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Uncovering Endemic Heart Failure and Hypertension in Low- and Middle-Income Countries: Challenges and Opportunities

Year: 2022

Type: editorial

Abstract: Hypertension, prevalent in over one billion people worldwide, is a major risk factor for the development of heart failure (HF), and is the largest driver of morbidity and mortality worldwide.1 Approximately 65% of hypertensive patients live in low-and middle-income countries (LMICs), where poverty, nutritional deficiencies, exposure to air pollution, and limited access to health care among others result in high prevalence, and reduced diagnosis, treatment, and control.In LMICs, as in Haiti, hypertension prevalence is around 30-45% among adults over age 30 years --higher than in high-income countries.[2][3][4] Among hospitalbased studies in LMICs, hypertension is a major cause of HF.It has long been unclear what is the population prevalence of HF in LMICs with high rates of hypertension.Trends in countries with more complete surveillance systems can prime our understanding.While age-adjusted mortality for overall cardiovascular disease (CVD) have decreased in the U.S. since the 1970s, mostly attributed to lower coronary heart disease, there has been a recent increase in hypertension, HF, and hypertensive heart disease (HHD, defined as clinical HF and diagnosis of hypertension). 5 The proportion of CVD deaths attributed to ischemic heart disease during 1999-2018 decreased (from 73% to 56%), whereas the proportion attributed to both HF and HHD increased (from 8% to 13%, and from 4% to 9%, respectively) during the same period.5 Furthermore, HF with preserved ejection fraction (HFpEF), which is frequently preceded by hypertension, has become more prevalent than HF with reduced ejection fraction (HFrEF).HFpEF particularly affects blacks and younger adults with hypertension, and is also a major cause of hospitalization for women with prior preeclampsia.6 Well-designed cohort studies and surveillance systems in LMICs are needed to investigate the consequences of hypertension and its effects on HF.

Source: Circulation Cardiovascular Quality and Outcomes

DOI: 10.1161/circoutcomes.122.009611

Authors: Gene F. Kwan, Victor G. Davila-Roman

Institutions: Boston University, Boston Medical Center, Partners In Health, Harvard University, Washington University in St. Louis

Language: English

Topic: Heart Failure Treatment and Management

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: green

Funders: National Heart, Lung, and Blood Institute, Fogarty International Center