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Hypertension. 2019 May;73(5):990-997. doi: 10.1161/HYPERTENSIONAHA.118.11916.

Improving Hypertension Outcome Measurement in Low- and Middle-Income Countries.

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From the International Consortium for Health Outcomes Measurement (ICHOM) (O.O., E.O., M.S., R.Z.).
Brazilian Society of Cardiology (C.A.).
The Public Health Foundation of India, Indian Institute of Public Health, Hyderabad (R.A.).
Hospital do Coração (O.B.).
University of Calgary (N.C.).
Sunway University; University of Malaya; and Malaysian Society of Hypertension (Y.-C.C.).
Eduardo Mondlane University (A.D.).
Heart Institute of Ho Chi Minh City (T.N.P.D.).
PASCAR, University of Yaounde (A.T.D.).
CCUL, Faculdade de Medicina da Universidade de Lisboa (M.F.).
Novartis Foundation (F.M.).
London School of Hygiene & Tropical Medicine (D.N.).
New York University Langone Medical Center (G.O.).
Belarusian Hypertension Society, Vitebsk State Medical University (V.P.).
Jewish General Hospital, McGill University (E.L.S.).
Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina da Universidade de Lisboa, Portugal (A.V.C.).
FHI360, London School of Hygiene & Tropical Medicine (P.L.).


High blood pressure is the leading modifiable risk factor for mortality, accounting for nearly 1 in 5 deaths worldwide and 1 in 11 in low-income countries. Hypertension control remains a challenge, especially in low-resource settings. One approach to improvement is the prioritization of patient-centered care. However, consensus on the outcomes that matter most to patients is lacking. We aimed to define a standard set of patient-centered outcomes for evaluating hypertension management in low- and middle-income countries. The International Consortium for Health Outcomes Measurement convened a Working Group of 18 experts and patients representing 15 countries. We used a modified Delphi process to reach consensus on a set of outcomes, case-mix variables, and a timeline to guide data collection. Literature reviews, patient interviews, a patient validation survey, and an open review by hypertension experts informed the set. The set contains 18 clinical and patient-reported outcomes that reflect patient priorities and evidence-based hypertension management and case-mix variables to allow comparisons between providers. The domains included are hypertension control, cardiovascular complications, health-related quality of life, financial burden of care, medication burden, satisfaction with care, health literacy, and health behaviors. We present a core list of outcomes for evaluating hypertension care. They account for the unique challenges healthcare providers and patients face in low- and middle-income countries, yet are relevant to all settings. We believe that it is a vital step toward international benchmarking in hypertension care and, ultimately, value-based hypertension management.


hypertension; patient-centered care; quality of life

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