Treating cardiovascular disease in Barbados

September 2016

The outwardly calm and relaxing Caribbean island of Barbados hides a pressure-cooker health crisis: more than one-third of Barbadians aged 25-70 years suffer from hypertension, the main risk factor for cardiovascular disease (CVD) – the world’s number one killer.

A woman choosing vegetables and fruits at a market in Barbados.
WHO/H Ruiz

Jenny Williams had counted herself among those at risk of heart attack and stroke. But that was until she joined 30,000 fellow Barbadians in a ground-breaking project – supported by WHO Pan-American Health Organization and the US Centers for Disease Control and Prevention (US CDC) – to further improve treatment for hypertensive patients through two polyclinics in the country.

"It is working for me," Jenny says of the treatment she has received through the Standardized Hypertension Treatment project. "I find that I have no problems with high blood pressure. Yes, I’m hypertensive, but I’m controlled."

Jenny’s story is one of many positive outcomes of the two-year project launched in 2015. The project set out to improve hypertension treatment and control among people with raised blood pressure. It did this through standardizing care for hypertensive patients, and prescribing, and making available, the most effective medicines for treating each person’s condition.

Dr Kenneth Connell, from the University of the West Indies, Cave Hill campus, and the principal investigator for the Barbados project, says there was a 14.5% increase in the proportion of hypertensive patients who, over 18 months of receiving care through the project, achieved satisfactory blood pressure control.

Setting the standard for CVD care

This was largely due to the implementation of a new treatment protocol for hypertension. Counselling patients on lifestyle changes, such as improving exercise and diet and reducing tobacco use, which are among the main risk factors for CVD), is a key part of the protocol. Other elements include guidance for healthcare providers to prescribe medications depending on blood pressure levels, based on the best available clinical evidence.

Additionally, an electronic registry allowed care providers the means to ensure appropriate patient follow up and to monitor blood pressure control.

"It was incredibly rewarding to see how much hypertension control rates improved over the course of the project," Dr Connell says. "It was also encouraging to see the cultural and behavioural change in the clinics among health workers who had to deliver a more focused form of care. There was sometimes resistance. But once the project started generating results, health workers embraced our new approach to CVD care."

CVD, primarily heart attacks and strokes, kill 17.5 million people worldwide each year, one-third before the age of 70 years.

Key factors increasing people’s risk of heart disease are tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol. WHO recommends that hypertension management include efforts to help people reduce their exposure to these risk factors, along with improving the access to medical treatment and essential drugs. The Barbados project has shown that patient-centred care greatly improves blood pressure control in people at risk of CVDs.

Support from the Global Hearts Initiative

The lessons learned and positive outcomes of this project will be expanded, thanks to support from a new global initiative – launched by WHO and CDC this month – to scale up prevention and control of CVD, especially in low and middle income countries.

The Global Hearts Initiative will initially be rolled out in Barbados, Benin, Colombia, Ethiopia, India, the Islamic Republic of Iran, Jordan, Nepal, Nigeria, Philippines, Sri Lanka, Tajikistan, Thailand and Uganda – and will be open to all countries wishing to participate.

Specific activities will include:

  • Developing salt reduction and tobacco control plans,
  • Implementing simplified and standardized management protocols,
  • Improving access to medicines and technologies, and
  • Building capacities of health and other providers.

"Four in five people who die from a cardiovascular disease are killed by a heart attack or a stroke," says Dr Etienne Krug, WHO Director for the Management of NCDs. "The Global Hearts Initiative focuses on these two main drivers of CVD to have the greatest impact."

Grassroots support is vital for the success of the initiative, and it is being backed by the World Heart Federation, the World Stroke Organization, International Society of Hypertension and the World Hypertension League.

Global Hearts relies on proven, effective and inexpensive interventions to counter the NCD risk factors, and strengthen detection and treatment of people at high risk of a CVD episode.

Dr Douglas Bettcher, WHO Director for Prevention of NCDs, adds: "While many richer countries have taken such steps, over three-quarters of deaths from heart attacks and strokes occur in low- and middle-income countries. The poor and disadvantaged should not be denied access to measures that can save lives. The goal of Global Hearts is to address this gap."