In the Global South less than one-third of high blood pressure patients treated

July 19, 2019

Healthcare in low- and middle-income countries is poorly prepared for the increasing number of high blood pressure (ie hypertension) disorders. More than two-thirds of all people affected go without treatment. Researchers led by the Harvard T.H. Chan School of Public Health, the University of Göttingen and the Medical Faculty of Heidelberg have discovered this. The study appeared in The Lancet.

The research team analysed the healthcare of hypertension in 44 countries of the Global South. Using a model known as "cascade methodology", they determined how well the health systems of the various countries are adapted. This method works like a stepped waterfall: a cascade of data shows step-by-step where patients are lost from health systems. First, the researchers determined how many people suffer from high blood pressure. Based on this, they determined how many of those patients were examined, diagnosed and treated each time. Finally, they analysed how many patients successfully controlled the disease with medication.

"Hypertension is already most prevalent in regions belonging to the Global South, particularly sub-Saharan Africa, as well as Central and South Asia," says Pascal Geldsetzer, postdoctoral research fellow at Harvard T.H. Chan School of Public Health and first author of the study. "Our study shows not only that care for hypertension in these countries is severely inadequate, but also where exactly patients are being lost in the treatment system."

The results: less than half of those affected are diagnosed with high blood pressure. Only 30 percent of these patients are treated and only one tenth have the disease under control. "High blood pressure can be treated relatively well and cheaply," says Sebastian Vollmer, Professor of Development Economics at the University of Göttingen. "Undiagnosed or untreated hypertension, on the other hand, is a considerable risk for the people affected and can lead to significant complications, including death." Till Bärnighausen, Professor of Global Health at Heidelberg University Hospital and Medical Faculty of Heidelberg, adds: "High blood pressure is already one of the major widespread diseases in the Global South and is becoming increasingly common as the populations in these countries age. This study provides important insights for policy-makers about where in the treatment chain for hypertension the greatest problems currently lie."

In order to improve the health systems of the countries concerned, the authors look at what worked in health systems that are managing to provide care. Costa Rica, Bangladesh, Brazil, Ecuador, Kyrgyzstan and Peru are good examples.
The analysis was carried out with the help of STEPS data from the World Health Organisation.

Original publication: Pascal Geldsetzer et al. The state of hypertension care in 44 low- and middle-income countries: a cross-sectional study of individual-level nationally representative data from 1.1 million adults. The Lancet (2019). Doi: 10.1016/S0140-6736(19)30955-9


Dr Pascal Geldsetzer
Department of Global Health and Population
Harvard T.H. Chan School of Public Health
665 Huntington Ave, Boston, MA 02115, USA
Tel: +1 415 694 8503

Professor Sebastian Vollmer
University of Göttingen
Centre for Modern Indian Studies (CeMIS)
Waldweg 26, Altbau, 37073 Göttingen
Tel: +49 (0)160 6152989

Professor Till Bärnighausen
Alexander von Humboldt University Professor
Director, Heidelberg Institute of Global Health
Heidelberg University Hospital and the Medical Faculty of Heidelberg
Im Neuenheimer Feld 130.3 | D-69120 Heidelberg
Tel: +49 (0) 6221 56-5637

University of Göttingen

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