Evaluating the Hypertension Cascade of Care in Adults in Urban Lao PDR: Evidence From the VITERBI Cohort Study

Georg Loss,1,2 Jordyn T Wallenborn,1,2 Miley Sinantha-Hu,1,2 Vattahanaphone Ouipoulikoune,3 Nicole Probst-Hensch,1,2 Sengchanh Kounnavong,3 Somphou Sayasone,3 Peter Odermatt,1,2 Günther Fink1,2 1Swiss Tropical and Public Health Institute, Allschwil, Switzerland; 2University of Basel, Basel, Switzerland; 3Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People’s Democratic RepublicCorrespondence: Georg Loss, Swiss Tropical and Public Health Institute (Swiss TPH), Department of Epidemiology & Public Health, Kreuzstrasse 2, Allschwil, CH-4123, Switzerland, Email [email protected]: Hypertension (HT) is a major risk factor for adult morbidity and mortality in low- and middle-income countries and little is known regarding the distribution of HT risk and treatment access within urban areas.Patients and methods: We used data from the Vientiane Multi-Generational Birth Cohort in urban Lao PDR to assess the prevalence of loss and retention across five stages of HT care for 40+ year old adults: i) prevalence of hypertension, ii) hypertensives who ever had their BP measured by a health care professional, iii) hypertensives ever diagnosed with HT by a professional, iv) patients currently treated with HT medication, and v) patients with currently controlled BP. We estimated associations between sociodemographic and lifestyle predictors and the proportion of participants who reached each care cascade step using mutually adjusted Poisson regression modeling.Results: Among the 3196 participants aged 40 to 99 years, the overall prevalence of HT was 16.3%, with higher rates for women, people over 60 years, peripheral district residents, low educated, widowed, and obese. Among people with HT, 90.2% ever had their BP measured by a health care professional, 69.3% ever received a HT diagnosis, 60.9% HT were currently on (drug) treatment, and 39.5% had currently controlled BP. The largest cascade of care losses occurred at the diagnosis and control stages with better outcomes for women. While central districts showed higher rates of diagnosis, control levels were lower than in peripheral districts, but there these differences appeared to be explained by adjusting for sociodemographic and lifestyle factors.Conclusion: While HT prevalence in Lao PDR is lower than reported for other LMICs, more than 16% over the age of 40 years suffer from HT, and 60% of these cases are currently not controlled. Major policy efforts are needed to support this population and to prevent HT-driven excess mortality.Keywords: blood pressure, hypertension, hypertension care cascade, Lao People’s Democratic Republic