Improving Hypertension Outcome Measurement in Low- and Middle-Income Countries

• Main Authors: Zack, Rachel, Okunade, Oluwakemi, Olson, Elizabeth, Salt, Matthew, Amodeo, Celso, Anchala, Raghupathy, Berwanger, Otavio, Campbell, Norm, Chia, Yook Chin, Damasceno, Albertino, Phuong Do, Thi Nam, Tamdja Dzudie, Anastase, Fiuza, Manuela, Mirza, Fareed, Nitsch, Dorothea, Ogedegbe, Gbenga, Podpalov, Vladislav, Schiffrin, Ernesto L., Vaz Carneiro, António, Lamptey, Peter
• Format: Article
• Published: American Heart Association 2019
• Subjects: R Medicine
• Online Access: http://eprints.um.edu.my/22942/; https://doi.org/10.1161/HYPERTENSIONAHA.118.11916

High blood pressure is the leading modifiable risk factor for mortality, accounting for nearly 1 in 5 deaths worldwide and 1 in 11 in low-income countries. Hypertension control remains a challenge, especially in low-resource settings. One approach to improvement is the prioritization of patient-centered care. However, consensus on the outcomes that matter most to patients is lacking. We aimed to define a standard set of patient-centered outcomes for evaluating hypertension management in low- and middle-income countries. The International Consortium for Health Outcomes Measurement convened a Working Group of 18 experts and patients representing 15 countries. We used a modified Delphi process to reach consensus on a set of outcomes, case-mix variables, and a timeline to guide data collection. Literature reviews, patient interviews, a patient validation survey, and an open review by hypertension experts informed the set. The set contains 18 clinical and patient-reported outcomes that reflect patient priorities and evidence-based hypertension management and case-mix variables to allow comparisons between providers. The domains included are hypertension control, cardiovascular complications, health-related quality of life, financial burden of care, medication burden, satisfaction with care, health literacy, and health behaviors. We present a core list of outcomes for evaluating hypertension care. They account for the unique challenges healthcare providers and patients face in low- and middle-income countries, yet are relevant to all settings. We believe that it is a vital step toward international benchmarking in hypertension care and, ultimately, value-based hypertension management.