Chile: where action against hypertension saves lives – PAHO / WHO
August 25, 2021 – In Chile, more people die from cardiovascular disease than from any other cause. More than a quarter of all deaths each year about 30,000 in total ̶ are due to disease.
Hypertension – also known as high blood pressure – is a serious illness and a key risk factor for cardiovascular disease. People with hypertension have constantly increased the pressure in their blood vessels, causing their hearts to work much harder.
Most people with hypertension are unaware of the condition because there are usually no warning signs or symptoms. This is why it is sometimes called the “silent killer”. Although hypertension can be detected quickly and easily by a healthcare professional, far too many people are unaware that they have the condition or that they are at risk.
About one in four men and one in five women live with hypertension in Chile, the equivalent of more than four million people. Fortunately, hypertension rates have steadily declined over the past few years.
This decline is the result of sustained action on non-communicable diseases over a period of several decades in Chile. Hypertension was at the center of the first national chronic disease control program carried out in the country’s primary health centers, and since the mid-1980s the country has strived to improve detection and control rates. .
Since the turn of this century, Chile has conducted three national health surveys that collect population data on hypertension. Data were collected on awareness, prevalence, treatment coverage and types of drugs, as well as levels of hypertension control. A recent analysis of these surveys revealed that hypertension rates have declined steadily since the first survey. Following the creation of national targets, levels of controlled hypertension have more than doubled.
More recently, hypertension was included in Chile’s universal health coverage plan called “AUGE” (universal access with explicit guarantees). This plan gives formal guarantees to people with hypertension on access to quality care as well as protection against financial hardship due to health care costs.
In 2013, the Pan American Health Organization (PAHO), with support from the United States Centers for Disease Control and Prevention, collaborated with Chile’s Ministry of Health to implement an innovative treatment project in two hypertension clinics. This project used an algorithm to treat hypertension that made drugs both more available and affordable; set up clinical registries to monitor hypertensive patients; and promoted “task sharing” – the process by which local health workers provided services that would otherwise only be available at specialist clinics. This initiative made it possible to improve the management of hypertension at the level of primary health care.
According to Dr. Pedro Ordunez, Chronic Disease Advisor at PAHO, this innovative work has had three main benefits:
First, clinics have achieved higher rates of blood pressure control in people with hypertension. Second, patient data is used to provide feedback to local health centers on how their hypertension services are performing. And third, the project has led to policy improvements in the way hypertension medications are delivered, including a fixed-dose combination drug pilot project that has improved drug adherence. “
Global Hearts Initiative
More recently, Chile was one of the first countries to adopt the WHO Global Hearts Initiative. Since its introduction, the HEARTS technical package has provided standardized treatment for hypertension to three million people in 18 low- and middle-income countries. Sixteen of these countries are in the Pan American Region, with more than 700 health centers involved. PAHO’s technical support to ministries of health in the Region, through the HEARTS in the Americas Initiative, helps countries like Chile adopt global best practices for managing hypertension.
As a result of HEARTS, more than half of health services in Chile use guidelines for the management of cardiovascular disease. And a similar proportion of primary health care sites offer “risk stratification” – a tool to identify those most vulnerable to heart disease so that they can receive tailored interventions. In addition to reducing the rates of hypertension, these activities have made it possible to advance in the control of hypertension at the population level in Chile.
Yet to come
Dr Anselm Hennis, Director of Noncommunicable Diseases at PAHO, said the results achieved in Chile so far can serve as a model for other countries in the Region:
“The declining prevalence of hypertension in Chile is the result of a sustained commitment to action against noncommunicable diseases. By combining evidence, investment and political priority, Chile shows us that many of the measures to improve hypertension control not only already exist, but are also effective. Chile continues to serve as a shining example of how countries can advance hypertension control, which will benefit not only people with hypertension, but also their families, communities and society ”.
Yet action against hypertension is not only essential to prevent more deaths from cardiovascular disease in Chile, but also to improve the quality of life for the four million people in the country who still live with hypertension. For this reason, Chile’s Ministry of Health is committed to adopting HEARTS in all primary health care centers by 2030.
In September 2017, WHO began a partnership with Resolve to Save Lives, an initiative of Vital Strategies, to help national governments implement the Global Hearts Initiative. Other partners contributing to the Global Hearts Initiative are: CDC Foundation, Global Health Advocacy Incubator, Johns Hopkins Bloomberg School of Public Health, PAHO, and US Centers for Disease Control and Prevention. Since the program’s implementation in 2017 in 18 low- and middle-income countries, 3 million people have received protocol-based hypertension treatment through person-centered models of care. These programs demonstrate the feasibility and effectiveness of standardized hypertension control programs.