Availability and affordability of blood pressure-lowering medicines and the effect on blood pressure control in high-income, middle-income, and low-income countries: an analysis of the PURE study data

Background Hypertension is considered the most important risk factor for cardiovascular diseases, but its control is poor worldwide. We aimed to assess the availability and affordability of blood pressure-lowering medicines, and the association with use of these medicines and blood pressure control...

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Published in:The Lancet Public Health
Main Author: Attaei M.W.; Khatib R.; McKee M.; Lear S.; Dagenais G.; Igumbor E.U.; AlHabib K.F.; Kaur M.; Kruger L.; Teo K.; Lanas F.; Yusoff K.; Oguz A.; Gupta R.; Yusufali A.M.; Bahonar A.; Kutty R.; Rosengren A.; Mohan V.; Avezum A.; Yusuf R.; Szuba A.; Rangarajan S.; Chow C.; Yusuf S.; O'Donnell M.; Mente A.; Leong D.; Smyth A.; Joseph P.; Islam S.; Zhang M.; Hu W.; Ramasundarahettige C.; Wong G.; Dayal L.; Casanova A.; Dehghan M.; Lewis G.; Aliberti A.; Reyes A.; Zaki A.; Lewis B.; Zhang B.; Agapay D.; Hari D.; Milazzo E.; Ramezani E.; Hussain F.; Shifaly F.; Kay I.; Rimac J.; Swallow J.; Heldman L.; Mushtaha M.; Mushtaha M.; Trottier M.; Aoucheva N.; Kandy N.; Mackie P.; Solano R.; Chin S.; Ramacham S.; Shahrook S.; Trottier S.; Tongana T.; ElSheikh W.; Lindeman J.; McQueen M.; Hall K.; Keys J.; Wang X.; Keneth J.; Devanath A.; Diaz R.; Orlandini A.; Linetsky B.; Toscanelli S.; Casaccia G.; Maini Cuneo J.M.; Rahman O.; Azad A.K.; Rabbani K.A.; Cherry H.M.; Mannan A.; Hassan I.; Talukdar A.T.; Tooheen R.B.; Khan M.U.; Sintaha M.; Choudhury T.; Haque R.; Parvin S.; Oliveira G.B.; Marcilio C.S.; Mattos A.C.; Dejesus J.; Poirier P.; Turbide G.; Auger D.; De Bluts A.L.; Proulx M.C.; Cayer M.; Bonneville N.; Gasevic D.; Corber E.; de Jong V.; Vukmirovich I.; Wielgosz A.; Fodor G.; Pipe A.; Shane A.; Seron P.; Martinez S.; Valdebenito A.; Oliveros M.; Wei L.; Lisheng L.; Chunming C.; Xingyu W.; Wenhua Z.; Hongye Z.; JiaXuan; Bo H.; Yi S.; Jian B.; Xiuwen Z.; Xiaohong C.; Tao C.; Hui C.; Qing D.; Xiaoru C.; Xinye H.; JiaXuan; Jian L.; Juan L.; Xu L.; Bing R.; Wei W.; Yang W.; Jun Y.; Yi Z.; Manlu Z.; Fanghong L.; Jianfang W.; Yindong L.; Yan H.; Liangqing Z.; Baoxia G.; Xiaoyang L.; Shiying Z.; BianRongwen; TianXiuzhen; Dong L.; Di C.; Jianguo W.; Yize X.; Tianlu L.; Peng Z.; Changlin D.; Ning L.; Xiaolan M.; Yuqing Y.; Rensheng L.; Minfan F.; Jing H.; Yu L.; Xiaojie X.; Qiang Z.; Lopez-Jaramillo P.; Lopez P.C.; Garcia R.; Jurado L.J.A.; Gómez-Arbeláez D.; Arguello J.F.; Dueñas R.; Silva S.; Pradilla L.P.; Ramirez F.; Molina D.I.; Cure-Cure C.; Perez M.; Hernandez E.; Arcos E.; Fernandez S.; Narvaez C.; Paez J.; Sotomayor A.; Garcia H.; Sanchez G.; David T.; Rico A.; Mony P.; Vaz M.; Bharathi A.V.; Swaminathan S.; Shankar K.; Kurpad A.V.; Jayachitra K.G.; Kumar N.; Hospital H.A.L.; Deepa M.; Parthiban K.; Anitha M.; Hemavathy S.; Rahulashankiruthiyayan T.; Anitha D.; Sridevi K.; Panwar R.B.; Mohan I.; Rastogi P.; Rastogi S.; Bhargava R.; Kumar R.; Thakur J.S.; Patro B.; Lakshmi P.V.M.; Mahajan R.; Chaudary P.; Vijayakumar K.; Ajayan K.; Rajasree G.; Renjini A.R.; Deepu A.; Sandhya B.; Asha S.; Soumya H.S.; Kelishadi R.; Mohammadifard N.; Heidari H.; Ismail T.S.T.; Ng K.K.; Devi A.; Nasir N.M.; Yasin M.M.; Miskan M.; Rahman E.A.; Arsad M.K.M.; Ariffin F.; Razak S.A.; Majid F.A.; Bakar N.A.; Yacob M.Y.; Zainon N.; Salleh R.; Ramli M.K.A.; Halim N.A.; Norlizan S.R.; Ghazali N.M.; Arshad M.N.; Razali R.; Ali S.; Othman H.R.; Hafar C.; Pit A.; Danuri N.; Basir F.; Zahari S.N.A.; Abdullah H.; Arippin M.A.; Zakaria N.A.; Noorhassim I.; Hasni M.J.; Azmi M.T.; Zaleha M.I.; Hazdi K.Y.; Rizam A.R.; Sazman W.; Azman A.; Khammash U.; Khatib A.; Giacaman R.; Iqbal R.; Afridi A.; Khawaja R.; Raza A.; Kazmi K.; Dans A.; Co H.U.; Sanchez J.T.; Pudol L.; Zamora-Pudol C.; Palileo-Villanueva L.A.M.; Aquino M.R.; Abaquin C.; Cabral M.L.; Zatonski W.; Zatonska K.; Ilow# R.; Ferus M.; Regulska-Ilow B.; Różańska D.; Wolyniec M.; Hersi A.; Kashour T.; Alfaleh H.; Alshamiri M.; Altaradi H.B.; Alnobani O.; Bafart A.; Alkamel N.; Ali M.; Abdulrahman M.; Nouri R.; Kruger A.; Voster H.H.; Schutte A.E.; Wentzel-Viljoen E.; Eloff F.C.; de Ridder H.; Moss H.; Potgieter J.; Roux A.A.; Watson M.; de Wet G.; Olckers A.; Jerling J.C.; Pieters M.; Hoekstra T.; Puoane T.; Tsolekile L.; Sanders D.; Ilow P.; Steyn N.; Peer N.; Mayosi B.; Rayner B.; Lambert V.; Levitt N.; Kolbe-Alexander T.; Ntyintyane L.; Hughes G.; Swart R.; Fourie J.; Muzigaba M.; Xapa S.; Gobile N.; Ndayi K.; Jwili B.; Ndibaza K.; Egbujie B.; Boström K.B.; Lindblad U.; Langkilde P.; Gustavsson A.; Andreasson M.; Snällman M.; Wirdemann L.; Pettersson K.; Moberg E.; Yeates K.; Sleeth J.; Kilonzo K.; Akalin A.A.K.; Calik K.B.T.; Imeryuz N.; Temizhan A.; Alphan E.; Gunes E.; Sur H.; Karsidag K.; Gulec S.; Altuntas Y.; Almahmeed W.; Swidan H.; Darwish E.A.; Hashemi A.R.A.; Al-Khaja N.; Muscat-Baron J.M.; Ahmed S.H.; Mamdouh T.M.; Darwish W.M.; Abdelmotagali M.H.S.; Awed S.O.; Movahedi G.A.; Shaibani H.A.; Gharabou R.I.M.; Youssef D.F.; Nawati A.Z.S.; Salah Z.A.; Abdalla R.F.E.; Shuwaihi S.A.; Omairi M.A.; Cadigal O.D.; Alejandrino R.S.; Chifamba J.; Gwaunza L.; Terera G.; Mahachi C.; Murambiwa P.; Machiweni T.; Mapanga R.
Format: Article
Language:English
Published: Elsevier Ltd 2017
Online Access:https://www.scopus.com/inward/record.uri?eid=2-s2.0-85028775982&doi=10.1016%2fS2468-2667%2817%2930141-X&partnerID=40&md5=ff1a95df70c52d86625734c64d5ecf92
id 2-s2.0-85028775982
author Attaei M.W.; Khatib R.; McKee M.; Lear S.; Dagenais G.; Igumbor E.U.; AlHabib K.F.; Kaur M.; Kruger L.; Teo K.; Lanas F.; Yusoff K.; Oguz A.; Gupta R.; Yusufali A.M.; Bahonar A.; Kutty R.; Rosengren A.; Mohan V.; Avezum A.; Yusuf R.; Szuba A.; Rangarajan S.; Chow C.; Yusuf S.; O'Donnell M.; Mente A.; Leong D.; Smyth A.; Joseph P.; Islam S.; Zhang M.; Hu W.; Ramasundarahettige C.; Wong G.; Dayal L.; Casanova A.; Dehghan M.; Lewis G.; Aliberti A.; Reyes A.; Zaki A.; Lewis B.; Zhang B.; Agapay D.; Hari D.; Milazzo E.; Ramezani E.; Hussain F.; Shifaly F.; Kay I.; Rimac J.; Swallow J.; Heldman L.; Mushtaha M.; Mushtaha M.; Trottier M.; Aoucheva N.; Kandy N.; Mackie P.; Solano R.; Chin S.; Ramacham S.; Shahrook S.; Trottier S.; Tongana T.; ElSheikh W.; Lindeman J.; McQueen M.; Hall K.; Keys J.; Wang X.; Keneth J.; Devanath A.; Diaz R.; Orlandini A.; Linetsky B.; Toscanelli S.; Casaccia G.; Maini Cuneo J.M.; Rahman O.; Azad A.K.; Rabbani K.A.; Cherry H.M.; Mannan A.; Hassan I.; Talukdar A.T.; Tooheen R.B.; Khan M.U.; Sintaha M.; Choudhury T.; Haque R.; Parvin S.; Oliveira G.B.; Marcilio C.S.; Mattos A.C.; Dejesus J.; Poirier P.; Turbide G.; Auger D.; De Bluts A.L.; Proulx M.C.; Cayer M.; Bonneville N.; Gasevic D.; Corber E.; de Jong V.; Vukmirovich I.; Wielgosz A.; Fodor G.; Pipe A.; Shane A.; Seron P.; Martinez S.; Valdebenito A.; Oliveros M.; Wei L.; Lisheng L.; Chunming C.; Xingyu W.; Wenhua Z.; Hongye Z.; JiaXuan; Bo H.; Yi S.; Jian B.; Xiuwen Z.; Xiaohong C.; Tao C.; Hui C.; Qing D.; Xiaoru C.; Xinye H.; JiaXuan; Jian L.; Juan L.; Xu L.; Bing R.; Wei W.; Yang W.; Jun Y.; Yi Z.; Manlu Z.; Fanghong L.; Jianfang W.; Yindong L.; Yan H.; Liangqing Z.; Baoxia G.; Xiaoyang L.; Shiying Z.; BianRongwen; TianXiuzhen; Dong L.; Di C.; Jianguo W.; Yize X.; Tianlu L.; Peng Z.; Changlin D.; Ning L.; Xiaolan M.; Yuqing Y.; Rensheng L.; Minfan F.; Jing H.; Yu L.; Xiaojie X.; Qiang Z.; Lopez-Jaramillo P.; Lopez P.C.; Garcia R.; Jurado L.J.A.; Gómez-Arbeláez D.; Arguello J.F.; Dueñas R.; Silva S.; Pradilla L.P.; Ramirez F.; Molina D.I.; Cure-Cure C.; Perez M.; Hernandez E.; Arcos E.; Fernandez S.; Narvaez C.; Paez J.; Sotomayor A.; Garcia H.; Sanchez G.; David T.; Rico A.; Mony P.; Vaz M.; Bharathi A.V.; Swaminathan S.; Shankar K.; Kurpad A.V.; Jayachitra K.G.; Kumar N.; Hospital H.A.L.; Deepa M.; Parthiban K.; Anitha M.; Hemavathy S.; Rahulashankiruthiyayan T.; Anitha D.; Sridevi K.; Panwar R.B.; Mohan I.; Rastogi P.; Rastogi S.; Bhargava R.; Kumar R.; Thakur J.S.; Patro B.; Lakshmi P.V.M.; Mahajan R.; Chaudary P.; Vijayakumar K.; Ajayan K.; Rajasree G.; Renjini A.R.; Deepu A.; Sandhya B.; Asha S.; Soumya H.S.; Kelishadi R.; Mohammadifard N.; Heidari H.; Ismail T.S.T.; Ng K.K.; Devi A.; Nasir N.M.; Yasin M.M.; Miskan M.; Rahman E.A.; Arsad M.K.M.; Ariffin F.; Razak S.A.; Majid F.A.; Bakar N.A.; Yacob M.Y.; Zainon N.; Salleh R.; Ramli M.K.A.; Halim N.A.; Norlizan S.R.; Ghazali N.M.; Arshad M.N.; Razali R.; Ali S.; Othman H.R.; Hafar C.; Pit A.; Danuri N.; Basir F.; Zahari S.N.A.; Abdullah H.; Arippin M.A.; Zakaria N.A.; Noorhassim I.; Hasni M.J.; Azmi M.T.; Zaleha M.I.; Hazdi K.Y.; Rizam A.R.; Sazman W.; Azman A.; Khammash U.; Khatib A.; Giacaman R.; Iqbal R.; Afridi A.; Khawaja R.; Raza A.; Kazmi K.; Dans A.; Co H.U.; Sanchez J.T.; Pudol L.; Zamora-Pudol C.; Palileo-Villanueva L.A.M.; Aquino M.R.; Abaquin C.; Cabral M.L.; Zatonski W.; Zatonska K.; Ilow# R.; Ferus M.; Regulska-Ilow B.; Różańska D.; Wolyniec M.; Hersi A.; Kashour T.; Alfaleh H.; Alshamiri M.; Altaradi H.B.; Alnobani O.; Bafart A.; Alkamel N.; Ali M.; Abdulrahman M.; Nouri R.; Kruger A.; Voster H.H.; Schutte A.E.; Wentzel-Viljoen E.; Eloff F.C.; de Ridder H.; Moss H.; Potgieter J.; Roux A.A.; Watson M.; de Wet G.; Olckers A.; Jerling J.C.; Pieters M.; Hoekstra T.; Puoane T.; Tsolekile L.; Sanders D.; Ilow P.; Steyn N.; Peer N.; Mayosi B.; Rayner B.; Lambert V.; Levitt N.; Kolbe-Alexander T.; Ntyintyane L.; Hughes G.; Swart R.; Fourie J.; Muzigaba M.; Xapa S.; Gobile N.; Ndayi K.; Jwili B.; Ndibaza K.; Egbujie B.; Boström K.B.; Lindblad U.; Langkilde P.; Gustavsson A.; Andreasson M.; Snällman M.; Wirdemann L.; Pettersson K.; Moberg E.; Yeates K.; Sleeth J.; Kilonzo K.; Akalin A.A.K.; Calik K.B.T.; Imeryuz N.; Temizhan A.; Alphan E.; Gunes E.; Sur H.; Karsidag K.; Gulec S.; Altuntas Y.; Almahmeed W.; Swidan H.; Darwish E.A.; Hashemi A.R.A.; Al-Khaja N.; Muscat-Baron J.M.; Ahmed S.H.; Mamdouh T.M.; Darwish W.M.; Abdelmotagali M.H.S.; Awed S.O.; Movahedi G.A.; Shaibani H.A.; Gharabou R.I.M.; Youssef D.F.; Nawati A.Z.S.; Salah Z.A.; Abdalla R.F.E.; Shuwaihi S.A.; Omairi M.A.; Cadigal O.D.; Alejandrino R.S.; Chifamba J.; Gwaunza L.; Terera G.; Mahachi C.; Murambiwa P.; Machiweni T.; Mapanga R.
spellingShingle Attaei M.W.; Khatib R.; McKee M.; Lear S.; Dagenais G.; Igumbor E.U.; AlHabib K.F.; Kaur M.; Kruger L.; Teo K.; Lanas F.; Yusoff K.; Oguz A.; Gupta R.; Yusufali A.M.; Bahonar A.; Kutty R.; Rosengren A.; Mohan V.; Avezum A.; Yusuf R.; Szuba A.; Rangarajan S.; Chow C.; Yusuf S.; O'Donnell M.; Mente A.; Leong D.; Smyth A.; Joseph P.; Islam S.; Zhang M.; Hu W.; Ramasundarahettige C.; Wong G.; Dayal L.; Casanova A.; Dehghan M.; Lewis G.; Aliberti A.; Reyes A.; Zaki A.; Lewis B.; Zhang B.; Agapay D.; Hari D.; Milazzo E.; Ramezani E.; Hussain F.; Shifaly F.; Kay I.; Rimac J.; Swallow J.; Heldman L.; Mushtaha M.; Mushtaha M.; Trottier M.; Aoucheva N.; Kandy N.; Mackie P.; Solano R.; Chin S.; Ramacham S.; Shahrook S.; Trottier S.; Tongana T.; ElSheikh W.; Lindeman J.; McQueen M.; Hall K.; Keys J.; Wang X.; Keneth J.; Devanath A.; Diaz R.; Orlandini A.; Linetsky B.; Toscanelli S.; Casaccia G.; Maini Cuneo J.M.; Rahman O.; Azad A.K.; Rabbani K.A.; Cherry H.M.; Mannan A.; Hassan I.; Talukdar A.T.; Tooheen R.B.; Khan M.U.; Sintaha M.; Choudhury T.; Haque R.; Parvin S.; Oliveira G.B.; Marcilio C.S.; Mattos A.C.; Dejesus J.; Poirier P.; Turbide G.; Auger D.; De Bluts A.L.; Proulx M.C.; Cayer M.; Bonneville N.; Gasevic D.; Corber E.; de Jong V.; Vukmirovich I.; Wielgosz A.; Fodor G.; Pipe A.; Shane A.; Seron P.; Martinez S.; Valdebenito A.; Oliveros M.; Wei L.; Lisheng L.; Chunming C.; Xingyu W.; Wenhua Z.; Hongye Z.; JiaXuan; Bo H.; Yi S.; Jian B.; Xiuwen Z.; Xiaohong C.; Tao C.; Hui C.; Qing D.; Xiaoru C.; Xinye H.; JiaXuan; Jian L.; Juan L.; Xu L.; Bing R.; Wei W.; Yang W.; Jun Y.; Yi Z.; Manlu Z.; Fanghong L.; Jianfang W.; Yindong L.; Yan H.; Liangqing Z.; Baoxia G.; Xiaoyang L.; Shiying Z.; BianRongwen; TianXiuzhen; Dong L.; Di C.; Jianguo W.; Yize X.; Tianlu L.; Peng Z.; Changlin D.; Ning L.; Xiaolan M.; Yuqing Y.; Rensheng L.; Minfan F.; Jing H.; Yu L.; Xiaojie X.; Qiang Z.; Lopez-Jaramillo P.; Lopez P.C.; Garcia R.; Jurado L.J.A.; Gómez-Arbeláez D.; Arguello J.F.; Dueñas R.; Silva S.; Pradilla L.P.; Ramirez F.; Molina D.I.; Cure-Cure C.; Perez M.; Hernandez E.; Arcos E.; Fernandez S.; Narvaez C.; Paez J.; Sotomayor A.; Garcia H.; Sanchez G.; David T.; Rico A.; Mony P.; Vaz M.; Bharathi A.V.; Swaminathan S.; Shankar K.; Kurpad A.V.; Jayachitra K.G.; Kumar N.; Hospital H.A.L.; Deepa M.; Parthiban K.; Anitha M.; Hemavathy S.; Rahulashankiruthiyayan T.; Anitha D.; Sridevi K.; Panwar R.B.; Mohan I.; Rastogi P.; Rastogi S.; Bhargava R.; Kumar R.; Thakur J.S.; Patro B.; Lakshmi P.V.M.; Mahajan R.; Chaudary P.; Vijayakumar K.; Ajayan K.; Rajasree G.; Renjini A.R.; Deepu A.; Sandhya B.; Asha S.; Soumya H.S.; Kelishadi R.; Mohammadifard N.; Heidari H.; Ismail T.S.T.; Ng K.K.; Devi A.; Nasir N.M.; Yasin M.M.; Miskan M.; Rahman E.A.; Arsad M.K.M.; Ariffin F.; Razak S.A.; Majid F.A.; Bakar N.A.; Yacob M.Y.; Zainon N.; Salleh R.; Ramli M.K.A.; Halim N.A.; Norlizan S.R.; Ghazali N.M.; Arshad M.N.; Razali R.; Ali S.; Othman H.R.; Hafar C.; Pit A.; Danuri N.; Basir F.; Zahari S.N.A.; Abdullah H.; Arippin M.A.; Zakaria N.A.; Noorhassim I.; Hasni M.J.; Azmi M.T.; Zaleha M.I.; Hazdi K.Y.; Rizam A.R.; Sazman W.; Azman A.; Khammash U.; Khatib A.; Giacaman R.; Iqbal R.; Afridi A.; Khawaja R.; Raza A.; Kazmi K.; Dans A.; Co H.U.; Sanchez J.T.; Pudol L.; Zamora-Pudol C.; Palileo-Villanueva L.A.M.; Aquino M.R.; Abaquin C.; Cabral M.L.; Zatonski W.; Zatonska K.; Ilow# R.; Ferus M.; Regulska-Ilow B.; Różańska D.; Wolyniec M.; Hersi A.; Kashour T.; Alfaleh H.; Alshamiri M.; Altaradi H.B.; Alnobani O.; Bafart A.; Alkamel N.; Ali M.; Abdulrahman M.; Nouri R.; Kruger A.; Voster H.H.; Schutte A.E.; Wentzel-Viljoen E.; Eloff F.C.; de Ridder H.; Moss H.; Potgieter J.; Roux A.A.; Watson M.; de Wet G.; Olckers A.; Jerling J.C.; Pieters M.; Hoekstra T.; Puoane T.; Tsolekile L.; Sanders D.; Ilow P.; Steyn N.; Peer N.; Mayosi B.; Rayner B.; Lambert V.; Levitt N.; Kolbe-Alexander T.; Ntyintyane L.; Hughes G.; Swart R.; Fourie J.; Muzigaba M.; Xapa S.; Gobile N.; Ndayi K.; Jwili B.; Ndibaza K.; Egbujie B.; Boström K.B.; Lindblad U.; Langkilde P.; Gustavsson A.; Andreasson M.; Snällman M.; Wirdemann L.; Pettersson K.; Moberg E.; Yeates K.; Sleeth J.; Kilonzo K.; Akalin A.A.K.; Calik K.B.T.; Imeryuz N.; Temizhan A.; Alphan E.; Gunes E.; Sur H.; Karsidag K.; Gulec S.; Altuntas Y.; Almahmeed W.; Swidan H.; Darwish E.A.; Hashemi A.R.A.; Al-Khaja N.; Muscat-Baron J.M.; Ahmed S.H.; Mamdouh T.M.; Darwish W.M.; Abdelmotagali M.H.S.; Awed S.O.; Movahedi G.A.; Shaibani H.A.; Gharabou R.I.M.; Youssef D.F.; Nawati A.Z.S.; Salah Z.A.; Abdalla R.F.E.; Shuwaihi S.A.; Omairi M.A.; Cadigal O.D.; Alejandrino R.S.; Chifamba J.; Gwaunza L.; Terera G.; Mahachi C.; Murambiwa P.; Machiweni T.; Mapanga R.
Availability and affordability of blood pressure-lowering medicines and the effect on blood pressure control in high-income, middle-income, and low-income countries: an analysis of the PURE study data
author_facet Attaei M.W.; Khatib R.; McKee M.; Lear S.; Dagenais G.; Igumbor E.U.; AlHabib K.F.; Kaur M.; Kruger L.; Teo K.; Lanas F.; Yusoff K.; Oguz A.; Gupta R.; Yusufali A.M.; Bahonar A.; Kutty R.; Rosengren A.; Mohan V.; Avezum A.; Yusuf R.; Szuba A.; Rangarajan S.; Chow C.; Yusuf S.; O'Donnell M.; Mente A.; Leong D.; Smyth A.; Joseph P.; Islam S.; Zhang M.; Hu W.; Ramasundarahettige C.; Wong G.; Dayal L.; Casanova A.; Dehghan M.; Lewis G.; Aliberti A.; Reyes A.; Zaki A.; Lewis B.; Zhang B.; Agapay D.; Hari D.; Milazzo E.; Ramezani E.; Hussain F.; Shifaly F.; Kay I.; Rimac J.; Swallow J.; Heldman L.; Mushtaha M.; Mushtaha M.; Trottier M.; Aoucheva N.; Kandy N.; Mackie P.; Solano R.; Chin S.; Ramacham S.; Shahrook S.; Trottier S.; Tongana T.; ElSheikh W.; Lindeman J.; McQueen M.; Hall K.; Keys J.; Wang X.; Keneth J.; Devanath A.; Diaz R.; Orlandini A.; Linetsky B.; Toscanelli S.; Casaccia G.; Maini Cuneo J.M.; Rahman O.; Azad A.K.; Rabbani K.A.; Cherry H.M.; Mannan A.; Hassan I.; Talukdar A.T.; Tooheen R.B.; Khan M.U.; Sintaha M.; Choudhury T.; Haque R.; Parvin S.; Oliveira G.B.; Marcilio C.S.; Mattos A.C.; Dejesus J.; Poirier P.; Turbide G.; Auger D.; De Bluts A.L.; Proulx M.C.; Cayer M.; Bonneville N.; Gasevic D.; Corber E.; de Jong V.; Vukmirovich I.; Wielgosz A.; Fodor G.; Pipe A.; Shane A.; Seron P.; Martinez S.; Valdebenito A.; Oliveros M.; Wei L.; Lisheng L.; Chunming C.; Xingyu W.; Wenhua Z.; Hongye Z.; JiaXuan; Bo H.; Yi S.; Jian B.; Xiuwen Z.; Xiaohong C.; Tao C.; Hui C.; Qing D.; Xiaoru C.; Xinye H.; JiaXuan; Jian L.; Juan L.; Xu L.; Bing R.; Wei W.; Yang W.; Jun Y.; Yi Z.; Manlu Z.; Fanghong L.; Jianfang W.; Yindong L.; Yan H.; Liangqing Z.; Baoxia G.; Xiaoyang L.; Shiying Z.; BianRongwen; TianXiuzhen; Dong L.; Di C.; Jianguo W.; Yize X.; Tianlu L.; Peng Z.; Changlin D.; Ning L.; Xiaolan M.; Yuqing Y.; Rensheng L.; Minfan F.; Jing H.; Yu L.; Xiaojie X.; Qiang Z.; Lopez-Jaramillo P.; Lopez P.C.; Garcia R.; Jurado L.J.A.; Gómez-Arbeláez D.; Arguello J.F.; Dueñas R.; Silva S.; Pradilla L.P.; Ramirez F.; Molina D.I.; Cure-Cure C.; Perez M.; Hernandez E.; Arcos E.; Fernandez S.; Narvaez C.; Paez J.; Sotomayor A.; Garcia H.; Sanchez G.; David T.; Rico A.; Mony P.; Vaz M.; Bharathi A.V.; Swaminathan S.; Shankar K.; Kurpad A.V.; Jayachitra K.G.; Kumar N.; Hospital H.A.L.; Deepa M.; Parthiban K.; Anitha M.; Hemavathy S.; Rahulashankiruthiyayan T.; Anitha D.; Sridevi K.; Panwar R.B.; Mohan I.; Rastogi P.; Rastogi S.; Bhargava R.; Kumar R.; Thakur J.S.; Patro B.; Lakshmi P.V.M.; Mahajan R.; Chaudary P.; Vijayakumar K.; Ajayan K.; Rajasree G.; Renjini A.R.; Deepu A.; Sandhya B.; Asha S.; Soumya H.S.; Kelishadi R.; Mohammadifard N.; Heidari H.; Ismail T.S.T.; Ng K.K.; Devi A.; Nasir N.M.; Yasin M.M.; Miskan M.; Rahman E.A.; Arsad M.K.M.; Ariffin F.; Razak S.A.; Majid F.A.; Bakar N.A.; Yacob M.Y.; Zainon N.; Salleh R.; Ramli M.K.A.; Halim N.A.; Norlizan S.R.; Ghazali N.M.; Arshad M.N.; Razali R.; Ali S.; Othman H.R.; Hafar C.; Pit A.; Danuri N.; Basir F.; Zahari S.N.A.; Abdullah H.; Arippin M.A.; Zakaria N.A.; Noorhassim I.; Hasni M.J.; Azmi M.T.; Zaleha M.I.; Hazdi K.Y.; Rizam A.R.; Sazman W.; Azman A.; Khammash U.; Khatib A.; Giacaman R.; Iqbal R.; Afridi A.; Khawaja R.; Raza A.; Kazmi K.; Dans A.; Co H.U.; Sanchez J.T.; Pudol L.; Zamora-Pudol C.; Palileo-Villanueva L.A.M.; Aquino M.R.; Abaquin C.; Cabral M.L.; Zatonski W.; Zatonska K.; Ilow# R.; Ferus M.; Regulska-Ilow B.; Różańska D.; Wolyniec M.; Hersi A.; Kashour T.; Alfaleh H.; Alshamiri M.; Altaradi H.B.; Alnobani O.; Bafart A.; Alkamel N.; Ali M.; Abdulrahman M.; Nouri R.; Kruger A.; Voster H.H.; Schutte A.E.; Wentzel-Viljoen E.; Eloff F.C.; de Ridder H.; Moss H.; Potgieter J.; Roux A.A.; Watson M.; de Wet G.; Olckers A.; Jerling J.C.; Pieters M.; Hoekstra T.; Puoane T.; Tsolekile L.; Sanders D.; Ilow P.; Steyn N.; Peer N.; Mayosi B.; Rayner B.; Lambert V.; Levitt N.; Kolbe-Alexander T.; Ntyintyane L.; Hughes G.; Swart R.; Fourie J.; Muzigaba M.; Xapa S.; Gobile N.; Ndayi K.; Jwili B.; Ndibaza K.; Egbujie B.; Boström K.B.; Lindblad U.; Langkilde P.; Gustavsson A.; Andreasson M.; Snällman M.; Wirdemann L.; Pettersson K.; Moberg E.; Yeates K.; Sleeth J.; Kilonzo K.; Akalin A.A.K.; Calik K.B.T.; Imeryuz N.; Temizhan A.; Alphan E.; Gunes E.; Sur H.; Karsidag K.; Gulec S.; Altuntas Y.; Almahmeed W.; Swidan H.; Darwish E.A.; Hashemi A.R.A.; Al-Khaja N.; Muscat-Baron J.M.; Ahmed S.H.; Mamdouh T.M.; Darwish W.M.; Abdelmotagali M.H.S.; Awed S.O.; Movahedi G.A.; Shaibani H.A.; Gharabou R.I.M.; Youssef D.F.; Nawati A.Z.S.; Salah Z.A.; Abdalla R.F.E.; Shuwaihi S.A.; Omairi M.A.; Cadigal O.D.; Alejandrino R.S.; Chifamba J.; Gwaunza L.; Terera G.; Mahachi C.; Murambiwa P.; Machiweni T.; Mapanga R.
author_sort Attaei M.W.; Khatib R.; McKee M.; Lear S.; Dagenais G.; Igumbor E.U.; AlHabib K.F.; Kaur M.; Kruger L.; Teo K.; Lanas F.; Yusoff K.; Oguz A.; Gupta R.; Yusufali A.M.; Bahonar A.; Kutty R.; Rosengren A.; Mohan V.; Avezum A.; Yusuf R.; Szuba A.; Rangarajan S.; Chow C.; Yusuf S.; O'Donnell M.; Mente A.; Leong D.; Smyth A.; Joseph P.; Islam S.; Zhang M.; Hu W.; Ramasundarahettige C.; Wong G.; Dayal L.; Casanova A.; Dehghan M.; Lewis G.; Aliberti A.; Reyes A.; Zaki A.; Lewis B.; Zhang B.; Agapay D.; Hari D.; Milazzo E.; Ramezani E.; Hussain F.; Shifaly F.; Kay I.; Rimac J.; Swallow J.; Heldman L.; Mushtaha M.; Mushtaha M.; Trottier M.; Aoucheva N.; Kandy N.; Mackie P.; Solano R.; Chin S.; Ramacham S.; Shahrook S.; Trottier S.; Tongana T.; ElSheikh W.; Lindeman J.; McQueen M.; Hall K.; Keys J.; Wang X.; Keneth J.; Devanath A.; Diaz R.; Orlandini A.; Linetsky B.; Toscanelli S.; Casaccia G.; Maini Cuneo J.M.; Rahman O.; Azad A.K.; Rabbani K.A.; Cherry H.M.; Mannan A.; Hassan I.; Talukdar A.T.; Tooheen R.B.; Khan M.U.; Sintaha M.; Choudhury T.; Haque R.; Parvin S.; Oliveira G.B.; Marcilio C.S.; Mattos A.C.; Dejesus J.; Poirier P.; Turbide G.; Auger D.; De Bluts A.L.; Proulx M.C.; Cayer M.; Bonneville N.; Gasevic D.; Corber E.; de Jong V.; Vukmirovich I.; Wielgosz A.; Fodor G.; Pipe A.; Shane A.; Seron P.; Martinez S.; Valdebenito A.; Oliveros M.; Wei L.; Lisheng L.; Chunming C.; Xingyu W.; Wenhua Z.; Hongye Z.; JiaXuan; Bo H.; Yi S.; Jian B.; Xiuwen Z.; Xiaohong C.; Tao C.; Hui C.; Qing D.; Xiaoru C.; Xinye H.; JiaXuan; Jian L.; Juan L.; Xu L.; Bing R.; Wei W.; Yang W.; Jun Y.; Yi Z.; Manlu Z.; Fanghong L.; Jianfang W.; Yindong L.; Yan H.; Liangqing Z.; Baoxia G.; Xiaoyang L.; Shiying Z.; BianRongwen; TianXiuzhen; Dong L.; Di C.; Jianguo W.; Yize X.; Tianlu L.; Peng Z.; Changlin D.; Ning L.; Xiaolan M.; Yuqing Y.; Rensheng L.; Minfan F.; Jing H.; Yu L.; Xiaojie X.; Qiang Z.; Lopez-Jaramillo P.; Lopez P.C.; Garcia R.; Jurado L.J.A.; Gómez-Arbeláez D.; Arguello J.F.; Dueñas R.; Silva S.; Pradilla L.P.; Ramirez F.; Molina D.I.; Cure-Cure C.; Perez M.; Hernandez E.; Arcos E.; Fernandez S.; Narvaez C.; Paez J.; Sotomayor A.; Garcia H.; Sanchez G.; David T.; Rico A.; Mony P.; Vaz M.; Bharathi A.V.; Swaminathan S.; Shankar K.; Kurpad A.V.; Jayachitra K.G.; Kumar N.; Hospital H.A.L.; Deepa M.; Parthiban K.; Anitha M.; Hemavathy S.; Rahulashankiruthiyayan T.; Anitha D.; Sridevi K.; Panwar R.B.; Mohan I.; Rastogi P.; Rastogi S.; Bhargava R.; Kumar R.; Thakur J.S.; Patro B.; Lakshmi P.V.M.; Mahajan R.; Chaudary P.; Vijayakumar K.; Ajayan K.; Rajasree G.; Renjini A.R.; Deepu A.; Sandhya B.; Asha S.; Soumya H.S.; Kelishadi R.; Mohammadifard N.; Heidari H.; Ismail T.S.T.; Ng K.K.; Devi A.; Nasir N.M.; Yasin M.M.; Miskan M.; Rahman E.A.; Arsad M.K.M.; Ariffin F.; Razak S.A.; Majid F.A.; Bakar N.A.; Yacob M.Y.; Zainon N.; Salleh R.; Ramli M.K.A.; Halim N.A.; Norlizan S.R.; Ghazali N.M.; Arshad M.N.; Razali R.; Ali S.; Othman H.R.; Hafar C.; Pit A.; Danuri N.; Basir F.; Zahari S.N.A.; Abdullah H.; Arippin M.A.; Zakaria N.A.; Noorhassim I.; Hasni M.J.; Azmi M.T.; Zaleha M.I.; Hazdi K.Y.; Rizam A.R.; Sazman W.; Azman A.; Khammash U.; Khatib A.; Giacaman R.; Iqbal R.; Afridi A.; Khawaja R.; Raza A.; Kazmi K.; Dans A.; Co H.U.; Sanchez J.T.; Pudol L.; Zamora-Pudol C.; Palileo-Villanueva L.A.M.; Aquino M.R.; Abaquin C.; Cabral M.L.; Zatonski W.; Zatonska K.; Ilow# R.; Ferus M.; Regulska-Ilow B.; Różańska D.; Wolyniec M.; Hersi A.; Kashour T.; Alfaleh H.; Alshamiri M.; Altaradi H.B.; Alnobani O.; Bafart A.; Alkamel N.; Ali M.; Abdulrahman M.; Nouri R.; Kruger A.; Voster H.H.; Schutte A.E.; Wentzel-Viljoen E.; Eloff F.C.; de Ridder H.; Moss H.; Potgieter J.; Roux A.A.; Watson M.; de Wet G.; Olckers A.; Jerling J.C.; Pieters M.; Hoekstra T.; Puoane T.; Tsolekile L.; Sanders D.; Ilow P.; Steyn N.; Peer N.; Mayosi B.; Rayner B.; Lambert V.; Levitt N.; Kolbe-Alexander T.; Ntyintyane L.; Hughes G.; Swart R.; Fourie J.; Muzigaba M.; Xapa S.; Gobile N.; Ndayi K.; Jwili B.; Ndibaza K.; Egbujie B.; Boström K.B.; Lindblad U.; Langkilde P.; Gustavsson A.; Andreasson M.; Snällman M.; Wirdemann L.; Pettersson K.; Moberg E.; Yeates K.; Sleeth J.; Kilonzo K.; Akalin A.A.K.; Calik K.B.T.; Imeryuz N.; Temizhan A.; Alphan E.; Gunes E.; Sur H.; Karsidag K.; Gulec S.; Altuntas Y.; Almahmeed W.; Swidan H.; Darwish E.A.; Hashemi A.R.A.; Al-Khaja N.; Muscat-Baron J.M.; Ahmed S.H.; Mamdouh T.M.; Darwish W.M.; Abdelmotagali M.H.S.; Awed S.O.; Movahedi G.A.; Shaibani H.A.; Gharabou R.I.M.; Youssef D.F.; Nawati A.Z.S.; Salah Z.A.; Abdalla R.F.E.; Shuwaihi S.A.; Omairi M.A.; Cadigal O.D.; Alejandrino R.S.; Chifamba J.; Gwaunza L.; Terera G.; Mahachi C.; Murambiwa P.; Machiweni T.; Mapanga R.
title Availability and affordability of blood pressure-lowering medicines and the effect on blood pressure control in high-income, middle-income, and low-income countries: an analysis of the PURE study data
title_short Availability and affordability of blood pressure-lowering medicines and the effect on blood pressure control in high-income, middle-income, and low-income countries: an analysis of the PURE study data
title_full Availability and affordability of blood pressure-lowering medicines and the effect on blood pressure control in high-income, middle-income, and low-income countries: an analysis of the PURE study data
title_fullStr Availability and affordability of blood pressure-lowering medicines and the effect on blood pressure control in high-income, middle-income, and low-income countries: an analysis of the PURE study data
title_full_unstemmed Availability and affordability of blood pressure-lowering medicines and the effect on blood pressure control in high-income, middle-income, and low-income countries: an analysis of the PURE study data
title_sort Availability and affordability of blood pressure-lowering medicines and the effect on blood pressure control in high-income, middle-income, and low-income countries: an analysis of the PURE study data
publishDate 2017
container_title The Lancet Public Health
container_volume 2
container_issue 9
doi_str_mv 10.1016/S2468-2667(17)30141-X
url https://www.scopus.com/inward/record.uri?eid=2-s2.0-85028775982&doi=10.1016%2fS2468-2667%2817%2930141-X&partnerID=40&md5=ff1a95df70c52d86625734c64d5ecf92
description Background Hypertension is considered the most important risk factor for cardiovascular diseases, but its control is poor worldwide. We aimed to assess the availability and affordability of blood pressure-lowering medicines, and the association with use of these medicines and blood pressure control in countries at varying levels of economic development. Methods We analysed the availability, costs, and affordability of blood pressure-lowering medicines with data recorded from 626 communities in 20 countries participating in the Prospective Urban Rural Epidemiological (PURE) study. Medicines were considered available if they were present in the local pharmacy when surveyed, and affordable if their combined cost was less than 20% of the households' capacity to pay. We related information about availability and affordability to use of these medicines and blood pressure control with multilevel mixed-effects logistic regression models, and compared results for high-income, upper-middle-income, lower-middle-income, and low-income countries. Data for India are presented separately because it has a large generic pharmaceutical industry and a higher availability of medicines than other countries at the same economic level. Findings The availability of two or more classes of blood pressure-lowering drugs was lower in low-income and middle-income countries (except for India) than in high-income countries. The proportion of communities with four drug classes available was 94% in high-income countries (108 of 115 communities), 76% in India (68 of 90), 71% in upper-middle-income countries (90 of 126), 47% in lower-middle-income countries (107 of 227), and 13% in low-income countries (nine of 68). The proportion of households unable to afford two blood pressure-lowering medicines was 31% in low-income countries (1069 of 3479 households), 9% in middle-income countries (5602 of 65 471), and less than 1% in high-income countries (44 of 10 880). Participants with known hypertension in communities that had all four drug classes available were more likely to use at least one blood pressure-lowering medicine (adjusted odds ratio [OR] 2·23, 95% CI 1·59–3·12); p<0·0001), combination therapy (1·53, 1·13–2·07; p=0·054), and have their blood pressure controlled (2·06, 1·69–2·50; p<0·0001) than were those in communities where blood pressure-lowering medicines were not available. Participants with known hypertension from households able to afford four blood pressure-lowering drug classes were more likely to use at least one blood pressure-lowering medicine (adjusted OR 1·42, 95% CI 1·25–1·62; p<0·0001), combination therapy (1·26, 1·08–1·47; p=0·0038), and have their blood pressure controlled (1·13, 1·00–1·28; p=0·0562) than were those unable to afford the medicines. Interpretation A large proportion of communities in low-income and middle-income countries do not have access to more than one blood pressure-lowering medicine and, when available, they are often not affordable. These factors are associated with poor blood pressure control. Ensuring access to affordable blood pressure-lowering medicines is essential for control of hypertension in low-income and middle-income countries. Funding Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, Canadian Institutes of Health Research Strategy for Patient Oriented Research through the Ontario SPOR Support Unit, the Ontario Ministry of Health and Long-Term Care, pharmaceutical companies (with major contributions from AstraZeneca [Canada], Sanofi Aventis [France and Canada], Boehringer Ingelheim [Germany amd Canada], Servier, and GlaxoSmithKline), Novartis and King Pharma, and national or local organisations in participating countries. © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license
publisher Elsevier Ltd
issn 24682667
language English
format Article
accesstype All Open Access; Gold Open Access; Green Open Access
record_format scopus
collection Scopus
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spelling 2-s2.0-85028775982
Attaei M.W.; Khatib R.; McKee M.; Lear S.; Dagenais G.; Igumbor E.U.; AlHabib K.F.; Kaur M.; Kruger L.; Teo K.; Lanas F.; Yusoff K.; Oguz A.; Gupta R.; Yusufali A.M.; Bahonar A.; Kutty R.; Rosengren A.; Mohan V.; Avezum A.; Yusuf R.; Szuba A.; Rangarajan S.; Chow C.; Yusuf S.; O'Donnell M.; Mente A.; Leong D.; Smyth A.; Joseph P.; Islam S.; Zhang M.; Hu W.; Ramasundarahettige C.; Wong G.; Dayal L.; Casanova A.; Dehghan M.; Lewis G.; Aliberti A.; Reyes A.; Zaki A.; Lewis B.; Zhang B.; Agapay D.; Hari D.; Milazzo E.; Ramezani E.; Hussain F.; Shifaly F.; Kay I.; Rimac J.; Swallow J.; Heldman L.; Mushtaha M.; Mushtaha M.; Trottier M.; Aoucheva N.; Kandy N.; Mackie P.; Solano R.; Chin S.; Ramacham S.; Shahrook S.; Trottier S.; Tongana T.; ElSheikh W.; Lindeman J.; McQueen M.; Hall K.; Keys J.; Wang X.; Keneth J.; Devanath A.; Diaz R.; Orlandini A.; Linetsky B.; Toscanelli S.; Casaccia G.; Maini Cuneo J.M.; Rahman O.; Azad A.K.; Rabbani K.A.; Cherry H.M.; Mannan A.; Hassan I.; Talukdar A.T.; Tooheen R.B.; Khan M.U.; Sintaha M.; Choudhury T.; Haque R.; Parvin S.; Oliveira G.B.; Marcilio C.S.; Mattos A.C.; Dejesus J.; Poirier P.; Turbide G.; Auger D.; De Bluts A.L.; Proulx M.C.; Cayer M.; Bonneville N.; Gasevic D.; Corber E.; de Jong V.; Vukmirovich I.; Wielgosz A.; Fodor G.; Pipe A.; Shane A.; Seron P.; Martinez S.; Valdebenito A.; Oliveros M.; Wei L.; Lisheng L.; Chunming C.; Xingyu W.; Wenhua Z.; Hongye Z.; JiaXuan; Bo H.; Yi S.; Jian B.; Xiuwen Z.; Xiaohong C.; Tao C.; Hui C.; Qing D.; Xiaoru C.; Xinye H.; JiaXuan; Jian L.; Juan L.; Xu L.; Bing R.; Wei W.; Yang W.; Jun Y.; Yi Z.; Manlu Z.; Fanghong L.; Jianfang W.; Yindong L.; Yan H.; Liangqing Z.; Baoxia G.; Xiaoyang L.; Shiying Z.; BianRongwen; TianXiuzhen; Dong L.; Di C.; Jianguo W.; Yize X.; Tianlu L.; Peng Z.; Changlin D.; Ning L.; Xiaolan M.; Yuqing Y.; Rensheng L.; Minfan F.; Jing H.; Yu L.; Xiaojie X.; Qiang Z.; Lopez-Jaramillo P.; Lopez P.C.; Garcia R.; Jurado L.J.A.; Gómez-Arbeláez D.; Arguello J.F.; Dueñas R.; Silva S.; Pradilla L.P.; Ramirez F.; Molina D.I.; Cure-Cure C.; Perez M.; Hernandez E.; Arcos E.; Fernandez S.; Narvaez C.; Paez J.; Sotomayor A.; Garcia H.; Sanchez G.; David T.; Rico A.; Mony P.; Vaz M.; Bharathi A.V.; Swaminathan S.; Shankar K.; Kurpad A.V.; Jayachitra K.G.; Kumar N.; Hospital H.A.L.; Deepa M.; Parthiban K.; Anitha M.; Hemavathy S.; Rahulashankiruthiyayan T.; Anitha D.; Sridevi K.; Panwar R.B.; Mohan I.; Rastogi P.; Rastogi S.; Bhargava R.; Kumar R.; Thakur J.S.; Patro B.; Lakshmi P.V.M.; Mahajan R.; Chaudary P.; Vijayakumar K.; Ajayan K.; Rajasree G.; Renjini A.R.; Deepu A.; Sandhya B.; Asha S.; Soumya H.S.; Kelishadi R.; Mohammadifard N.; Heidari H.; Ismail T.S.T.; Ng K.K.; Devi A.; Nasir N.M.; Yasin M.M.; Miskan M.; Rahman E.A.; Arsad M.K.M.; Ariffin F.; Razak S.A.; Majid F.A.; Bakar N.A.; Yacob M.Y.; Zainon N.; Salleh R.; Ramli M.K.A.; Halim N.A.; Norlizan S.R.; Ghazali N.M.; Arshad M.N.; Razali R.; Ali S.; Othman H.R.; Hafar C.; Pit A.; Danuri N.; Basir F.; Zahari S.N.A.; Abdullah H.; Arippin M.A.; Zakaria N.A.; Noorhassim I.; Hasni M.J.; Azmi M.T.; Zaleha M.I.; Hazdi K.Y.; Rizam A.R.; Sazman W.; Azman A.; Khammash U.; Khatib A.; Giacaman R.; Iqbal R.; Afridi A.; Khawaja R.; Raza A.; Kazmi K.; Dans A.; Co H.U.; Sanchez J.T.; Pudol L.; Zamora-Pudol C.; Palileo-Villanueva L.A.M.; Aquino M.R.; Abaquin C.; Cabral M.L.; Zatonski W.; Zatonska K.; Ilow# R.; Ferus M.; Regulska-Ilow B.; Różańska D.; Wolyniec M.; Hersi A.; Kashour T.; Alfaleh H.; Alshamiri M.; Altaradi H.B.; Alnobani O.; Bafart A.; Alkamel N.; Ali M.; Abdulrahman M.; Nouri R.; Kruger A.; Voster H.H.; Schutte A.E.; Wentzel-Viljoen E.; Eloff F.C.; de Ridder H.; Moss H.; Potgieter J.; Roux A.A.; Watson M.; de Wet G.; Olckers A.; Jerling J.C.; Pieters M.; Hoekstra T.; Puoane T.; Tsolekile L.; Sanders D.; Ilow P.; Steyn N.; Peer N.; Mayosi B.; Rayner B.; Lambert V.; Levitt N.; Kolbe-Alexander T.; Ntyintyane L.; Hughes G.; Swart R.; Fourie J.; Muzigaba M.; Xapa S.; Gobile N.; Ndayi K.; Jwili B.; Ndibaza K.; Egbujie B.; Boström K.B.; Lindblad U.; Langkilde P.; Gustavsson A.; Andreasson M.; Snällman M.; Wirdemann L.; Pettersson K.; Moberg E.; Yeates K.; Sleeth J.; Kilonzo K.; Akalin A.A.K.; Calik K.B.T.; Imeryuz N.; Temizhan A.; Alphan E.; Gunes E.; Sur H.; Karsidag K.; Gulec S.; Altuntas Y.; Almahmeed W.; Swidan H.; Darwish E.A.; Hashemi A.R.A.; Al-Khaja N.; Muscat-Baron J.M.; Ahmed S.H.; Mamdouh T.M.; Darwish W.M.; Abdelmotagali M.H.S.; Awed S.O.; Movahedi G.A.; Shaibani H.A.; Gharabou R.I.M.; Youssef D.F.; Nawati A.Z.S.; Salah Z.A.; Abdalla R.F.E.; Shuwaihi S.A.; Omairi M.A.; Cadigal O.D.; Alejandrino R.S.; Chifamba J.; Gwaunza L.; Terera G.; Mahachi C.; Murambiwa P.; Machiweni T.; Mapanga R.
Availability and affordability of blood pressure-lowering medicines and the effect on blood pressure control in high-income, middle-income, and low-income countries: an analysis of the PURE study data
2017
The Lancet Public Health
2
9
10.1016/S2468-2667(17)30141-X
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85028775982&doi=10.1016%2fS2468-2667%2817%2930141-X&partnerID=40&md5=ff1a95df70c52d86625734c64d5ecf92
Background Hypertension is considered the most important risk factor for cardiovascular diseases, but its control is poor worldwide. We aimed to assess the availability and affordability of blood pressure-lowering medicines, and the association with use of these medicines and blood pressure control in countries at varying levels of economic development. Methods We analysed the availability, costs, and affordability of blood pressure-lowering medicines with data recorded from 626 communities in 20 countries participating in the Prospective Urban Rural Epidemiological (PURE) study. Medicines were considered available if they were present in the local pharmacy when surveyed, and affordable if their combined cost was less than 20% of the households' capacity to pay. We related information about availability and affordability to use of these medicines and blood pressure control with multilevel mixed-effects logistic regression models, and compared results for high-income, upper-middle-income, lower-middle-income, and low-income countries. Data for India are presented separately because it has a large generic pharmaceutical industry and a higher availability of medicines than other countries at the same economic level. Findings The availability of two or more classes of blood pressure-lowering drugs was lower in low-income and middle-income countries (except for India) than in high-income countries. The proportion of communities with four drug classes available was 94% in high-income countries (108 of 115 communities), 76% in India (68 of 90), 71% in upper-middle-income countries (90 of 126), 47% in lower-middle-income countries (107 of 227), and 13% in low-income countries (nine of 68). The proportion of households unable to afford two blood pressure-lowering medicines was 31% in low-income countries (1069 of 3479 households), 9% in middle-income countries (5602 of 65 471), and less than 1% in high-income countries (44 of 10 880). Participants with known hypertension in communities that had all four drug classes available were more likely to use at least one blood pressure-lowering medicine (adjusted odds ratio [OR] 2·23, 95% CI 1·59–3·12); p<0·0001), combination therapy (1·53, 1·13–2·07; p=0·054), and have their blood pressure controlled (2·06, 1·69–2·50; p<0·0001) than were those in communities where blood pressure-lowering medicines were not available. Participants with known hypertension from households able to afford four blood pressure-lowering drug classes were more likely to use at least one blood pressure-lowering medicine (adjusted OR 1·42, 95% CI 1·25–1·62; p<0·0001), combination therapy (1·26, 1·08–1·47; p=0·0038), and have their blood pressure controlled (1·13, 1·00–1·28; p=0·0562) than were those unable to afford the medicines. Interpretation A large proportion of communities in low-income and middle-income countries do not have access to more than one blood pressure-lowering medicine and, when available, they are often not affordable. These factors are associated with poor blood pressure control. Ensuring access to affordable blood pressure-lowering medicines is essential for control of hypertension in low-income and middle-income countries. Funding Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, Canadian Institutes of Health Research Strategy for Patient Oriented Research through the Ontario SPOR Support Unit, the Ontario Ministry of Health and Long-Term Care, pharmaceutical companies (with major contributions from AstraZeneca [Canada], Sanofi Aventis [France and Canada], Boehringer Ingelheim [Germany amd Canada], Servier, and GlaxoSmithKline), Novartis and King Pharma, and national or local organisations in participating countries. © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license
Elsevier Ltd
24682667
English
Article
All Open Access; Gold Open Access; Green Open Access