About this Research Topic
Hypertension is a major risk factor for cardiovascular disease and premature death worldwide. Of the estimated 1.13 billion people who suffer from hypertension, two-thirds are living in low and middle-income countries (LMICs). The latter statistics underscore that the disease is driven by socio-economic rather than genetic or pathophysiologic factors.
Despite major advances in pharmacological treatment; increased efficacy, fewer side-effects, and preventive strategies, worldwide the prevalence of hypertension has increased from 594 million in 1975 to 1.13 billion in 2015. More concerning is that approximately a third of people with hypertension are undiagnosed, and of those diagnosed, around half are non-adherent of antihypertensive medications. Globally, fewer than 1 in 5 people with hypertension meet guidelines of hypertension control.
This data summons a call to action, and solicitation of clinical research investigations to address and revisit the current hypertension management strategies. Identification of the areas that have a scope of improvement, with a focus on reducing disparities in diagnosis and management of hypertension in lower socioeconomic populations also needs to be investigated.
Since poor adherence to treatment is a serious challenge that partly accounts for the inability to achieve management targets, particularly in lower socioeconomic strata. Local media, opinions of friends and family about disease and medication are a few factors that may influence adherence but have not been rigorously studied. We propose to solicit articles on approaches to improve adherence to therapy and access to diagnosis and treatment, especially in LMICs.
In addition, the benefits of technology usage in the detection and management of hypertension especially in conjunction with co-interventions, such as medication titration or education/lifestyle counselling are understudied and need to be explored further.
Also, the rising burden of hypertension in LMICs, calls for consideration of easily accessible and culturally acceptable pharmacological and non-pharmacological interventions that may also prove to be an affordable health resource in the LMICs. However, there is a dearth of research on their efficacy and side effects, and the published data lacks scientific rigor. Additional evidence through well-designed scientific studies and critical re-evaluation of previously available evidence is required so that precise information could be disseminated, and recommendations could be developed for the safe and effective use of these interventions in LMICs.
Furthermore, the growing evidence of psychosocial stress in the pathogenesis of hypertension makes it imperative to collect more evidence for the interventions (such as yoga, meditation-Chi, mindfulness, etc.) that may reduce psychosocial stress and blood pressure. Also, the efficacy of some dietary supplements such as garlic, cocoa, vitamin C, coenzyme Q10, omega-3 fatty acids, and magnesium that are suggested to lower BP need to be supplemented with more evidence.
In summary, we would like to call for original clinical research articles, controlled trials, observational studies, systematic reviews and meta-analyses on:
1. Efficacy, adherence, side-effects, accessibility and affordability of pharmacological and under-studied non-pharmacological interventions.
2. Strategies including self-monitoring and use of technology to improve access to diagnosis and management of hypertension.
3. Comparative studies of pharmacological and non-pharmacological management of earlier stages of hypertension.
Keywords: hypertension, adherence, management, lower middle income countries, interventions, pharmacological, non pharmacological
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