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Availability and affordability of blood pressure-lowering medicines and the effect on blood pressure control in high-income, middle-income, and low-income countries: an analysis of the PURE study data

Published on Sep 1, 2017in The Lancet. Public health
· DOI :10.1016/S2468-2667(17)30141-X
Marjan W Attaei1
Estimated H-index: 1
(McMaster University),
Rasha Khatib18
Estimated H-index: 18
(Loyola University Medical Center)
+ 409 AuthorsR Mapanga4
Estimated H-index: 4
Cite
Abstract
Summary Background Hypertension is considered the most important risk factor for cardiovascular diseases, but its control is poor worldwide. We aimed to assess the availability and affordability of blood pressure-lowering medicines, and the association with use of these medicines and blood pressure control in countries at varying levels of economic development. Methods We analysed the availability, costs, and affordability of blood pressure-lowering medicines with data recorded from 626 communities in 20 countries participating in the Prospective Urban Rural Epidemiological (PURE) study. Medicines were considered available if they were present in the local pharmacy when surveyed, and affordable if their combined cost was less than 20% of the households' capacity to pay. We related information about availability and affordability to use of these medicines and blood pressure control with multilevel mixed-effects logistic regression models, and compared results for high-income, upper-middle-income, lower-middle-income, and low-income countries. Data for India are presented separately because it has a large generic pharmaceutical industry and a higher availability of medicines than other countries at the same economic level. Findings The availability of two or more classes of blood pressure-lowering drugs was lower in low-income and middle-income countries (except for India) than in high-income countries. The proportion of communities with four drug classes available was 94% in high-income countries (108 of 115 communities), 76% in India (68 of 90), 71% in upper-middle-income countries (90 of 126), 47% in lower-middle-income countries (107 of 227), and 13% in low-income countries (nine of 68). The proportion of households unable to afford two blood pressure-lowering medicines was 31% in low-income countries (1069 of 3479 households), 9% in middle-income countries (5602 of 65 471), and less than 1% in high-income countries (44 of 10 880). Participants with known hypertension in communities that had all four drug classes available were more likely to use at least one blood pressure-lowering medicine (adjusted odds ratio [OR] 2·23, 95% CI 1·59–3·12); p Interpretation A large proportion of communities in low-income and middle-income countries do not have access to more than one blood pressure-lowering medicine and, when available, they are often not affordable. These factors are associated with poor blood pressure control. Ensuring access to affordable blood pressure-lowering medicines is essential for control of hypertension in low-income and middle-income countries. Funding Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, Canadian Institutes of Health Research Strategy for Patient Oriented Research through the Ontario SPOR Support Unit, the Ontario Ministry of Health and Long-Term Care, pharmaceutical companies (with major contributions from AstraZeneca [Canada], Sanofi Aventis [France and Canada], Boehringer Ingelheim [Germany amd Canada], Servier, and GlaxoSmithKline), Novartis and King Pharma, and national or local organisations in participating countries.
  • References (36)
  • Citations (14)
Cite
References36
Newest
Published on Jan 1, 2017in The Lancet 59.10
Veronika J Wirtz14
Estimated H-index: 14
(BU: Boston University),
Hans V Hogerzeil11
Estimated H-index: 11
(UG: University of Groningen)
+ 19 AuthorsRegina M Mbindyo1
Estimated H-index: 1
(WHO: World Health Organization)
Author(s): Wirtz, VJ; Hogerzeil, HV; Gray, AL; Bigdeli, M; de Joncheere, CP; Ewen, MA; Gyansa-Lutterodt, M; Jing, S; Luiza, VL; Mbindyo, RM; Moller, H; Moucheraud, C; Pecoul, B; Rago, L; Rashidian, A; Ross-Degnan, D; Stephens, PN; Teerawattananon, Y; Hoen, EFM; Wagner, AK; Yadav, P; Reich, MR
Published on Nov 1, 2016in The Lancet 59.10
Michael H. Olsen43
Estimated H-index: 43
(NWU: North-West University),
Sonia Y. Angell15
Estimated H-index: 15
(DOHMH: New York City Department of Health and Mental Hygiene)
+ 17 AuthorsDagmara Hering22
Estimated H-index: 22
(UWA: University of Western Australia)
Elevated blood pressure is the strongest modifiable risk factor for cardiovascular disease worldwide. Despite extensive knowledge about ways to prevent as well as to treat hypertension, the global incidence and prevalence of hypertension and, more importantly, its cardiovascular complications are not reduced—partly because of inadequacies in prevention, diagnosis, and control of the disorder in an ageing world. The aim of the Lancet Commission on hypertension is to identify key actions to improv...
Published on May 26, 2016in The New England Journal of Medicine 70.67
Salim Yusuf Mb Bs DPhil Frcpc209
Estimated H-index: 209
(McMaster University),
Jackie Bosch43
Estimated H-index: 43
(McMaster University)
+ 30 AuthorsAntonio L. Dans17
Estimated H-index: 17
(UPM: University of the Philippines Manila)
BackgroundPrevious trials have shown that the use of statins to lower cholesterol reduces the risk of cardiovascular events among persons without cardiovascular disease. Those trials have involved persons with elevated lipid levels or inflammatory markers and involved mainly white persons. It is unclear whether the benefits of statins can be extended to an intermediate-risk, ethnically diverse population without cardiovascular disease. MethodsIn one comparison from a 2-by-2 factorial trial, we r...
Published on May 26, 2016in The New England Journal of Medicine 70.67
Eva Lonn64
Estimated H-index: 64
(McMaster University),
Jackie Bosch43
Estimated H-index: 43
(McMaster University)
+ 30 AuthorsAntonio L. Dans17
Estimated H-index: 17
(UPM: University of the Philippines Manila)
BackgroundAntihypertensive therapy reduces the risk of cardiovascular events among high-risk persons and among those with a systolic blood pressure of 160 mm Hg or higher, but its role in persons at intermediate risk and with lower blood pressure is unclear. MethodsIn one comparison from a 2-by-2 factorial trial, we randomly assigned 12,705 participants at intermediate risk who did not have cardiovascular disease to receive either candesartan at a dose of 16 mg per day plus hydrochlorothiazide a...
Published on May 26, 2016in The New England Journal of Medicine 70.67
Salim Yusuf Mb Bs DPhil Frcpc209
Estimated H-index: 209
(McMaster University),
Eva Lonn64
Estimated H-index: 64
(McMaster University)
+ 29 AuthorsLeopoldo Soares Piegas24
Estimated H-index: 24
BACKGROUND Elevated blood pressure and elevated low-density lipoprotein (LDL) cholesterol increase the risk of cardiovascular disease. Lowering both should reduce the risk of cardiovascular events substantially.METHODS In a trial with 2-by-2 factorial design, we randomly assigned 12,705 participants at intermediate risk who did not have cardiovascular disease to rosuvastatin (10 mg per day) or placebo and to candesartan (16 mg per day) plus hydrochlorothiazide (12.5 mg per day) or placebo. In th...
Published on Jan 1, 2016
Un Desa1
Estimated H-index: 1
Information document of the Scoping meeting on collaboration between Regional Seas Programmes and Regional Fisheries Bodies in the Southwest Indian Ocean
Published on Jan 1, 2016in The Lancet 59.10
Rasha Khatib18
Estimated H-index: 18
(BZU: Birzeit University),
Martin McKee103
Estimated H-index: 103
(Lond: University of London)
+ 29 AuthorsRichi Gupta79
Estimated H-index: 79
Summary Background WHO has targeted that medicines to prevent recurrent cardiovascular disease be available in 80% of communities and used by 50% of eligible individuals by 2025. We have previously reported that use of these medicines is very low, but now aim to assess how such low use relates to their lack of availability or poor affordability. Methods We analysed information about availability and costs of cardiovascular disease medicines (aspirin, β blockers, angiotensin-converting enzyme inh...
Published on Dec 1, 2015in BMC Health Services Research 1.93
Isabelle Risso-Gill5
Estimated H-index: 5
(Lond: University of London),
Dina Balabanova26
Estimated H-index: 26
(Lond: University of London)
+ 10 AuthorsTara McCready6
Estimated H-index: 6
(Population Health Research Institute)
Background The growing burden of non-communicable diseases in middle-income countries demands models of care that are appropriate to local contexts and acceptable to patients in order to be effective. We describe a multi-method health system appraisal to inform the design of an intervention that will be used in a cluster randomized controlled trial to improve hypertension control in Malaysia.
Published on Dec 1, 2015in Clinical Hypertension
Noah Mohammed Jarari1
Estimated H-index: 1
(University of Benghazi),
Narayanam V. Rao1
Estimated H-index: 1
(Andhra Medical College)
+ 13 AuthorsSyed Ibrahim Jamallulail1
Estimated H-index: 1
Hypertension continues to be an important public health concern because of its associated morbidity, mortality and economic impact on the society. It is a significant risk factor for cardiovascular, cerebrovascular and renal complications. It has been estimated that by 2025, 1.56 billion individuals will have hypertension. The increasing prevalence of hypertension and the continually increasing expense of its treatment influence the prescribing patterns among physicians and compliance to the tre...
Published on Apr 24, 2015in PLOS ONE 2.78
Helena Legido-Quigley19
Estimated H-index: 19
(Lond: University of London),
Paul Camacho López2
Estimated H-index: 2
+ 7 AuthorsMartin McKee103
Estimated H-index: 103
(Lond: University of London)
Hypertension is a leading cause of premature death worldwide and the most important modifiable risk factor for cardiovascular disease. Effective screening programs, communication with patients, regular monitoring, and adherence to treatment are essential to successful management but may be challenging in health systems facing resource constraints. This qualitative study explored patients’ knowledge, attitudes, behaviour and health care seeking experiences in relation to detection, treatment and ...
Cited By14
Newest
Published on Jun 1, 2019in American Heart Journal 4.02
Rajnish Joshi (AIIMS: All India Institute of Medical Sciences), Twinkle Agarwal (St. John's University)+ 13 AuthorsAlben Singamani
Abstract Background There is a need to identify and test low cost approaches for cardiovascular disease (CVD) risk reduction that can enable health systems to achieve such a strategy. Objective Community health workers (CHWs) are an integral part of health-care delivery system in lower income countries. Our aim was to assess impact of CHW based interventions in reducing CVD risk factors in rural households in India. Methods We performed an open-label cluster-randomized trial in 28 villages in 3 ...
Published on Jul 18, 2019in The Lancet 59.10
Clara K. Chow35
Estimated H-index: 35
(USYD: University of Sydney),
Richi Gupta79
Estimated H-index: 79
(Rajasthan University of Health Sciences)
Published on Jul 18, 2019in The Lancet 59.10
Pascal Geldsetzer10
Estimated H-index: 10
(Harvard University),
Jennifer Manne14
Estimated H-index: 14
(Harvard University)
+ 40 AuthorsSilver Bahendeka9
Estimated H-index: 9
Summary Background Evidence from nationally representative studies in low-income and middle-income countries (LMICs) on where in the hypertension care continuum patients are lost to care is sparse. This information, however, is essential for effective targeting of interventions by health services and monitoring progress in improving hypertension care. We aimed to determine the cascade of hypertension care in 44 LMICs—and its variation between countries and population groups—by dividing the progr...
Published on Jul 12, 2019in Obesity Reviews 8.19
David Patterson (UG: University of Groningen), Kent Buse26
Estimated H-index: 26
(Joint United Nations Programme on HIV/AIDS)
+ 1 AuthorsBrigit Toebes7
Estimated H-index: 7
(UG: University of Groningen)
Published on Jan 17, 2019
Andre Lamy30
Estimated H-index: 30
(HHS: Hamilton Health Sciences),
Eva Lonn64
Estimated H-index: 64
(HHS: Hamilton Health Sciences)
+ 5 AuthorsSalim Yusuf Mb Bs DPhil Frcpc209
Estimated H-index: 209
(HHS: Hamilton Health Sciences)
Published on Jun 1, 2019in Journal of Vascular Surgery 3.24
Michael S. Conte47
Estimated H-index: 47
(UCSF: University of California, San Francisco),
Andrew W. Bradbury42
Estimated H-index: 42
(University of Birmingham)
+ 91 AuthorsM. Hassan Murad89
Estimated H-index: 89
(Mayo Clinic)
Abstract Chronic limb-threatening ischemia (CLTI) is associated with mortality, amputation, and impaired quality of life. These Global Vascular Guidelines (GVG) are focused on definition, evaluation, and management of CLTI with the goals of improving evidence-based care and highlighting critical research needs. The term CLTI is preferred over critical limb ischemia, as the latter implies threshold values of impaired perfusion rather than a continuum. CLTI is a clinical syndrome defined by the pr...
Robinson Oyando (Wellcome Trust), Martin Njoroge2
Estimated H-index: 2
(Wellcome Trust)
+ 8 AuthorsKenneth Munge3
Estimated H-index: 3
(Wellcome Trust)
Published on Mar 1, 2019in Revista Colombiana de Cardiología
Juan F. Gómez , Paul A. Camacho11
Estimated H-index: 11
(UNAB: Autonomous University of Bucaramanga)
+ 1 AuthorsPatricio López-Jaramillo42
Estimated H-index: 42
Resumen Las enfermedades cardiovasculares son la primera causa de muerte prematura en el mundo y entre los factores de riesgo modificables mas prevalentes se encuentra la hipertension arterial, que es la tercera causa de muerte en el mundo, atribuyendosele una de cada ocho muertes a nivel global. La hipertension arterial se identifica facilmente a traves de metodos no invasivos; estudios poblacionales mundiales han mostrado que la prevalencia de hipertension arterial en adultos mayores de 35 ano...
Published on Dec 1, 2018in American Heart Journal 4.02
Philip Joseph13
Estimated H-index: 13
(Population Health Research Institute),
Prem Pais42
Estimated H-index: 42
(St. John's Medical College)
+ 13 AuthorsHabib Gamra19
Estimated H-index: 19
(University of Monastir)
Background It is hypothesized that in individuals without clinical cardiovascular disease (CVD), but at increased CVD risk, a 50% to 60% reduction in CVD risk could be achieved using fixed dose combination (FDC) therapy (usually comprised of multiple blood-pressure agents and a statin [with or without aspirin]) in a single “polypill”. However, the impact of a polypill in preventing clinical CV events has not been evaluated in a large randomized controlled trial. Methods TIPS-3 is a 2x2x2 factori...