The Cuban health system’s focus on primary health care and preventative medicine has delivered substantial reductions in child and infant mortality, but premature death from the chronic disease of middle age remains high. Hypertension control in primary care has been given priority as a cost-effective means of addressing premature cardiovascular mortality in Cuba. However, there is little evidence from large-scale studies on the prevalence and management of hypertension in the country, and no direct evidence of the expected benefit of such efforts on cardiovascular mortality.
Researchers conducted a large prospective study of 150,000 adults, established by Dr Alfredo Dueñas Herrera in the late 1990s in collaboration with CTSU. A subset of participants were resurveyed in 2006-08 and all were followed up for mortality until 2016.
The study found that about a third of people in the study had hypertension, of whom two thirds had been previously diagnosed. Just over three quarters of those with diagnosed hypertension were being treated, the majority with only one hypertension medication. However, blood pressure was controlled in just a third of those receiving treatment. Uncontrolled hypertension was associated with an approximate doubling in risk of cardiovascular death and accounted for around 20% of premature cardiovascular deaths.
Professor Sarah Lewington said that although levels of hypertension diagnosis and treatment were comparable to those in some high-income countries, the proportion of people whose blood pressure was controlled was low. The under-treatment of hypertension might in part reflect the limited availability of blood pressure lowering medication, indeed the baseline survey was conducted immediately following a time of economic crisis in Cuba that began in 1991.
“As well as reducing hypertension prevalence, public health programmes in Cuba should aim to monitor and improve blood pressure control in people with diagnosed hypertension to prevent premature cardiovascular deaths”, said Dr Ben Lacey a public health consultant and co-author of the paper.