertensive participants had either diagnosed but uncontrolled or undiagnosed hypertension. Conclusions We found high hypertension prevalence coupled with, from an international perspective, encouraging awareness and control figures. Still, there remains ample room for improvement. Our findings can assist in designing integrated primary healthcare measures that further strengthen equitable and effective access to hypertension care and control.

A prospective longitudinal approach to examine the association between social position in childhood, adolescence, and adulthood with the control of hypertension during adulthood

“…Our results show that patients had progressively lower systolic blood pressure and higher levels of hypertension control throughout time. This suggests that this sample had a high level of control when compared to other studies in Colombia, which reported much lower levels (7,44,45). These differences might be explained by the higher levels of adherence to the treatment found in another study with this same sample, particularly in terms of pharmacological treatment adherence (46).…”

The Rationale for Using Fixed-Dose Combination Therapy in the Management of Hypertension in Colombia: A Narrative Review

“…The reported prevalence of hypertension in Colombia depends on the sampled population (Table 1 ), but hypertension affects between 28 and 44% of the adult population [ 10 , 11 , 15 – 18 ]. The prevalence increases with age [ 17 , 19 ], body mass index (BMI) [ 16 , 17 , 20 ], comorbidities [ 21 ], and correlates of low socioeconomic status, such as low education level and Afro-descendent ethnicity [ 15 , 17 , 18 ].…”

“…Among Colombian patients treated for hypertension, ~ 65% achieve BP control, but because many patients do not receive treatment, this equates to BP control in only ~ 39% of patients with hypertension [ 10 , 11 ]. In the 2016 Colombian National Survey of Health, Welfare and Aging, factors associated with poor BP control were age > 74 years and living in a rural area [ 24 ].…”

“…Among the modifiable risk factors, hypertension is responsible for the highest fraction of the population attributable risk (18.7%) for CVD in South America, ahead of obesity (15.4%), smoking (13.5%), and diabetes (5.3%) [ 8 ], and is a significant contributor to the risk of dementia in Latin America and the Caribbean (18.0% of the population attributable risk) [ 9 ]. Yet, rates of BP control in Colombia are low [ 10 , 11 ], possibly because of underutilization of combination therapy and poor patient adherence.…”

Protocol for a controlled before-after quasi-experimental study to evaluate the effectiveness of a multi-component intervention to reduce gaps in hypertension care and control in low-income communes of Medellin, Colombia

“…In 2016, we conducted a cross-sectional survey in a low-income commune of Medellin 19 to estimate the prevalence of hypertension in the adult population and the magnitude and determinants of the main gaps in hypertension care and control. The definitions of those gaps are shown in table 1 .…”