National program for cardiovascular disease and hypertension in primary healthcare: WHO-PEN program initial scale-up in Iran (IraPEN).

INTRODUCTION

We evaluated the IraPEN program, a localized adaptation of the WHO PEN initiative in Iran, with respect to cardiovascular disease and hypertension screening and management.

METHODS

A cross-sectional ecological study utilizing the Input-Process-Output-Outcome framework was conducted during 2020-2021. Aggregated data from non-communicable disease (NCD) facilities were collected and analyzed by urban/rural primary healthcare settings.

RESULTS

The study evaluated 610 NCD facilities, serving 1.8 million adults aged ≥ 30, of whom 515,488 underwent 10-year WHO/ISH CVD risk scoring and hypertension assessment, indicating coverage of 30%. Input/process showed all NCD facilities had functional blood pressure devices, 87% had POCT for measurement of glucose and cholesterol and 14% experienced medication stock-outs in the past three months. All staff received CVD risk scoring training, with 60% re-trained during the last two years. Output/outcome indicators revealed 3% of individuals were at moderate risk (CVD risk 10-19%), 0.6% at high risk (20-29%), 0.9% at very high risk (≥ 30%), and 2.7% had a prior CVD history. Prevalence of hypertension was 17%, compared with a national survey, indicating an observed-to-expected ratio of 55%. 80% of patients with hypertension received blood pressure-lowering medications, and 74% of them achieved blood pressure control; 38% of CVD patients received antiplatelet/anticoagulant therapy, and 66% of eligible patients took statins.

CONCLUSION

IraPEN demonstrated low coverage for CVD risk scoring and hypertension detection but acceptable treatment and control rates. Management of patients with CVD seems suboptimal. The WHO/ISH CVD risk scoring may lack in detecting high and very high-risk individuals.