• David Peiris, Arpita Ghosh, Jennifer Manne-Goehler, Lindsay M Jaacks, Michaela Theilmann, Maja E Marcus, Zhaxybay Zhumadilov, Lindiwe Tsabedze, Adil Supiyev, Bahendeka K Silver, Abla M Sibai, Bolormaa Norov, Mary T Mayige, Joao S Martins, Nuno Lunet, Demetre Labadarios, Jutta M A Jorgensen, Corine Houehanou, David Guwatudde, Mongal S Gurung, Albertino Damasceno, Krishna K Aryal, Glennis Andall-Brereton, Kokou Agoudavi, Briar McKenzie, Jacqui Webster, Rifat Atun, Till Bärnighausen, Sebastian Vollmer, Justine I Davies, and Pascal Geldsetzer.
• The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia.
• PLoS Med. 2021 Mar 1; 18 (3): e1003485e1003485.

BackgroundGlobal cardiovascular disease (CVD) burden is high and rising, especially in low-income and middle-income countries (LMICs). Focussing on 45 LMICs, we aimed to determine (1) the adult population's median 10-year predicted CVD risk, including its variation within countries by socio-demographic characteristics, and (2) the prevalence of self-reported blood pressure (BP) medication use among those with and without an indication for such medication as per World Health Organization (WHO) guidelines.Methods And FindingsWe conducted a cross-sectional analysis of nationally representative household surveys from 45 LMICs carried out between 2005 and 2017, with 32 surveys being WHO Stepwise Approach to Surveillance (STEPS) surveys. Country-specific median 10-year CVD risk was calculated using the 2019 WHO CVD Risk Chart Working Group non-laboratory-based equations. BP medication indications were based on the WHO Package of Essential Noncommunicable Disease Interventions guidelines. Regression models examined associations between CVD risk, BP medication use, and socio-demographic characteristics. Our complete case analysis included 600,484 adults from 45 countries. Median 10-year CVD risk (interquartile range [IQR]) for males and females was 2.7% (2.3%-4.2%) and 1.6% (1.3%-2.1%), respectively, with estimates indicating the lowest risk in sub-Saharan Africa and highest in Europe and the Eastern Mediterranean. Higher educational attainment and current employment were associated with lower CVD risk in most countries. Of those indicated for BP medication, the median (IQR) percentage taking medication was 24.2% (15.4%-37.2%) for males and 41.6% (23.9%-53.8%) for females. Conversely, a median (IQR) 47.1% (36.1%-58.6%) of all people taking a BP medication were not indicated for such based on CVD risk status. There was no association between BP medication use and socio-demographic characteristics in most of the 45 study countries. Study limitations include variation in country survey methods, most notably the sample age range and year of data collection, insufficient data to use the laboratory-based CVD risk equations, and an inability to determine past history of a CVD diagnosis.ConclusionsThis study found underuse of guideline-indicated BP medication in people with elevated CVD risk and overuse by people with lower CVD risk. Country-specific targeted policies are needed to help improve the identification and management of those at highest CVD risk.

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