ROADMAP FOR HYPERTENSION - WORLD HEART FEDERATION Informing health systems approaches to CVD by prioritizing practical, proven, cost-effective action
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WORLD HEART FEDERATION ROADMAP FOR HYPERTENSION Informing health systems approaches to CVD by prioritizing practical, proven, cost-effective action
HYPERTENSION
2008 1 BILLION
600 MILLION
Complications
due to raised
blood pressure 1980 [WHO]
Known as the ‘silent killer’ ABOUT HYPERTENSION THE MAGNITUDE OF
Raised blood pressure is considered to be THE PROBLEM
because there are often no any systolic blood pressure greater than Due to the ageing and expanding global
symptoms until significant 115 mmHg. The level of blood pressure population, the size of the burden of
at which treatments have been shown complications due to raised blood pressure
damage has been done, to be effective in reducing risk is generally continues to rise; from 600 million people
raised blood pressure accepted as more than 140 mmHg affected in 1980 to 1 billion in 2008 [WHO].
systolic and 90 mmHg diastolic: this level Uncontrolled hypertension imposes an
accounts for about half is known as ‘hypertension’, the term used enormous economic burden on society, in
heart disease and stroke in this Roadmap. terms of both direct health care costs and
substantial productivity losses resulting from
related deaths. Despite this, Making lifestyle changes can reduce the risk disability and premature mortality.
there remain low levels of getting hypertension and help to lower it if
it is high. This includes eating a healthy diet
awareness, treatment and with plenty of fruit and vegetables, avoiding Common consequences of
control in all regions of harmful use of alcohol, being physically uncontrolled hypertension include:
active and maintaining a healthy weight.
the world. • Increased mortality and morbidity
• Increased risk of heart disease, heart
attack and stroke
• Life-threatening aneurysm
Reference: Adler AJ, Prabhakaran D, Bovet P, et al. Reducing Cardiovascular Mortality Through Prevention
• Reduced quality of life
and Management of Raised Blood Pressure: A World Heart Federation Roadmap. Glob Heart 2015;10: 111–22.
2
TREATMENT CASCADE FOR PATIENTS WITH HYPERTENSION
Patients with high blood pressure
Patients who know their blood pressure
Patients with hypertension being treated
PATIENT STORY: Patients with blood pressure
under control
HOW MY ACCIDENTAL DIAGNOSIS PUT Patient
adherence
ME ON THE PATH TO HEART HEALTH
“
Finding out I had healthily. In a few months I’d managed to lose and cholesterol levels under control. If I stop
around 5kg through diet and gentle exercise exercising I know that my blood pressure goes
hypertension was a but my blood pressure and cholesterol were up, so I’m determined to carry on so that my
shock. I’d always thought still too high. I bought myself a monitor so medicines can be kept at a low dose.
that I could keep track of what was helping
I was fairly healthy for my to lower my blood pressure. The answer was The fact that I’m still here and feeling better
age, and put anything out of exercise. I joined a gym and now, five year than before is all thanks to my optician for
later, I’ve managed to get my blood pressure insisting on that eye test.
the ordinary down to simply
getting older.
My diagnosis was completely accidental.
I thought I had an eye infection and had
called my optician to cancel my annual eye
test because of it. He insisted I came in, took a
look and told me that it wasn’t an infection…
it was burst blood vessels caused by high
blood pressure. I called my doctor, had a
blood pressure test straight away and was told
that I had hypertension. It turned out that my
cholesterol was also very high and the doctor
said I could have a heart attack or stroke at
any point.
My doctor prescribed some medications and
told me to lose weight, get more active and eat
3
HEALTH-SYSTEM
REQUIREMENTS TO ACHIEVE
RAISED BLOOD PRESSURE
MANAGEMENT TARGETS
Actions needed Individuals aware Priority Patients are
to achieve the they are at risk/ medicines* adherent
raised blood aware of their are prescribed to treatment
pressure target blood pressure plan
Human Availability of trained Availability of HCPs to prescribe HCPs aware that blood
resources HCPs to do screening recommendations at diagnosis pressure treatment is
and for long-term education nearly always for life
of HCPs on guidelines
Physical Calibrated sphygmometers Availability of priority interventions at community level*
resources Settings for opportunistic Healthcare-system facilities available and accessible to
screening patients when and where needed
Intellectual Availability of standardized Availability of practical and locally
resources guidelines for screening relevant clinical guidelines
Healthcare Opportunistic screening Healthcare organized to maximize existing resources to ensure
delivery efficiency in the interaction between HCPs and patients.
Adequate supply of affordable medications
Healthcare Patients aware that Interventions Patients aware and willing
recipient they are at risk/open culturally acceptable to follow recommendations.
to screening Patients understand that
recommendations are for life
Financing Free availability Patients can afford access to healthcare facilities
of screening Priority interventions are affordable to both the healthcare
system and the patient
Governance Adequate governance to Adequate political and regulatory framework supporting the
support screening strategy to implement and maintain priority interventions
A simple, timely, acceptable and representative information
Information Ability to link identified
system toprovide reliable data about the incidence, prognosis
System individuals with treatment
and quality of care of patients with hypertension or at high-risk
of hypertension
4
POTENTIAL SOLUTIONS
to overcome obstacles include:
• Educate general populations and carry out • Invest in e-health technology
opportunistic screening • Promote use of inexpensive, good-quality
• Educate health care professionals on risk and • generic medications
guidelines • Conduct education campaigns to encourage
• Promote task sharing to increase availability adherence to treatments
of professionals
• Develop simple, practical guidelines and
clinical decision support systems
THE GAP Only 1 in 10
hypertension patients have
the condition
under control
(i.e.
TAKING ACTION
AGAINST HYPERTENSION
A global framework for regional and national action, WHF Roadmaps are now being used to
convene country-specific Roundtables through WHF and our Members. They are gathering
relevant stakeholders to identify obstacles and potential solutions that are relevant to their
settings, and produce national plans.
6“
ADAPTING THE HYPERTENSION As a direct result of the WHF Hypertension
ROADMAP IN KENYA Roadmap and Roundtable, four clear calls to Roadmaps are scientific
action were agreed in Kenya. documents for translating
The need to address hypertension in Kenya
The Ministry of Health (MoH) then requested
science into policy. They
is urgent. According to Professor Elijah Ogola, help all people to get the
that WHF and KCS collaborate to disseminate
PASCAR Secretary General: “An estimated
and implement the Kenya National Guidelines best science for promoting
75% of Kenyans who live with hypertension
for CVD Management. Together, we are now health, for preventing and
do not know they suffer from it, and only 4%
working to achieve this and by the end of 2019 controlling disease, and
are controlled.”
will have reached 15 trainers, 2000 health
workers, 100 health facilities and 10,000 people for rehabilitating patients.
To drive action, WHF in partnership with our
Member the Kenya Cardiac Society (KCS) living with cardiovascular disease. It is time for ‘Health in All
convened a Roundtable bringing together Policies’ worldwide. As not
From the starting part of the WHF
representatives from the Ministry of Health and
country health directorates, primary health care,
civil society, the private sector, academia and
faith-based organizations.
Hypertension Roadmap and Roundtable,
we have been able to empower key national
stakeholders to achieve real progress in the
only doctors but also world
citizens, we are proud to
be part of this World Heart
“
fight against CVD in Kenya. Federation initiative.
Drawing on the WHF Hypertension Roadmap,
the Roundtable focused on a pressing need DANIEL PINIERO
to put people living with CVD at the centre of Roadmap Liaison Officer to the
hypertension prevention and management World Heart Federation Board
by involving communities in gathering health
data, exploring public-private partnerships
and rethinking financing for healthcare. Real
concerns were also raised around funding
and the need to better enable all levels of the
health care system to achieve diagnosis and
appropriate treatment of hypertension.
THE CALL TO ACTION AGREED IN KENYA
Ongoing work with our partners,
Empower people living with NCDs e.g. NCD Alliance, Global
Coalition for Circulatory Health
Establish a national registry for NCDs Dissemination of cardiovascular
guidelines with MoH
Create an enabling environment for National Roundtable on task shifting and
task-sharing in the management of development of curriculum to develop
cardiovascular diseases competencies and skills on task shifting
Tax unhealthy commodities and Ongoing advocacy work on
allocate those revenues to healthcare for innovative financing for health
people living with CVD and other NCDs
7WORLD HEART FEDERATION
ROADMAPS
Already the world’s number one killer, Health resources are limited and so cost-
deaths from cardiovascular disease (CVD) effective interventions for the prevention,
are increasing globally. CVD and related detection and management of CVD must be
conditions can be detected early and prioritized in order to plan effective health
treated cost-effectively, preventing costly systems responses.
hospitalizations and death. But this requires
coordinated national policy and health
systems responses built around evidence-
based strategies.
WHAT ARE ROADMAPS?
WHF Roadmaps are a global framework that are adapted and used at national or regional level.
THEIR PURPOSE IS TO:
1.S
ummarize current CVD recommendations that are proven, practical and cost effective
2. Highlight obstacles to implementing these recommendations
3. Propose potential solutions for overcoming these obstacles
4. Provide tools and strategies to adapt solutions to local needs
HOW DO THEY WORK? • Roundtables with multiple stakeholders These involve diverse stakeholders, such as:
WHF Roadmaps offer a global framework, to discuss obstacles, solutions and • Governments and policy makers
tools and solutions that are then used and appropriate strategies
• NGOs, health activists and advocates
adapted, through stakeholder collaboration, • A plan to implement and evaluate the
to meet the specific needs of individual • Healthcare professionals
proposed strategies
regions and nations. • Corporate entities
• Academic and research institutions
This requires: WHO ARE THEY FOR?
• A situation analysis of the current health WHF Roadmaps empower our Members,
including CVD foundations, societiesand patient
WHY ARE THEY IMPORTANT?
system based on tools such as WHF To trigger effective action that can measurably
CVD Scorecards associations, to lead country specific, action-
reduce premature deaths and the associated
oriented initiatives, including Roundtables.
global economic burden caused by CVD.
TO DOWNLOAD THE FULL ROADMAP PLEASE VISIT – CVDROADMAPS.ORG
WORLD HEART FEDERATION
/worldheartfederation
32, rue de Malatrex, 1201 Geneva, Switzerland
(+41 22) 807 03 20 /worldheartfed
info@worldheart.org
/world-heart-federation
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