Risk-based antihypertensive treatment allocation in Peru: comparison of local and international guidelines analysing national health surveys between 2015-2020
ABSTRACT: Background: While there is a growing interest in antihypertensive medication rates among people with hypertension in low- and middle-income countries, little has been described about antihypertensive medication rates among eligible people based on the absolute cardiovascular risk approach...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-09-01
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| Series: | The Lancet Regional Health. Americas |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2667193X21000144 |
| _version_ | 1818838555014725632 |
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| author | Rodrigo M. Carrillo-Larco Wilmer Cristobal Guzman-Vilca Antonio Bernabe-Ortiz |
| author_facet | Rodrigo M. Carrillo-Larco Wilmer Cristobal Guzman-Vilca Antonio Bernabe-Ortiz |
| author_sort | Rodrigo M. Carrillo-Larco |
| collection | DOAJ |
| description | ABSTRACT: Background: While there is a growing interest in antihypertensive medication rates among people with hypertension in low- and middle-income countries, little has been described about antihypertensive medication rates among eligible people based on the absolute cardiovascular risk approach. Following the risk-based approach, we described the proportion of eligible people receiving antihypertensive medication in Peru. Methods: Analysis of six (2015-2020) national health surveys. Absolute cardiovascular risk was computed with the 2019 WHO cardiovascular risk charts and based on local guidelines. Antihypertensive treatment allocation based on the absolute cardiovascular risk was defined using the Package of essential noncommunicable (PEN) disease interventions for primary health care in low-resource settings and the HEARTS guidelines by the WHO; we also followed the recommendations by local guidelines. Results: There were 120,059 people. Overall, according to the local guidelines the 17.9% of the population would be eligible for antihypertensive medication while this estimate was 8.1% based on the WHO guidelines. At the national level, depending on the guidelines, we observed a steady trend of eligible people receiving antihypertension medication (e.g., men, local guidelines), a decreasing trend (e.g., men, <60, local guidelines) or an increasing trend (e.g., men, ≥60, local guidelines). At the sub-national level, seventeen regions showed an increasing antihypertensive treatment rate based on the local guidelines; when based on the WHO guidelines, eleven regions showed a decreasing rate. Conclusions: Peru needs to define a tool for surveillance of absolute cardiovascular risk and to monitor antihypertensive treatment allocation among high-risk people. Funding: Wellcome Trust (214185/Z/18/Z). |
| first_indexed | 2024-12-19T03:40:15Z |
| format | Article |
| id | doaj.art-005a7868b6424478b0423bc1ff79298f |
| institution | Directory Open Access Journal |
| issn | 2667-193X |
| language | English |
| last_indexed | 2024-12-19T03:40:15Z |
| publishDate | 2021-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Americas |
| spelling | doaj.art-005a7868b6424478b0423bc1ff79298f2022-12-21T20:37:14ZengElsevierThe Lancet Regional Health. Americas2667-193X2021-09-011100022Risk-based antihypertensive treatment allocation in Peru: comparison of local and international guidelines analysing national health surveys between 2015-2020Rodrigo M. Carrillo-Larco0Wilmer Cristobal Guzman-Vilca1Antonio Bernabe-Ortiz2Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.; CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Correspondence author: Rodrigo M Carrillo-Larco, MD, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College LondonCRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; School of Medicine “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru; Sociedad Científica de Estudiantes de Medicina Cayetano Heredia (SOCEMCH), Universidad Peruana Cayetano Heredia, Lima, PeruCRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Universidad Científica del Sur, Lima, PeruABSTRACT: Background: While there is a growing interest in antihypertensive medication rates among people with hypertension in low- and middle-income countries, little has been described about antihypertensive medication rates among eligible people based on the absolute cardiovascular risk approach. Following the risk-based approach, we described the proportion of eligible people receiving antihypertensive medication in Peru. Methods: Analysis of six (2015-2020) national health surveys. Absolute cardiovascular risk was computed with the 2019 WHO cardiovascular risk charts and based on local guidelines. Antihypertensive treatment allocation based on the absolute cardiovascular risk was defined using the Package of essential noncommunicable (PEN) disease interventions for primary health care in low-resource settings and the HEARTS guidelines by the WHO; we also followed the recommendations by local guidelines. Results: There were 120,059 people. Overall, according to the local guidelines the 17.9% of the population would be eligible for antihypertensive medication while this estimate was 8.1% based on the WHO guidelines. At the national level, depending on the guidelines, we observed a steady trend of eligible people receiving antihypertension medication (e.g., men, local guidelines), a decreasing trend (e.g., men, <60, local guidelines) or an increasing trend (e.g., men, ≥60, local guidelines). At the sub-national level, seventeen regions showed an increasing antihypertensive treatment rate based on the local guidelines; when based on the WHO guidelines, eleven regions showed a decreasing rate. Conclusions: Peru needs to define a tool for surveillance of absolute cardiovascular risk and to monitor antihypertensive treatment allocation among high-risk people. Funding: Wellcome Trust (214185/Z/18/Z).http://www.sciencedirect.com/science/article/pii/S2667193X21000144cardiovascular riskcardiovascular diseaseshealth metrics |
| spellingShingle | Rodrigo M. Carrillo-Larco Wilmer Cristobal Guzman-Vilca Antonio Bernabe-Ortiz Risk-based antihypertensive treatment allocation in Peru: comparison of local and international guidelines analysing national health surveys between 2015-2020 The Lancet Regional Health. Americas cardiovascular risk cardiovascular diseases health metrics |
| title | Risk-based antihypertensive treatment allocation in Peru: comparison of local and international guidelines analysing national health surveys between 2015-2020 |
| title_full | Risk-based antihypertensive treatment allocation in Peru: comparison of local and international guidelines analysing national health surveys between 2015-2020 |
| title_fullStr | Risk-based antihypertensive treatment allocation in Peru: comparison of local and international guidelines analysing national health surveys between 2015-2020 |
| title_full_unstemmed | Risk-based antihypertensive treatment allocation in Peru: comparison of local and international guidelines analysing national health surveys between 2015-2020 |
| title_short | Risk-based antihypertensive treatment allocation in Peru: comparison of local and international guidelines analysing national health surveys between 2015-2020 |
| title_sort | risk based antihypertensive treatment allocation in peru comparison of local and international guidelines analysing national health surveys between 2015 2020 |
| topic | cardiovascular risk cardiovascular diseases health metrics |
| url | http://www.sciencedirect.com/science/article/pii/S2667193X21000144 |
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