A recent Pan American Health Organization (PAHO) study published in the Journal of Pharmaceutical Policy and Practice reveals significant barriers in access to essential hypertension medications across Latin America and the Caribbean, including outdated essential medicines lists and diffuse procurement practices, and underscored the need for more standardized antihypertensive medicines to help reduce the cardiovascular disease burden in the region.
Cardiovascular diseases are the leading cause of death in the Americas, accounting for over 2 million deaths annually. Hypertension affects 35.4% of adults aged 30-79 and remains inadequately managed: 37% of individuals with hypertension in Latin America and the Caribbean are undiagnosed, 15% of those diagnosed do not receive treatment, and 47% of those treated do not have their blood pressure controlled. These gaps contribute to elevated rates of stroke and heart disease.
PAHO has been helping countries address this issue through the HEARTS initiative, which aims to enhance hypertension management and cardiovascular risk prevention through standardized treatment protocols and improved access to essential medications.
The study, covering 22 countries participating in the HEARTS initiative, found notable inconsistencies in the inclusion of recommended antihypertensive medicines on National Essential Medicines Lists (NEMLs). The limited availability of fixed-dose combinations (FDCs) antihypertensive products on such lists was particularly concerning. FDCs, included in the World Health Organization (WHO) List of Essential Medicines in 2019, have been demonstrated to effectively control blood pressure, enhance patient adherence, and reduce side effects and adverse events compared to monotherapy.
Additionally, the study revealed significant variations in medicine registration, pricing, and procurement practices, which collectively hinder access and affordability.
“Antihypertensive medicines are inexpensive to produce and can save millions of lives,” Pedro Orduñez, Advisor on Chronic Diseases at PAHO and one of the authors of the study, said. “Reducing the price and improving the quality is a key intervention to improve access and quality of care.”
“Despite the high prevalence of hypertension, many people in the region lack access to the medications needed to control their blood pressure,” Christopher Lim, lead author of the study and Chief of PAHO’s Strategic Fund, said. “Our findings highlight the need for decision-makers to update NEMLs to include these critical medicines.”
Key recommendations from the study include:
- Update National Essential Medicines Lists: Align NEMLs with evidence-based guidelines and include essential FDCs to improve treatment adherence and control.
- Improve procurement practices: Streamline procurement processes and leverage pooled procurement mechanisms, such as the PAHO Strategic Fund, to consolidate demand, negotiate better prices, availability, and ensure consistent supply of quality-assured medicines.
- Increase transparency: Address transparency issues in medicine pricing through standardized reporting and the development of platforms for price information sharing.
- Enhance market access: Support the registration and availability of essential medications across all countries to prevent market fragmentation and ensure equitable access.
“PAHO’s Strategic Fund can play a crucial role in helping countries overcome these challenges by facilitating pooled procurement of quality-assured medications,” Lim added. “This approach has proven successful in the management of other diseases and offers valuable insights for enhancing access to antihypertensive treatments.”
The study’s results underscore the importance of continued collaboration among governments, healthcare systems, and stakeholders to address barriers in access to medication in order to improve cardiovascular health outcomes throughout the region.
(https://www.paho.org/en/news/26-8-2024-paho-study-highlights-challenges-access-hypertension-medication-latin-america-and)
