Weak Primary Care Systems, Not Screening, Undermine Global Hypertension Control
Original framing: “[Correspondence] Facility-based blood pressure measurement and treatment” — The Lancet
Robust cohort data reveal that only 15‑25 % of screened individuals achieve target blood pressure without continuous primary‑care follow‑up, while integrated care models raise control rates above 60 %. Randomised trials of task‑shifting and fixed‑dose combination therapy provide strong evidence for system‑level interventions.
The Lancet correspondence reveals that the superficial allure of mass hypertension screening conceals a systemic failure to invest in primary‑care infrastructure, a pattern rooted in colonial health legacies and sustained by market‑driven drug policies.
Indigenous and cross‑cultural perspectives underscore that blood‑pressure control is as much a relational and spiritual matter as a biomedical one, demanding community‑led, culturally resonant interventions. Robust scientific evidence, future modelling, and successful case studies from Brazil, Ethiopia, and digital pilots demonstrate that integrating community health workers, securing fixed‑dose medication supply, and co‑designing programs with local knowledge holders can transform episodic screening into continuous, equitable care. By exposing the trickster paradox of celebrated screening that diverts from genuine system building, we can redirect policy and funding toward the resilient primary‑care networks that truly lower hypertension‑related morbidity and mortality.