Innovative Implementation Strategies for Hypertension Control in Low- and Middle-Income Countries: a Narrative Review
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IMPLEMENTATION TO INCREASE BLOOD PRESSURE CONTROL: WHAT WORKS? (J BRETTLER AND K REYNOLDS, SECTION EDITORS)
Innovative Implementation Strategies for Hypertension Control in Low- and Middle-Income Countries: a Narrative Review Tim Mercer 1 & Shanti Nulu 2 & Rajesh Vedanthan 3
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review This review summarizes the most recent and innovative implementation strategies for hypertension control in low- and middle-income countries (LMICs). Recent Findings Implementation strategies from Latin America, Africa, and Asia were organized across three levels: community, health system, and policy/population. Multicomponent interventions involving task-shifting strategies, with or without mobile health tools, had the most supporting evidence, with policy or population-level interventions having the least, focused only on salt reduction with mixed results. More research is needed to better understand how context affects intervention implementation. Summary There is an emerging evidence base for implementation strategies for hypertension control and CVD risk reduction in LMICs at the community and health system levels, but further research is needed to determine the most effective policy and population-level strategies. How to best account for local context in adapting and implementing these evidence-based interventions in LMICs still remains largely unknown. Accelerating the translation of this implementation research into policy and practice is imperative to improve health and save lives globally. Keywords Hypertension . Cardiovascular disease . Implementation research . Community . Health system . Policy . Low- and middle-income countries (LMICs)
Introduction Hypertension is a major modifiable risk factor for cardiovascular disease (CVD) and the leading global risk factor for mortality [1, 2]. Both hypertension and CVD disproportion-
This article is part of the Topical Collection on Implementation to Increase Blood Pressure Control: What Works? * Tim Mercer [email protected] 1
Department of Population Health, Division of Global Health, The University of Texas at Austin Dell Medical School, 1601 Trinity St., Bldg. B, Austin, TX 78712, USA
2
Department of Internal Medicine, Division of Cardiology, The University of Texas at Austin Dell Medical School, Austin, TX, USA
3
Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
ately affect those living in low- and middle-income countries (LMICs), and hypertension control rates in LMICs are very low [3, 4]. While evidence-based interventions are well known for prevention and management of both hypertension and CVD, implementation of these interventions in LMICs is sub-optimal [5–7]. Most LMICs are plagued by common but pernicious challenges that threaten their ability to control hypertension and reduce CVD risk at a population level. These include a lack of affordability and availability of antihypertensive drugs; too few skilled health care workers; hi
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