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

Demetrio Lamloum; Federico Fassio; Brianna Osetinsky; Fabrizio Tediosi

doi:10.3389/ijph.2023.1606428

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

Int J Public Health. 2023 Oct 12:68:1606428. doi: 10.3389/ijph.2023.1606428. eCollection 2023.

Authors

Demetrio Lamloum^{1

2}, Federico Fassio³, Brianna Osetinsky^{4

5}, Fabrizio Tediosi^{4

5}

Affiliations

¹ Department of Preventive, Restorative and Pediatric Dentistry, University of Bern, Bern, Switzerland.
² Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.
³ Department of Public Health, Experimental and Forensic Medicine, Section of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy.
⁴ Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
⁵ University of Basel, Basel, Switzerland.

Abstract

Objective: High blood pressure is the leading risk factor for cardiovascular disease. The hypertension care cascade (HCC) is increasingly being used to evaluate the effectiveness of interventions. This systematic review aims to examine HCC in low-income settings. Methods: The search strategy included articles published between January 2010 and April 2023. We excluded studies with incomplete HCC, on fragile patients or aged <18 years, reviews. We used the MOOSE guideline. Five researchers retrieved data on the survey year, country, population, HCC and diagnostic methods for hypertension. We used JBI Critical Appraisal Tools for quality assessment. Results: Ninety-five articles were analyzed. Average hypertension prevalence was 33% (95% CI: 31%-34%), lower in LICs than in LMICs (25% vs. 34%). The overall mean awareness of hypertension was 48% (95% CI: 45%-51%), its treatment was 35% (95% IC: 32%-38%) and its control 16% (95% CI: 14%-18%). In almost all steps, percentages were lower in LICs and in Sub-Saharan Africa. Conclusion: Trends in HCC vary between countries, with poorer performance in LICs. This review highlights the need for interventions tailored to low-income settings in order to improve hypertension care.

Keywords: care cascade; hypertension (HTN); low income country (LIC); lower-middle income country (LMIC); prevalence.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Cardiovascular Diseases*
Developing Countries
Humans
Hypertension* / epidemiology
Poverty
Risk Factors

Grants and funding

This study was supported by the grant number 183760 by Swiss Programme for Research on Global Issues for Development (r4d programme) a joint funding initiative by the Swiss Agency for Development and Cooperation (SDC) and the Swiss National Science Foundation (SNSF). https://p3.snf.ch/project-183760, https://www.snf.ch/en, https://www.eda.admin.ch/sdc. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.