Trends in the hypertension care cascade under dual guideline criteria in Peru, 2014–2024: a decade of nationally representative surveys with joinpoint analysis and projections toward the WHO 2030 targets

Ballena-Caicedo J.; Vera-Ponce V.J. · Frontiers in Public Health (2026) · DOI: 10.3389/fpubh.2026.1830773

Resumen

Background – Prior assessments of the hypertension care cascade in Peru have covered short periods and used a single diagnostic threshold. Objective – To describe 11-year trends (2014–2024) in the hypertension care cascade under two contemporary criteria (2023 ESH and 2025 ACC/AHA), quantify socioeconomic inequalities, and project the cascade to 2030 relative to WHO HEARTS targets. Methods – Repeated cross-sectional analysis of 238, 738 adults (≥18 years) from the Peruvian Demographic and Family Health Survey (ENDES), 2014–2024. Hypertension was defined by ESH 2023 (≥140/90 mmHg or lifetime prior diagnosis) and ACC/AHA 2025 (≥130/80 mmHg or lifetime prior diagnosis). The cascade comprised awareness, pharmacological treatment, and control (<140/90 and <130/80 mmHg). Prevalences were age-standardized to the WHO World Standard Population. Joinpoint regression was applied to 23 time series and wealth-related inequalities were assessed with the Erreygers concentration index. Results – Age-standardized ESH prevalence did not change significantly (AAPC 0.88%; p = 0.261), whereas ACC/AHA prevalence increased (AAPC 1.92%; p = 0.022), as did guideline discordance (AAPC 2.88%; p = 0.002); no joinpoints were identified. In 2024 (ESH), 53.6% of hypertensive adults were aware of their diagnosis, 60.3% of those diagnosed received treatment, and 59.0% of treated individuals achieved control <140/90 mmHg; population-level treatment and control were 32.3 and 19.1%. The Erreygers index indicated stronger pro-rich inequality for treatment than for awareness. Projected 2030 values for awareness, treatment, and control were 54.2, 33.5, and 21.0%, leaving gaps of 25.8, 30.5, and 30.2 percentage points relative to 80–80-80 targets. Conclusion – Peru’s population-level hypertension care cascade showed persistent stagnation during 2014–2024. Current trends indicate the country will not achieve HEARTS 2030 targets without large-scale primary care interventions with an equity focus. Copyright

Instituciones: Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas