Factors associated with uncontrolled hypertension in santander, colombia: baseline findings from the RE-HOPE study – Nature

Report on Hypertension Control in Santander, Colombia: Baseline Findings from the RE-HOPE Study and Implications for Sustainable Development Goals

A cross-sectional analysis from the RE-HOPE study in Santander, Colombia, highlights significant challenges in hypertension management, directly impacting the achievement of several Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being) and SDG 10 (Reduced Inequalities).

Study Demographics and Scope

Participant Profile

The analysis included a total of 3,481 participants with hypertension, defined by self-reported history, medication use, or elevated blood pressure readings. Key demographic characteristics include:

• Mean age: 60.2 years
• Gender distribution: 62% female
• Mean systolic blood pressure: 144 mmHg
• Mean diastolic blood pressure: 86 mmHg

Key Findings on Hypertension Management and SDG Alignment

Challenges to SDG 3: Good Health and Well-being

The study reveals a critical gap between awareness and effective control of hypertension, undermining progress towards SDG Target 3.4, which aims to reduce premature mortality from non-communicable diseases (NCDs). Despite high rates of awareness and treatment, control remains alarmingly low.

• Awareness: 81% of participants were aware of their condition.
• Medication Use: 76% were receiving antihypertensive medication.
• Controlled Hypertension ( Only 26% of participants achieved this target.
• Optimal Control ( A mere 9.6% met the more stringent control target.

This discrepancy indicates that current health interventions are insufficient to manage NCDs effectively, posing a direct threat to achieving global health targets.

Factors Associated with Uncontrolled Hypertension

Mixed-effects logistic regression models identified several factors significantly associated with poor hypertension control. These findings are crucial for developing targeted interventions that align with SDG principles of leaving no one behind.

1. Age (≥ 60 years): Older individuals were more than twice as likely to have uncontrolled hypertension (OR = 2.19), highlighting the need for age-sensitive healthcare strategies to support SDG 3.
2. Smoking: Current smokers had a nearly 2.5 times higher odds of poor control (OR = 2.48), emphasizing the importance of SDG Target 3.a (strengthen tobacco control).
3. Gender: Being female was inversely associated with uncontrolled hypertension (OR = 0.62), suggesting a gender-based disparity where men face greater risks. This points to a need for targeted health programs for men to advance SDG 5 (Gender Equality) in health outcomes.

Disparities in Health Access: A Challenge to SDG 10 and SDG 11

The study identified significant geographic disparities, which directly contravenes the goals of SDG 10 (Reduced Inequalities) and SDG 11 (Sustainable Cities and Communities). Control rates were notably higher in the capital city compared to peripheral and rural provinces. This urban-rural divide underscores inequalities in access to effective healthcare and resources, indicating that health systems in non-urban areas require substantial strengthening to ensure equitable health outcomes for all citizens.

Conclusion and Recommendations for Policy Action

The findings from Santander, Colombia, underscore a critical public health issue with direct relevance to the Sustainable Development Agenda. The low rate of hypertension control, despite high awareness and treatment levels, signals systemic failures in healthcare delivery. To accelerate progress towards the SDGs, the following actions are recommended:

• Develop targeted public health initiatives focused on priority groups, including men, the elderly (age ≥ 60), and current smokers, to address the specific risk factors identified.
• Implement policy actions aimed at strengthening healthcare infrastructure and service delivery in rural and peripheral regions to reduce the inequalities highlighted in SDG 10.
• Enhance early diagnosis and management protocols within primary care to bridge the gap between treatment and effective blood pressure control, thereby contributing directly to SDG 3.

Analysis of Sustainable Development Goals (SDGs) in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being

  This is the primary SDG addressed. The article focuses entirely on hypertension, a major non-communicable disease (NCD). It discusses its prevalence, the low rates of control (“only 26% of participants had controlled hypertension”), and associated risk factors like smoking and obesity. The study’s aim to improve hypertension management directly contributes to ensuring healthy lives and promoting well-being for all at all ages.

• SDG 10: Reduced Inequalities

  The article explicitly points out disparities in health outcomes among different population groups. It states that hypertension control rates are lower “particularly in low-income communities” and vary geographically, with higher rates “in the capital city compared to peripheral and rural provinces.” By identifying these inequalities, the study highlights the need for targeted interventions to ensure equitable healthcare access and outcomes, which is central to SDG 10.

• SDG 5: Gender Equality

  The study analyzes data stratified by sex and finds that “Being female was inversely associated with uncontrolled hypertension.” This disaggregation of health data is crucial for understanding gender-specific health risks and outcomes, which is a component of achieving gender equality and empowering all women and girls by ensuring their specific health needs are understood and addressed.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.4: Reduce by one third premature mortality from non-communicable diseases through prevention and treatment.

   The article’s focus on the low control rates of hypertension is directly linked to this target. Hypertension is a leading risk factor for cardiovascular diseases, which are a major cause of premature mortality from NCDs. The study’s call for “targeted public health initiatives and policy actions to enhance hypertension control” is a direct strategy for achieving Target 3.4.

2. Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.

   The article’s findings that hypertension control is worse in “low-income communities” and “peripheral and rural provinces” demonstrate a lack of health equity, which is a form of social exclusion. The recommendation to identify “priority groups” aligns with the goal of Target 10.2 by aiming to reduce these health disparities and promote the inclusion of vulnerable populations in health services.

3. Target 3.a: Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate.

   The article identifies that “current smoking” was positively associated with poor hypertension control (OR = 2.48). This finding underscores the importance of tobacco control as a public health measure to manage NCDs like hypertension, directly supporting the objective of this target.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• Indicators for Target 3.4

  The article provides several quantitative measures that can serve as indicators for monitoring the prevention and treatment of NCDs:

  • Percentage of the population with controlled hypertension: The article states that “only 26% of participants had controlled hypertension (
  • Prevalence of risk factors: The study measures factors like “current smoking,” which is a key behavioral risk factor for NCDs. The odds ratio (OR = 2.48) quantifies its impact.
  • Awareness and treatment rates: The data on “high levels of awareness (81%) and medication use (76%)” compared to low control rates (26%) can be used to measure gaps in the healthcare cascade for hypertension management.

• Indicators for Target 10.2

  The article implies indicators for measuring health inequality by presenting disaggregated data:

  • Hypertension control rates disaggregated by geographic location: The comparison of control rates between “the capital city” and “peripheral and rural provinces” serves as an indicator of urban-rural health disparities.
  • Hypertension control rates disaggregated by demographic factors: The analysis of risk based on age (“age ≥ 60 years”) and sex (“Being female was inversely associated”) provides data to track inequalities among different demographic groups.

4. Summary Table of SDGs, Targets, and Indicators

Source: nature.com