Global study highlights hypertension treatment failings

Many people around the world who are diagnosed with hypertension stop treatment and most then lose control of their blood pressure, potentially putting them at risk of significant heart problems and even death, according to an international study.

Patient data from China, Indonesia, Mexico and South Africa was analysed by an international group of academics, and concluded that policies solely aimed at improving diagnosis or initiating treatment may not lead to long-term hypertension control improvements in these and similar countries.

The researchers, including from the University of Birmingham, investigated how people with hypertension moved through care over time and looked at adults aged 40 and over.

They discovered that, over a five- to nine-year follow-up period, only around 30% of undiagnosed individuals became diagnosed, whilst 25% of untreated individuals became treated.

The most striking finding, however, was that, among those who were on treatment and had controlled blood pressure, the majority lost blood pressure control and a substantial number stopped treatment over the same five- to nine-year period.

The findings have been published in the journal Science Translational Medicine and concluded that patients from South Africa had the lowest rates of undiagnosed hypertension, treatment discontinuation and blood pressure control loss. This country also reported the highest probabilities of individuals reaching blood pressure control.

China, by comparison, had one of the lowest rates of reaching blood pressure control with just 9% of individuals likely to achieve this – regardless of treatment status.

In Indonesia, 92% of individuals lost blood pressure control at follow-up, with the country also displaying the highest treatment discontinuation and lowest treatment initiation rates. This suggested that, here, there were suggesting substantial barriers to accessing and following up care.

In Mexico, only 27% of people were likely to be diagnosed with hypertension, while 34% of individuals with a diagnosis later discontinued their treatment.

Professor Justine Davies, professor global health research in the university’s Institute of Applied Health Research, said: “Hypertension affects one in four adults and is the world’s leading cause of cardiovascular disease and early death.

“Two-thirds of people with hypertension live in low- and middle-income countries and these countries in particular face considerable population ageing, which is likely to generate a surge in people requiring hypertension care.

“Treating hypertension substantially reduces deaths from cardiovascular disease mortality, yet many countries have crucial gaps in hypertension diagnosis and control,” she added.