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Evaluating the Cascade of Hypertension Care in Belgium

Authors:

Philippe Bos ,

University of Antwerp, Centre for Population, Family & Health, Belguim, BE
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Veerle Buffel,

University of Antwerp, Centre for Population, Family & Health, Belguim, BE
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Katrien Danhieux,

University of Antwerp, Primary and Interdisciplinary Care, BE
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Josefien van Olmen,

University of Antwerp, Primary and Interdisciplinary Care, BE
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Roy Remmen,

University of Antwerp, Primary and Interdisciplinary Care, BE
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Edwin Wouters

University of Antwerp, Centre for Population, Family & Health, Belguim, BE
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Abstract

Introduction: Raised blood pressure (BP) is a major risk factor for cardiovascular disease worldwide. Although effective treatment exists and is widely available, few patients manage to achieve BP control, even in high-income countries such as Belgium. As hypertension (HTN) is a chronic condition, it requires lifelong continuous and coordinated action from healthcare systems along the continuum of care. This raises the need to evaluate the delivery of HTN care accordingly, using a cascade of care (CoC) approach, rather than solely focussing on the outcomes (i.e. BP control).

Objectives and methods: The objective of the current study is twofold. First, we use a CoC approach to identify where most patients are lost along the continuum of HTN care. Second, we identify patient characteristics that are associated with the leakages in the CoC. Based on cross-sectional data from the 2018 Belgian Health Interview Survey and the Belgian Health Examination Study, we estimate the prevalence of HTN among the Belgian population aged 40-80 and the proportions that reach each stage of the HTN CoC: being screened, diagnosed, linked to care, treated, followed-up and well-controlled. Next, cox regression models are estimated to assess the factors associated with an elevated risk of not being linked to care, treated and followed-up.

Results: Our preliminary findings indicate that 44.7% of the Belgian population aged 40-80 has HTN. Of these, 96.7% had their BP measured in the past 3 years, but only 56.1% self-reported having been diagnosed. Furthermore, 52.9% is linked to care, 49.5% is in treatment and 43.1% is followed-up by means of a yearly blood cholesterol measure. Finally, only about a quarter (25.8%) is well controlled.

Men diagnosed with HTN are more likely to be unlinked to care, while once they are in treatment, they are more likely to be followed-up appropriately. Age and BMI were positively associated with being linked to care and in treatment, but not with being followed-up. Finally, the results revealed a socio-economic gradient: both perceived financial strain and being lower educated was associated with an increased risk of being diagnosed but unlinked to care. 

Conclusion: Patients are lost at each stage of the HTN CoC and only about a quarter of the HTN population is well controlled. The largest loss occurs early on in the cascade: less than half of the HTN population reported to be diagnosed. Once diagnosed, the healthcare system retains patients fairly well, but there are differences between population sub-groups. 

Implications for applicability and limitations: A limitation of the current study is that we were unable to study HTN patients’ characteristics that are associated with ‘being undiagnosed’, due to data limitations. Further research is therefore warranted, as this constitutes the largest drop in the Belgian HTN CoC. Nevertheless, this study is the first to inform Belgian policymakers about where patient retention needs to be improved along the HTN CoC and which high-risk groups require special attention in this regard.
How to Cite: Bos P, Buffel V, Danhieux K, van Olmen J, Remmen R, Wouters E. Evaluating the Cascade of Hypertension Care in Belgium. International Journal of Integrated Care. 2022;22(S3):305. DOI: http://doi.org/10.5334/ijic.ICIC22154
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Published on 04 Nov 2022.

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