Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Trop Med Int Health. 2021 Aug;26(8):895-907. doi: 10.1111/tmi.13599. Epub 2021 May 22.
To assess hypertension prevalence and the extent and associated factors of hypertension diagnosis, follow-up, treatment and control gaps in low-income urban Medellin, Colombia.
We randomly sampled 1873 adults aged 35 or older. Unaware hypertensive individuals were defined as those without previous diagnosis whose average blood pressure was equal to or above 140/90 mmHg. For aware hypertensive patients, control was delimited as average blood pressure below 140/90 if under 59 years old or diabetic, and as less than 150/90 otherwise. We used logistic regression to identify care gap-associated factors.
Hypertension prevalence was 43.5% (95% CI 41.2-45.7). We found 28.2% aware and 15.3% unaware hypertensive individuals, which corresponds to a 35.1% (95% CI 31.9-38.5) underdiagnosis. This gap was determined by age, sex, education and lifestyle factors. 14.4% (95% CI 11.6-17.6) of aware hypertensive patients presented a follow-up gap, 93.4% (95% CI 90.9-95.2) were prescribed antihypertensive drugs, but 38.9% (95% CI 34.7-43.3) were not compliant. The latter was strongly associated with follow-up. The hypertension control gap in aware hypertensive patients, 39.0% (95% CI: 34.9-43.2), was associated with being older, having diabetes, weakly adhering to pharmacological treatment and receiving poor non-pharmacological advice. Overall, 60.4% (95% CI 57.0-63.8) of aware and unaware hypertensive participants had either diagnosed but uncontrolled or undiagnosed hypertension.
We found high hypertension prevalence coupled with, from an international perspective, encouraging awareness and control figures. Still, there remains ample room for improvement. Our findings can assist in designing integrated primary healthcare measures that further strengthen equitable and effective access to hypertension care and control.
评估哥伦比亚麦德林低收入城市的高血压患病率以及高血压诊断、随访、治疗和控制差距的程度和相关因素。
我们随机抽取了 1873 名年龄在 35 岁或以上的成年人。未确诊的高血压患者定义为未经诊断且平均血压等于或高于 140/90mmHg 的患者。对于已知的高血压患者，控制定义为平均血压低于 140/90mmHg，如果年龄在 59 岁以下或患有糖尿病，则控制在低于 150/90mmHg；否则控制在低于 150/90mmHg。我们使用逻辑回归来确定与护理差距相关的因素。
高血压患病率为 43.5%（95%CI 41.2-45.7）。我们发现 28.2%的患者知晓且 15.3%的患者不知晓自己患有高血压，这对应着 35.1%（95%CI 31.9-38.5）的漏诊率。这种差距是由年龄、性别、教育和生活方式因素决定的。14.4%（95%CI 11.6-17.6）的知晓高血压患者存在随访差距，93.4%（95%CI 90.9-95.2）接受了抗高血压药物治疗，但 38.9%（95%CI 34.7-43.3）的患者不依从。后者与随访密切相关。在知晓高血压患者中，高血压控制差距为 39.0%（95%CI：34.9-43.2），与年龄较大、患有糖尿病、药物治疗依从性差以及接受不良非药物治疗建议有关。总的来说，60.4%（95%CI 57.0-63.8）的知晓和不知晓高血压患者存在已诊断但未控制或未诊断的高血压。
我们发现高血压患病率较高，从国际角度来看，高血压的知晓率和控制率也令人鼓舞。尽管如此，仍有很大的改进空间。我们的研究结果可以帮助设计综合的初级医疗保健措施，进一步加强高血压护理和控制的公平和有效获得。
