美国哈佛大学公共卫生学院Till Barnighausen小组统计了44个中低收入国家（LMIC）的高血压护理状况：对110万成年人的全国代表性个人数据进行横断面研究。2019年8月24日出版的《柳叶刀》发表了这项成果。

该课题组的目标是确定44个LMICs的高血压护理状况及其在国家和人口群体之间的差异。在该横断面研究中，课题组人员收集了44个LMICs中2005年后基于人群的个体数据，高血压定义为收缩压高于140毫米汞柱，舒张压高于90毫米汞柱，或有报告服用高血压药物治疗。

在高血压患者中，该课题组计算了曾经测量过血压、曾被诊断患有高血压、曾因高血压接受治疗和服药后控制住血压的人的比例，并按年龄、性别、受教育程度、人均财富、体重指数、吸烟状况、所处国家和地区等对高血压护理进行分类。研究人员共收集了1100507名参与者的数据，其中192441人（17.5%）患有高血压。高血压患者中，73.6%曾测量过血压，39.2%曾被诊断出高血压，29.9%接受了治疗，10.3%治疗后血压得到控制。

拉丁美洲和加勒比地区的国家相对于他们的人均国内生产总值（GDP）预测总体表现最好，而撒哈拉以南非洲国家的表现最差。孟加拉国、巴西、哥斯达黎加、厄瓜多尔、吉尔吉斯斯坦和秘鲁相对于他们的人均GDP高血压护理做得更好。女性、年龄较大、受教育程度更高、更富有，以及不吸烟的人群获得更好的高血压护理。

鉴于LMICs中高血压引起的高疾病负担，该研究为LMICs高血压健康政策和服务干预的设计和目标制定提供了重要证据，有助于实现这些国家的卫生保健服务全面覆盖。

据介绍，LMICs的全国性研究中，很少有证据表明，哪些国家的患者无法得到高血压连续治疗。

附：英文原文

Title: The state of hypertension care in 44 low-income and middle-income countries: a cross-sectional study of nationally representative individual-level data from 1·1 million adults

Author: Pascal Geldsetzer, ScD;Jennifer Manne-Goehler, MD;Maja-Emilia Marcus;Prof Till Bärnighausen, MD  †;Prof Rifat Atun, FRCP †;Prof Sebastian Vollmer, PhD †;Lindsay M Jaacks, PhD; et al

Issue&Volume: VOLUME 394, ISSUE 10199, P663-671, AUGUST 24, 2019

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 progression in the care process, from need of care to successful treatment, into discrete stages and measuring the losses at each stage.

Methods

In this cross-sectional study, we pooled individual-level population-based data from 44 LMICs. We first searched for nationally representative datasets from the WHO Stepwise Approach to Surveillance (STEPS) from 2005 or later. If a STEPS dataset was not available for a LMIC (or we could not gain access to it), we conducted a systematic search for survey datasets; the inclusion criteria in these searches were that the survey was done in 2005 or later, was nationally representative for at least three 10-year age groups older than 15 years, included measured blood pressure data, and contained data on at least two hypertension care cascade steps. Hypertension was defined as a systolic blood pressure of at least 140 mm Hg, diastolic blood pressure of at least 90 mm Hg, or reported use of medication for hypertension. Among those with hypertension, we calculated the proportion of individuals who had ever had their blood pressure measured; had been diagnosed with hypertension; had been treated for hypertension; and had achieved control of their hypertension. We weighted countries proportionally to their population size when determining this hypertension care cascade at the global and regional level. We disaggregated the hypertension care cascade by age, sex, education, household wealth quintile, body-mass index, smoking status, country, and region. We used linear regression to predict, separately for each cascade step, a country's performance based on gross domestic product (GDP) per capita, allowing us to identify countries whose performance fell outside of the 95% prediction interval.

Findings

Our pooled dataset included 1?100?507 participants, of whom 192?441 (17·5%) had hypertension. Among those with hypertension, 73·6% of participants (95% CI 72·9–74·3) had ever had their blood pressure measured, 39·2% of participants (38·2–40·3) had been diagnosed with hypertension, 29·9% of participants (28·6–31·3) received treatment, and 10·3% of participants (9·6–11·0) achieved control of their hypertension. Countries in Latin America and the Caribbean generally achieved the best performance relative to their predicted performance based on GDP per capita, whereas countries in sub-Saharan Africa performed worst. Bangladesh, Brazil, Costa Rica, Ecuador, Kyrgyzstan, and Peru performed significantly better on all care cascade steps than predicted based on GDP per capita. Being a woman, older, more educated, wealthier, and not being a current smoker were all positively associated with attaining each of the four steps of the care cascade.

Interpretation

Our study provides important evidence for the design and targeting of health policies and service interventions for hypertension in LMICs. We show at what steps and for whom there are gaps in the hypertension care process in each of the 44 countries in our study. We also identified countries in each world region that perform better than expected from their economic development, which can direct policy makers to important policy lessons. Given the high disease burden caused by hypertension in LMICs, nationally representative hypertension care cascades, as constructed in this study, are an important measure of progress towards achieving universal health coverage.

DOI: https://doi.org/10.1016/S0140-6736(19)30955-9

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30955-9/fulltext#