Low medication co-payments may help bring hypertension (HT) under control and improve treatment compliance, researchers found in a meta-analysis that assessed the effect of healthcare systems in different parts of the world. Other factors linked to better outcomes among hypertensive patients include having health insurance and being under the regular care of a provider.

The study authors, led by Will Maimaris, BM, Bchir, of the London School of Hygiene and Tropical Medicine, identified 53 studies that examined the impact of regional or national healthcare systems on hypertension awareness, treatment, medication compliance and control of the condition. Their research was published in the July issue of PLOS Medicine.

Thirty-six studies took place in the U.S. and eight in other high-income countries. The others were conducted in low or middle-income countries (LMICs).

The authors noted that most of the available literature was not of the highest quality; however, they were still able to make some connections.

Most of the included studies (a total of 38, primarily from the U.S. and other high-income countries) focused on financial aspects of healthcare systems that influenced HT outcomes.

“The finding of an association between reduced medication co-payments and improved HT outcomes is intuitive and suggests that costs of medications or health care consultations may act as a barrier to optimal HT care in the U.S., and potentially other settings, including LMICs,” the authors wrote.

Access to regular medical care was also linked to HT outcomes.

“Although lacking longitudinal studies, we found a large positive association between having a routine physician or place of care for HT management and treatment, awareness, control, and adherence to antihypertensive treatment,” the authors wrote. This finding came mostly from U.S.-based research.

Although LMICs struggle with weak health systems and rampant hypertension, little research has been done in these regions. The authors stressed the importance of higher-quality, more robust research globally, but especially in the lower-income  parts of the world.

Future research should also move toward other realms of healthcare systems.

“The focus on financing has highlighted important barriers to effective care and control of HT but needs to be supplemented by research examining other domains, such as delivery and governance mechanisms, production of knowledge, and the social function in the health systems,” the researchers said.