학술논문
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
Document Type
article
Author
Marjan W Attaei, MA; Rasha Khatib, PhD; Prof Martin McKee, DSc; Prof Scott Lear, PhD; Prof Gilles Dagenais, MD; Ehimario U Igumbor, PhD; Khalid F AlHabib, MD; Prof Manmeet Kaur, PhD; Lanthe Kruger, PhD; Prof Koon Teo, PhD; Fernando Lanas, MD; Khalid Yusoff, MD; Aytekin Oguz, MD; Prof Rajeev Gupta, PhD; Afzalhussein M Yusufali, MD; Ahmad Bahonar, MD; Prof Raman Kutty, MD; Prof Annika Rosengren, MD; Prof Viswanathan Mohan, DSc; Prof Alvaro Avezum, PhD; Prof Rita Yusuf, PhD; Prof Andrzej Szuba, PhD; Sumathy Rangarajan, MSc; Clara Chow, PhD; Prof Salim Yusuf, DPhil; S Yusuf; S Rangarajan; K K Teo; C K Chow; M O'Donnell; A Mente; D Leong; A Smyth; P Joseph; S Islam; M Zhang; W Hu; C Ramasundarahettige; G Wong; L Dayal; A Casanova; M Dehghan; G Lewis; A Aliberti; A Reyes; A Zaki; B Lewis; B Zhang; D Agapay; D Hari; E Milazzo; E Ramezani; F Hussain; F Shifaly; I Kay; J Rimac; J Swallow; L Heldman; M(a) Mushtaha; M(o) Mushtaha; M Trottier; N Aoucheva; N Kandy; P Mackie; R Solano; S Chin; S Ramacham; S Shahrook; S Trottier; T Tongana; W ElSheikh; J Lindeman; M McQueen; K Hall; J Keys; X Wang; J Keneth; A Devanath; R Diaz; A Orlandini; B Linetsky; S Toscanelli; G Casaccia; JM Maini Cuneo; O Rahman; R Yusuf; AK Azad; KA Rabbani; HM Cherry; A Mannan; I Hassan; AT Talukdar; RB Tooheen; MU Khan; M Sintaha; T Choudhury; R Haque; S Parvin; A Avezum; GB Oliveira; CS Marcilio; AC Mattos; K Teo; J Dejesus; W Elsheikh; G Dagenais; P Poirier; G Turbide; D Auger; A LeBlanc De Bluts; MC Proulx; M Cayer; N Bonneville; S Lear; D Gasevic; E Corber; V de Jong; I Vukmirovich; A Wielgosz; G Fodor; A Pipe; A Shane; F Lanas; P Seron; S Martinez; A Valdebenito; M Oliveros; Li Wei; Liu Lisheng; Chen Chunming; Wang Xingyu; Zhao Wenhua; Zhang Hongye; JiaXuan; Hu Bo; Sun Yi; Bo Jian; Zhao Xiuwen; Chang Xiaohong; Chen Tao; Chen Hui; Deng Qing; Cheng Xiaoru; He Xinye; Li Jian; Li Juan; Liu Xu; Ren Bing; Wang Wei; Wang Yang; Yang Jun; Zhai Yi; Zhu Manlu; Lu Fanghong; Wu Jianfang; Li Yindong; Hou Yan; Zhang Liangqing; Guo Baoxia; Liao Xiaoyang; Zhang Shiying; BianRongwen; TianXiuzhen; Li Dong; Chen Di; Wu Jianguo; Xiao Yize; Liu Tianlu; Zhang Peng; Dong Changlin; Li Ning; Ma Xiaolan; Yang Yuqing; Lei Rensheng; Fu Minfan; He Jing; Liu Yu; Xing Xiaojie; Zhou Qiang; P Lopez-Jaramillo; PA Camacho Lopez; R Garcia; LJA Jurado; D Gómez-Arbeláez; JF Arguello; R Dueñas; S Silva; LP Pradilla; F Ramirez; DI Molina; C Cure-Cure; M Perez; E Hernandez; E Arcos; S Fernandez; C Narvaez; J Paez; A Sotomayor; H Garcia; G Sanchez; T David; A Rico; P Mony; M Vaz; A V Bharathi; S Swaminathan; K Shankar; AV Kurpad; KG Jayachitra; N Kumar; HAL Hospital; V Mohan; M Deepa; K Parthiban; M Anitha; S Hemavathy; T Rahulashankiruthiyayan; D Anitha; K Sridevi; R Gupta; RB Panwar; I Mohan; P Rastogi; S Rastogi; R Bhargava; R Kumar; J S Thakur; B Patro; PVM Lakshmi; R Mahajan; P Chaudary; V Raman Kutty; K Vijayakumar; K Ajayan; G Rajasree; AR Renjini; A Deepu; B Sandhya; S Asha; HS Soumya; R Kelishadi; A Bahonar; N Mohammadifard; H Heidari; K Yusoff; TST Ismail; KK Ng; A Devi; NM Nasir; MM Yasin; M Miskan; EA Rahman; MKM Arsad; F Ariffin; SA Razak; FA Majid; NA Bakar; MY Yacob; N Zainon; R Salleh; MKA Ramli; NA Halim; SR Norlizan; NM Ghazali; MN Arshad; R Razali; S Ali; HR Othman; CWJCW Hafar; A Pit; N Danuri; F Basir; SNA Zahari; H Abdullah; MA Arippin; NA Zakaria; I Noorhassim; MJ Hasni; MT Azmi; MI Zaleha; KY Hazdi; AR Rizam; W Sazman; A Azman; R Khatib; U Khammash; A Khatib; R Giacaman; R Iqbal; A Afridi; R Khawaja; A Raza; K Kazmi; A Dans; HU Co; JT Sanchez; L Pudol; C Zamora-Pudol; LAM Palileo-Villanueva; MR Aquino; C Abaquin; SL Pudol; ML Cabral; W Zatonski; A Szuba; K Zatonska; R Ilow#; M Ferus; B Regulska-Ilow; D Różańska; M Wolyniec; KF AlHabib; A Hersi; T Kashour; H Alfaleh; M Alshamiri; HB Altaradi; O Alnobani; A Bafart; N Alkamel; M Ali; M Abdulrahman; R Nouri; A Kruger; H H Voster; A E Schutte; E Wentzel-Viljoen; FC Eloff; H de Ridder; H Moss; J Potgieter; AA Roux; M Watson; G de Wet; A Olckers; JC Jerling; M Pieters; T Hoekstra; T Puoane; E Igumbor; L Tsolekile; D Sanders; P Naidoo; N Steyn; N Peer; B Mayosi; B Rayner; V Lambert; N Levitt; T Kolbe-Alexander; L Ntyintyane; G Hughes; R Swart; J Fourie; M Muzigaba; S Xapa; N Gobile; K Ndayi; B Jwili; K Ndibaza; B Egbujie; A Rosengren; K Bengtsson Boström; U Lindblad; P Langkilde; A Gustavsson; M Andreasson; M Snällman; L Wirdemann; K Pettersson; E Moberg; K Yeates; J Sleeth; K Kilonzo; A Oguz; AAK Akalin; KBT Calik; N Imeryuz; A Temizhan; E Alphan; E Gunes; H Sur; K Karsidag; S Gulec; Y Altuntas; AM Yusufali; W Almahmeed; H Swidan; EA Darwish; ARA Hashemi; N Al-Khaja; JM Muscat-Baron; SH Ahmed; TM Mamdouh; WM Darwish; MHS Abdelmotagali; SA Omer Awed; GA Movahedi; H Al Shaibani; RIM Gharabou; DF Youssef; AZS Nawati; ZAR Abu Salah; RFE Abdalla; SM Al Shuwaihi; MA Al Omairi; OD Cadigal; R.S. Alejandrino; J Chifamba; L Gwaunza; G Terera; C Mahachi; P Murambiwa; T Machiweni; R Mapanga
Source
The Lancet Public Health, Vol 2, Iss 9, Pp e411-e419 (2017)
Subject
Language
English
ISSN
2468-2667
Abstract
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