Global Standardized Hypertension Treatment Project

Transcription

1 Global Standardized Hypertension Treatment Project Pedro Ordúñez, MD Advisor for Noncommunicable Diseases, PAHO on behalf of Sonia Angell, MD MPH XXIV InterAmerican Congress of Cardiology-XXXIX Argentine Congress of Cardiology October 2013

2 The Call to Act is Global, the Time to Act is Now WHO Global Monitoring Framework with targets and indicators By 2025 the prevalence of raised blood pressure will be reduced by 25%

3 Hypertension Prevalence ~ 1/3 of adults 1 billion people worldwide Costs of non-optimal blood pressure Hypertension cost $372 billion (US) in % of the overall healthcare expenditures If blood pressure levels remain unchanged over the next 10 years... $1 trillion globally in direct healthcare expenses $3.6 trillion in indirect costs * Source: Gaziano TA, et al. J Hypertens 2009;27: ; Mendis S, Puska P, Norrving B, editors. Global atlas on cardiovascular disease prevention and control. Geneva, Switzerland: World Health Organization; Available from: whqlibdoc.who.int/publications/2011/ _eng.pdf.

4 Barriers to Blood Pressure Control Patient Limited access to treatment Poor adherence to treatment Health Care Provider Raised blood pressure attributed to white coat hypertension Reluctance to treat an asymptomatic condition Lack of adequate time with patient Therapeutic inertia Lack of adherence to current treatment guidelines

5 Barriers to Blood Pressure Control Health Systems Failure to delegate responsibility to non-physicians Inappropriate follow-up Absence of feedback to clinicians Issues related to supply, distribution, and cost of medications Complex medication regimens

6 Hypertension Treatment Considerations Medication adherence can be improved Availability Affordability Complexity Appropriate follow-up A Canadian study has shown that a simplified algorithm for the management of hypertension is implementable, changes physician-prescribing patterns, and results in better blood pressure control than conventional guideline-based care Sources: Feldman RD, et al. Hypertension 2009;53:

7 Building on Lessons Learned from Tuberculosis Structured approach High quality standardized care Diagnosis and treatment Management and support systems Targets and indicators define further actions and additional indicators Expansion of services Identifying and treating more patients Reducing the burden of disease Source: Seita A, Harries AD. Int J Tuberc Lung Dis 2013;17:

8 Call to Action Effective treatment has potential to significantly improve global population health Development of a strategy and framework for standardizing the pharmacologic treatment of hypertension that is both feasible and flexible to have worldwide applicability that acknowledges and supports use of existing evidenced-based guidelines for diagnosis and treatment of hypertension The project is not purposed to replace existing and recognized hypertension guidelines.

9 Global Standardized Hypertension Treatment Purpose To support the development of a strategy and framework for standardizing hypertension medication treatment to have worldwide applicability Regional collaboration to start Centers for Disease Control and Prevention (CDC) Pan American Health Organization (PAHO) Key stakeholders and organizations across the Americas

10 A Framework for the Pharmacologic Treatment of HTN Standardize, Simplify. Identification of a Core Set of Medications Widespread Medication Availability Improved Care Delivery and Medication Use Improved Hypertension Control

11 Global Standardized Hypertension Treatment Project Project funded by CDC Partners Identified and LAC selected as initial focus area HTN Treatment Planning & Review Group (HTPRG) Formed Draft Framework for the Global Standardization of HTN Treatment Implementation and Monitoring and Evaluation Project scope and desired outcomes defined Expedited review of literature & PAHO Survey Workshop 1: Core Set of HTN Medications March 4-8, 2013 Workshops Workshop 2: Key Elements of Care Delivery Mechanism to Make Medications Available Global Spread

12 Workshop Attendees CDC PAHO Ministries of Health Physicians Pharmacists, pharmacologists Epidemiologists Society Representation: American Heart Association Barbados Drug Service Caribbean Cardiac Society Healthy Caribbean Coalition InterAmerican Society of Cardiology Latin American Federation of Obstetrics and Gynecology Latin American Society of Hypertension Society of Latin American Nephrology and Hypertension World Heart Federation

13 Core Set of Medications

14 Key Elements of a Care Delivery to Support Hypertension Treatment And Control Strategy Guidelines Registries/Information Systems Medications Patient-Centeredness (including self-management interventions) Care System (organizational management to implement a primary health care-led system) Community

15 Pathway to Controlled Hypertension Controlled Hypertension Mechanism to Make Medications Available Implementation, Monitoring and Evaluation, and Global Spread Workshop 2: Care Delivery Model 2013 Workshop 1: Core Set of Medications

16 The Vision of Hypertension Control Globally

17 Moving Forward Together For the Global Standardized Hypertension Treatment Project to work efficiently toward its goals, we need: Strong partnerships between Ministries of Health, CDC, PAHO, and other health care entities Interest, commitment, and will to increased hypertension treatment rates and decrease related morbidity and mortality Resources staff, funding, treatment protocols, procurement mechanisms for medications Collaboration, engagement, information sharing, and optimism

18 Thank you! For more information, please contact: Sonia Angell, MD MPH Senior Advisor for Noncommunicable Diseases Centers for Disease Control and Prevention (U.S.) AND Pragna Patel, MD MPH Special Projects Lead, Noncommunicable Diseases Centers for Disease Control and Prevention (U.S.)