Gaps in Hypertension Guidelines in Low- and Middle-Income Versus High-Income Countries: A Systematic Review

Hypertension, a leading cause of other cardiovascular diseases, is also a leading cause of disability and death worldwide.1 Over 1 billion people are diagnosed with hypertension, such that 1 in 3 individuals has elevated blood pressure in numerous countries.2 About 90% of the burden of cardiovascular disease is borne by the low-and middle-income countries (LMIC) that have only ≈10% of the research capacity and healthcare resources to confront the scourge.3 Hypertension had been regarded as a disease of the affluent people of the world.4,5 However, it has emerged in the LMIC where it affected ≈1 in 5 adults in 2013.5 This rate has been projected to increase such that 3 in 4 adults will be living with hypertension by 2025 in LMIC.6,7 Awareness and levels of hypertension control in LMIC are still low when compared with that in HIC.8 For instance, hypertension control in United States is 52% compared with 5% to 10% in Africa.9 The major reason for this disparity could be the lack of awareness of access and adherence to implementable hypertension guidelines in LMIC.10 Furthermore, hypertension management is complicated by choice, availability, and affordability of appropriate medications. The cultural aspects of life-long use of medications for hypertension, variable needs of individual patients, and inconsistent designs and outcomes from clinical trials have also compounded the management.11 The different genetic architectures of individuals with hypertension12,13 may determine the choice and response to treatment. Some of these antihypertensive agents are costly and not evenly accessible and distributed in LMIC. Therefore, guidelines that work in HIC settings may not be acceptable, effective, implementable, and applicable to LMIC because of the lack of supporting resources. In addition to broad international guidelines tailored to the needs …

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