Unravelling the Belgian cascade of hypertension care and its determinants

Abstract

Abstract Objective. To use a cascade of care approach to identify where most patients are lost along the continuum of hypertension care in Belgium, and to assess the main risk factors for attrition at various stages of hypertension management. Methods. Using cross-sectional data from the 2018 Belgian Health Interview Survey and Belgian Health Examination Survey, we estimated hypertension prevalence among the Belgian population aged 40-79 years, and the proportion that was (1) screened, (2) diagnosed, (3) linked to care, (4) in treatment, (5) followed up and (6) well-controlled. Cox regression was used to identify risk factors for being unlinked to hypertension care, untreated and not followed up appropriately. Results. The prevalence of hypertension based on self-reported and measured high blood pressure (BP) was 43.3%. While 98% of the hypertensive population had their BP measured in the past 5 years, only 56.7% was diagnosed. Furthermore, 53.4% of the hypertensive population was linked to care, 49.8% was in treatment and 43.4% received adequate follow-up. Less than a quarter (23.5%) achieved BP control. Males, those of younger age, without comorbidity, and smokers, were more likely to be unlinked to care. Younger age, lower BMI, financial hardship, and psychological distress were associated with a higher risk of being untreated. Finally, females, those of younger age, and without comorbidity were more likely to receive no adequate follow-up. Conclusion. Our results show that undiagnosed hypertension is the most significant barrier to BP control in Belgium. Health interventions are needed to improve the accurate and timely diagnosis of hypertension.