The cascade of care in managing hypertension in the Arab world: a systematic assessment of the evidence on awareness, treatment and control

Abstract

Background: Hypertension is a leading risk factor for mortality and morbidity globally and in the Arab world. We summarize the evidence on awareness, treatment, and control of hypertension, to assess the extent of gaps in the hypertension continuum of care. We also assess the influence of gender and other social determinants at each level of the cascade of care. Methods: We searched MEDLINE and SSCI databases for studies published between 2000 and 2017, reporting the rates of awareness, treatment or control of hypertension and/or their determinants in the Arab region. We included sources on both general populations and on clinical populations. The review process was based on the PRISMA guidelines. We present rates on the three stages of the care cascade corresponding to (1) awareness (2) treatment and (3) control of blood pressure, and estimated the losses that occur when moving from one stage to another. We also take stock of the evidence on social determinants and assess the statistical significance of gender differences in awareness, treatment and control. Results: Data from 73 articles were included. Substantial proportions of hypertensives were lost at each step of the hypertension care continuum, with more missed opportunities for care resulting from lack of awareness of hypertension and from uncontrolled blood pressure. More than 40% and 19% of all hypertensive individuals were found to be unaware and to have uncontrolled blood pressure, respectively, but among individuals diagnosed with hypertension, less than 21% were untreated. Awareness rates were higher among women than men but this advantage was not consistently translated into better blood pressure control rates among women. Conclusions: This analysis of the cascade of care indicates that barriers to proper diagnosis and adequate control are greater than barriers to delivery of treatment, and discusses potential factors that may contribute to the gaps in delivery.

Health Belief Model and Hypertension Prevention

“…The pre-post test scores in the intervention group on the dimensions of barriers / benefits 57. 14 23 Research on 403 residents in Iran, it was found that after 6 months of the intervention, the intervention group felt less inhibited, and got more cues to action than the control group. Salt intake restriction was higher in the intervention group.…”

“…Scores in the intervention group, pre-test and posttest scores were obtained in the dimensions of susceptibility 41.12 ± 5.89; 42. 14 HBM-based education programs were proven to increase perceived severity, perceived benefits, and perceived self-efficacy in the intervention group compared to the control group.…”

“…Hypertension can be prevented by controlling risky behaviors such as not smoking, a healthy diet, reducing consumption of sugar, salt, fat, avoiding obesity, doing physical activity, not consuming alcohol, and good stress management. 14 Efforts that can be made to prevent and control hypertension are with health promotion through communication, information, and education. 15 Various models and theories can be used as approaches in the prevention of hypertension.…”

Self-monitoring of blood pressure to improve hypertension management in a middle-income country: A proof of concept study

“…Uncontrolled blood pressure is a major public health issue in the Arab world, regardless of wealth or level of development (11). The cultural similarities between Lebanon and other Arab countries, and the diversity in socioeconomic status, modes of health care delivery, and degree of medicalization in Lebanon, imply that the results of the project are relevant to the region as a whole.…”

“…Global data show that control of blood pressure is poor (7-9) especially in low-and middle-income countries (LMICs) with a recent review indicating that only 10% of hypertensive adults in LMICs have their blood pressure under control (10). In Arab countries, less than third of hypertensive patients have controlled blood pressure, according to a recent review (11), and in Lebanon, a middle-income country of the Arab region (12), control rates are suboptimal and comparable to the regional average (10,13,14).…”