Resource Library

Journal Articles

Trends in hypertension prevalence, awareness, treatment, and control in the Thai population, 2004 to 2020

A new study in BMC conducted and funded by RTSL’s partners in Thailand analyzes trends in hypertension prevalence, awareness, treatment, and control in Thailand over the past 15 years. Despite significant strides such as the adoption of universal health coverage, hypertension awareness and blood pressure control remain a challenge throughout Thailand. An urgent and concerted public health response is needed to improve diagnosis and control of hypertension to prevent premature deaths from this leading killer.

Resolve to Save Lives works closely with governments to improve heart health and save lives from high blood pressure, the world’s leading killer. Learn more here.

Improving hypertension care among private sector providers in India

Andrew E. Moran, et al.

A recent analysis authored by RTSL and our partners in India shows a lack of awareness among private sector providers in India that high blood pressure is a critical health threat. Providing prescriptions to patients is the first step in increasing medication availability and affordability. To encourage evidence-based hypertension care, the government and NGOs could implement strategies such as tailored incentives, financial rewards, tax benefits, accreditation, and recognition for private healthcare providers who prioritize controlling high blood pressure. Professional bodies in the private sector should establish programs emphasizing quality assurance and certifications in this area. Future research should focus on designing and testing new models for private sector hypertension service delivery.

front page of JAMA article on blood pressure positioning

Key Resource

Arm Position and Blood Pressure Readings: The ARMS Crossover Randomized Clinical Trial

Faulty blood pressure readings can put lives at risk. A new randomized clinical trial shows that commonly used arm positions (lap or side) result in substantially higher blood pressure readings which can lead to false diagnoses and over-treatment. To measure blood pressures accurately, the arm should be supported at heart level. The authors call for clinical guidelines to include this new evidence-based knowledge.

 

Key Points

Question  What is the effect of commonly used arm positions on blood pressure (BP) measurements compared to the standard, recommended position?

Findings  This crossover randomized clinical trial of 133 adults showed that supporting the arm on the lap overestimated systolic BP by 3.9 mm Hg and diastolic BP by 4.0 mm Hg. An unsupported arm at the side overestimated systolic BP by 6.5 mm Hg and diastolic BP by 4.4 mm Hg, with consistent results across subgroups.

Meaning  Commonly used, nonstandard arm positions during BP measurements substantially overestimate BP, highlighting the need for standardized positioning.

Abstract

Importance  Guidelines for blood pressure (BP) measurement recommend arm support on a desk with the midcuff positioned at heart level. Still, nonstandard positions are used in clinical practice (eg, with arm resting on the lap or unsupported on the side).

Objective  To determine the effect of different arm positions on BP readings.

Design, Setting, and Participants  This crossover randomized clinical trial recruited adults between the ages of 18 and 80 years in Baltimore, Maryland, from August 9, 2022, to June 1, 2023.

Intervention  Participants were randomly assigned to sets of triplicate BP measurements with the arm positioned in 3 ways: (1) supported on a desk (desk 1; reference), (2) hand supported on lap (lap), and (3) arm unsupported at the side (side). To account for intrinsic BP variability, all participants underwent a fourth set of BP measurements with the arm supported on a desk (desk 2).

Main Outcomes and Measures  The primary outcomes were the difference in differences in mean systolic BP (SBP) and diastolic BP (DBP) between the reference BP (desk 1) and the 2 arm support positions (lap and side): (lap or side − desk 1) − (desk 2 − desk 1). Results were also stratified by hypertensive status, age, obesity status, and access to health care within the past year.

Results  The trial enrolled 133 participants (mean [SD] age, 57 [17] years; 70 [53%] female); 48 participants (36%) had SBP of 130 mm Hg or higher, and 55 participants (41%) had a body mass index (calculated as weight in kilograms divided by height in meters squared) of 30 or higher. Lap and side positions resulted in statistically significant higher BP readings than desk positions, with the difference in differences as follows: lap, SBP Δ 3.9 (95% CI, 2.5-5.2) mm Hg and DBP Δ 4.0 (95% CI, 3.1-5.0) mm Hg; and side, SBP Δ 6.5 (95% CI, 5.1-7.9) mm Hg and DBP Δ 4.4 (95% CI, 3.4-5.4) mm Hg. The patterns were generally consistent across subgroups.

Conclusion and Relevance  This crossover randomized clinical trial showed that commonly used arm positions (lap or side) resulted in substantial overestimation of BP readings and may lead to misdiagnosis and overestimation of hypertension.

Trial Registration  ClinicalTrials.gov Identifier: NCT05372328

 

Decentralizing hypertension care in Punjab and Maharashtra States

BioMed Central Ltd

By bringing care delivery closer to communities, we can provide more people with access to quality care, improve hypertension control and save more lives. Our experts in India documented the decentralization process and its impact on patient outcomes in nine districts from 2018–2022.

Factors affecting patient retention to hypertension treatment in a North Indian State: A mixed-method study

Patient retention to hypertension treatment: A mixed-method study from North India

The Journal of Clinical Hypertension

Improving hypertension control requires patient retention to hypertension treatment, which requires ready access to care. This study highlights the need for improved primary care services and patient-centered services, including extended clinic hours and diagnostic facilities.

Experts from Resolve to Save Lives India analyzed patient retention rates in hypertension treatment using a mixed-method concurrent design in a North Indian district, considering socio-demographic characteristics and patient follow-up rates along with focus group discussions and in-depth interviews with health care providers and patients. Patient retention and blood pressure control were better at Health and Wellness Centers (HWCs) levels;  barriers such as medication side effects, pill burden, and limited health care access hindered patient retention and medication adherence, compromising hypertension control at higher-level facilities, notably among females.

“The decentralization process involved training, treatment protocol provision, supervision, and monitoring. Among 394,038 individuals registered with hypertension from 2018–2021, 69% were under care in 2022. Nearly half of those under care (129,720/273,355) received treatment from HWCs in 2022. Care of hypertensive individuals from district hospitals (14%), community health centres (20%), and primary health centres (24%) were decentralized to HWCs. Overall BP control rose from 20% (4,004/20,347) in 2019 to 58% (157,595/273,355) in 2022, while missed visits decreased from 61% (12,394/20,347) in 2019 to 26% (70,894/273,355) in 2022. This trend was consistent in both states. HWCs exhibited the highest BP control and the lowest missed visits throughout the study period compared to other facility types.”

Read the full study here.

Authors: Nidhi Jaswal PhD, Sonu Goel PhD, Kritika Upadhyay MPH, Anupam Khungar Pathni MBBS, Om Prakash Bera MPH, MBA, Vandana Shah LLM

Saving 100 million lives

Journal of Clinical Hypertension

Journal of Clinical Hypertension article on lifesaving potential of hypertension control, salt reduction and trans fat elimination

Annotated bibliography: Hypertension control

U.S. CDC

Annotated bibliography on hypertension control from the US CDC. Last updated in 2018.

Reducing Premature Mortality from Cardiovascular and Other Non-Communicable Diseases by One Third: Achieving Sustainable Development Goal Indicator 3.4.1

RTSL and Vital Strategies

A paper authored by Resolve to Save Lives and Vital Strategies highlights how the world is not currently on track to reach its SDG 3.4.1 goal to reduce premature death from NCDs, but that it’s possible. Progress will require improvements to access to quality health care and medications and financial protections for health programs in addition to accountability measures for specific, high-impact health outcomes.

 

Abstract

Non-communicable diseases (NCDs) are the world’s leading causes of death and disability, with cardiovascular disease (CVD) accounting for half of NCD deaths. An ambitious global target established by the United Nations Sustainable Development Goals – indicator 3.4.1 – aims to reduce the risk of premature death among people aged 30–69 years from CVD, cancer, diabetes, and chronic lung disease by one third by 2030. This article reviews the science and practice informing what is required to achieve this target, identifying seven interventions that can accelerate progress: 1) tobacco control; 2) treatment to reduce cardiovascular risk; 3) reduction of dietary sodium; 4) reduction of household air pollution; 5) elimination of artificial trans fat; 6) reduction of alcohol use; and 7) prevention, detection, and treatment of cancers. Achieving the target is possible – there has already been progress in some areas, particularly related to CVD reduction – but only if there is faster, more concerted action.