Under the leadership of the Ministry of Public Health (Minsap), Cuba is implementing a series of actions aimed at strengthening the arterial hypertension (AHT) control programme at the primary health care level.

Dr Yamilé Valdés González, a specialist in internal medicine and vice-president of the National Technical Advisory Commission on Arterial Hypertension, explained to Granma that these actions are part of an innovative organisational strategy based on the technical packages of the Hearts in the Americas Initiative.

«This is a regional programme involving 32 countries in Latin America and the Caribbean, whose purpose is to reduce premature mortality caused by cardiovascular diseases, one of the main consequences of high blood pressure. Cuba was among the four founding nations of the Initiative in 2016».

The main author of this scientific result, which merited the National Award for Technological Innovation 2023, conferred by the Ministry of Science, Technology and Environment, Dr Valdés González explained that the proposed methodology facilitated the adaptation of the HTA control programme to the first level of care.

«Through its application, we provide health personnel at polyclinics and family doctor and nurse practitioners’ offices with tools for the diagnosis and treatment of hypertension that are more effective and based on cardiovascular risk, as a means of reducing the burden of the disease and associated mortality, as well as encouraging changes in lifestyles and improving patient access to national medicines and technologies.

«It is fair to recall that, since 1975, our country has had an HTN control programme, which is now being enriched and refined by the gradual introduction of the promising organisational strategy».

PROJECT CREDENTIALS

According to the researcher from the National Institute of Endocrinology (INEN), the strategy began to be used in a demonstration polygon created at the Carlos Verdugo Martínez polyclinic in Matanzas in 2016.

«Once validated there, it was extended to two other polyclinics in Villa Clara and Cienfuegos in 2018. Taking into account the results, three years later 22 more sites were already included, including all the health areas of the municipalities of Matanzas and Cienfuegos; the José Martí polyclinic in Santiago de Cuba; as well as six health areas belonging to two municipalities in Havana.

«At present, there are 451 polyclinics in the 15 provinces and the special municipality of Isla de la Juventud, integrated into the experience. This means that, of the approximately three million people with hypertension in Cuba, around two million are registered in the hypertension control programme.

Among the main innovations implemented for the adaptation of the technical package of the Hearts Initiative to the HTN control programme in our country, the use of educational materials on habits, lifestyles and the correct way to take blood pressure, together with the use of the Via Clinica product for HTN care at the primary health care level and the introduction of instruments to calculate cardiovascular risk, stand out.

Also included are the obtaining, registration and start of marketing of the antihypertensive drug Lisinopril in the national pharmacy network, and progress in the development of the first fixed-dose combination drugs Lisinopril+Hydrochlorothiazide and Lisinopril+Losartan, created at Medsol Laboratories, part of the BioCubaFarma Business Group.

The completion of the first national clinical validation study of Hipermax BF automatic sphygmomanometers in the general population, produced in Cuba by the company Combiomed Tecnología Médica Digital, is also of particular importance.

To achieve this certification, a clinical trial promoted by the Institute of Cardiology and Cardiovascular Surgery of the Minsap and conducted by the Centre for State Control of Medicines, Equipment and Devices (Cecmed) was carried out over the last three years.

RISING PREVALENCE

As reported by Prof. Valdés González, the progressive application of the system corroborated a higher and more accurate prevalence of arterial hypertension in the current Cuban population.

«Today we have a total of 2,494,098 hypertensive patients dispensed in primary health care, a figure that represents 79.1 % of the estimated total number of patients. While in 2010 the incidence of known cases was 22.4 % per 100 inhabitants, by the end of last year it had risen to 29.5 %».

«Thanks to the results of the management of the organisational strategy, as of March 2024, a modification of the system of registration of medical care for hypertensive patients at the first level of care, according to their cardiovascular risk, will be implemented.

For Dr. Yamilé Valdés, achieving adequate control of high blood pressure would reduce the risk of premature mortality and the complications and disability associated with the diseases that this chronic non-communicable disease can trigger over time, such as ischaemic heart disease, stroke, chronic kidney disease, cognitive impairment and dementia.

«The accumulated experience alerts us that many people are unaware of their hypertensive condition or may be uncontrolled without knowing it. Hence the importance of going to their primary health care team to be evaluated at least three times a year».