PAHO study highlights challenges in access to hypertension medication in Latin America and the Caribbean – PAHO/WHO

Washington, DC, August 26, 2024 (PAHO) – A Recent study by the Pan American Health Organization (PAHO) published in the Journal of pharmaceutical policy and practice reveals significant barriers to accessing essential hypertension medicines in Latin America and the Caribbean, including outdated essential medicines lists and diffuse procurement practices, and underscored the need for more standardized antihypertensive medications to help reduce the burden of cardiovascular disease in the region.

Cardiovascular diseases are the leading cause of death in the Americas, causing more than 2 million deaths annually. Hypertension affects 35.4% of adults aged 30 to 79 years and remains poorly controlled: 37% of hypertensive patients in Latin America and the Caribbean are undiagnosed, 15% of those diagnosed are not receiving treatment, and 47% of those treated do not have their blood pressure controlled. These deficiencies contribute to high rates of stroke and heart disease.

PAHO has been helping countries address this problem through the HEARTS initiative, which aims to improve the management of hypertension and the prevention of cardiovascular risk through standardized treatment protocols and improved access to essential medicines.

The study, which covered 22 countries participating in the HEARTS initiative, found notable inconsistencies in the inclusion of recommended antihypertensive medications in National Essential Medicines Lists (NEMLs). The limited availability of antihypertensive products with fixed-dose combinations (FDCs) on such lists was particularly concerning. FDCs, included in the World Health Organization (WHO) Essential Medicines List in 2019, have been shown to effectively control blood pressure, improve patient adherence, and reduce side effects and adverse events compared to monotherapy.

Furthermore, the study revealed significant variations in drug registration, pricing and procurement practices, which together hinder access and affordability.

“Antihypertensive drugs are cheap to produce and can save millions of lives,” said Pedro Orduñez, PAHO Chronic Diseases Advisor and one of the authors of the study. “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,” said Christopher Lim, lead author of the study and Director of PAHO’s Strategic Fund. “Our findings highlight the need for decision-makers to update the NEMLs to include these critical medications.”

Key recommendations from the study include:

1. Updating national lists of essential medicines:Align NEMLs with evidence-based guidelines and include essential FDCs to improve treatment adherence and monitoring.
2. Improving procurement practices:Streamline procurement processes and take advantage of joint procurement mechanisms, such as the PAHO Strategic Fund, to consolidate demand, negotiate better prices and availability, and ensure a constant supply of quality-assured medicines.
3. Increase transparencyAddressing drug pricing transparency issues through standardized reporting and the development of platforms for sharing pricing information.
4. Improving market access:Support the registration and availability of essential medicines in all countries to avoid market fragmentation and ensure equitable access.

«The PAHO Strategic Fund can play a crucial role in helping countries overcome these challenges by facilitating the pooled procurement of quality-assured medicines,» Lim added. «This approach has proven effective in treating other diseases and offers valuable insights for improving access to antihypertensive treatments.»

The results of the study underscore the importance of continued collaboration between governments, health systems and stakeholders to address barriers to access to medicines in order to improve cardiovascular health outcomes across the region.