Table 3 Proposed expanded hypertension care cascade description
Cascade Steps | Description | Proposed Measurement Techniques | Previous Studies that report this step in the care cascade | Notes and Considerations |
|---|---|---|---|---|
True population in need (A) | Percent of population with blood pressure > 140/90 mmHg or previously correctly diagnosed as hypertensive | Cross-sectional and longitudinal population-based surveys with biometric measurements | Part of the existing care cascade | A high blood pressure reading at one point in time is not sufficient to diagnose hypertension. Cross-sectional studies that classify hypertensives based on one high blood pressure reading may be over-estimating the size of the population in need |
Population screened (B) | Percent of population with high blood pressure who have had previously had blood pressure measured according to standards | Cross-sectional and longitudinal population-based surveys based on self-report. Linked patient observations/facility records to determine how often providers measure patient blood pressure | [22] | Population beyond those in need (A) should be screened for high blood pressure, however for the cascade framework, it is important to understand how many of those in need of services were previously screened. Individuals may also need to be screened more or less frequently based on other risk factors (e.g. age or comorbidities) |
Population diagnosed (C) | Percent of population with high blood pressure who were previously diagnosed by a health worker | Cross-sectional and longitudinal population-based surveys based on self-report. Linked facility records to determine number of hypertensive patients | Part of the existing care cascade | Often referred to as the population “aware” of their condition. If providers are diagnosing non-hypertensive patients (false positives), the population diagnosed and true population in need (A and C) could be over-estimated |
Population linked to any care (D) | Percent of population with high blood pressure who are linked to any treatment | Cross-sectional and longitudinal population-based surveys based on self-report | Part of the existing care cascade | Previously referred to as the population “treated” or receiving any treatment for hypertension. Discrepancies can arise from differences in definitions of contact coverage (e.g. taking any medication vs interactions with health providers) |
Population receiving hypertension management services according to standards (E) | Percent of population with high blood pressure who are linked to quality treatment | Cross-sectional and longitudinal population-based surveys including the drugs prescribed. Linked facility records to determine quality of hypertension care provided | This estimate requires some incorporation of a definition of “quality” of hypertension treatment. For standardization purposes, fidelity to national/global treatment guidelines would be the best way to assess service quality | |
Population adhering to treatment (F) | Percent of population with high blood pressure receiving quality treatment and adhering to treatment as prescribed | Cross-sectional and longitudinal population-based surveys potentially including pill counts or diaries | Adherence to medications and/or lifestyle advice could be considered in this step | |
Population achieving health gain (G) | Percent of hypertensive population with controlled blood pressure | Cross-sectional and longitudinal population-based surveys with biometric measurements | Part of the existing care cascade | Health gain can be defined in multiple ways (e.g. controlled blood pressure levels, improved health, reduced hospitalization) |