Non-communicable diseases (NCD), such as cardiovascular disease (CVD), diabetes, cancers and chronic respiratory diseases, are the leading causes of death worldwide. More than 75% of NCD-related deaths occur in low- and middle-income countries (LMIC). NCD-related deaths account for 69% of deaths in Southeast Asia and CVD accounts for nearly 25% of these, mostly in individuals aged <70 years.1
Hypertension (HTN) is the leading risk factor for NCDs globally. It is estimated that 33% of the population in Southeast Asia has HTN.1 The WHO Southeast Asian SEAHEARTS initiative aims to reduce CVD risk through multiple integrated primary care risk factor interventions, including achieving a 25% relative reduction in the prevalence of raised blood pressure (BP) and an overall 30% reduction in mortality from NCDs by 2030.1 Sri Lanka is an LMIC in South Asia and an early partner in the SEAHEARTS initiative. This narrative review discusses Sri Lanka’s current approaches to community HTN management, highlights some key factors affecting HTN care and provides recommendations to support future programme development.
Methods
For this review, ‘community HTN care’ refers to the screening, diagnosis and management of essential HTN in adults in outpatient clinical settings. The objectives of this review are to describe how Sri Lanka’s healthcare system screens, diagnoses and manages essential HTN in the adult outpatient population, and to identify important factors affecting the delivery of community HTN care.
A knowledge resource specialist completed a structured search on 22 October 2024 using Medline, PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL), limited to English-language articles. The search was built with MeSH vocabulary specific to age, male/female, HTN (i.e. screening, diagnosis, treatment, epidemiology), location, patient education and other pertinent terms, without time constraints, but tailored to retrieve results balancing comprehensiveness and relevancy.
Fifty-eight articles were first identified. Studies of in-hospital populations, older data (>20 years), study protocols, molecular diagnostics and other studies not addressing the main search objectives were excluded. Twenty-two articles were deemed relevant for inclusion, featuring HTN prevalence, diagnosis, treatment, healthcare accessibility, treatment affordability, patient education and sociodemographic factors. Focused supplementary searches were also conducted across several databases (Medline, PubMed, CINAHL, HealthSTAR) and grey literature sources using Google and Google Scholar to gather information, ensuring broad contextual coherence for the review. Coauthors also provided supplementary articles from regional journals and government publications.
Hypertension in Sri Lanka
Sri Lanka is an island situated below the southern tip of India. It has a population of nearly 22 million people, with approximately 80% of the population living in a rural environment. The country has achieved a relatively high overall standard of health despite its LMIC status. With its epidemiological transition, NCDs are the greatest causes of morbidity and mortality, despite improvements in health outcomes overall. NCDs are estimated to account for 81% of all deaths, mainly from ischaemic heart disease, other CVDs and diabetes.2
The WHO’s STEPwise approach to NCD risk factor surveillance (STEPS) is used to understand key behavioural and biological NCD risk factors and enables monitoring of trends within a country, as well as comparisons between countries.3 In Sri Lanka, the 2015 survey measured a population prevalence of HTN of approximately 25%. Sri Lanka’s last STEPS survey was completed in 2021 and showed an increase in the prevalence of HTN to 35%, using diagnostic criteria of BP ≥140/90 mmHg.4 Of those being treated for HTN, only approximately 40% had achieved good BP control, whereas nearly 70% of men and approximately 50% of women on medication had not achieved treatment goals.4
The prevalence of the burden of HTN in Sri Lanka may be underestimated using the traditional BP threshold of 140/90 mmHg. Rannan-Eliya et al. showed that reclassifying adults in the Sri Lankan Health and Ageing longitudinal study according to American College of Cardiology/American Heart Association 2017 revised criteria of BP ≥130/80 mmHg, the prevalence of HTN increased from approximately 28% to 51%.5 With Sri Lanka’s rapidly ageing population (Figure 1), the burden and complications of HTN will further challenge the healthcare system. The increasing prevalence of HTN is also associated with higher occupational stress, higher BMI and sedentary behaviour.6–8 A recent multidistrict survey in Sri Lanka identified HTN as the most prevalent chronic disease and reported that 70% of respondents rely on the public healthcare system for treatment.9
Sri Lanka’s National Health System
The primary responsibility of Sri Lanka’s national Ministry of Health (MoH) is to deliver allopathic (western medicine) healthcare services, which are the most widely used in the country. The MoH also oversees the operation of alternative and Ayurveda medical hospitals.10 Healthcare service delivery is managed by the MoH and its nine provincial health ministries. The MoH develops policies and guidelines, manages the training and recruitment of healthcare staff, operates the highest tertiary-level public health institutions (including teaching hospitals) and regulates private healthcare services. Human resource management is shared between the MoH and provincial ministries. The MoH also runs vertical health programmes (i.e. NCD prevention, maternal and child health, family planning, occupational and environmental health) that oversee and guide primary healthcare (PHC) institutions in these areas.11 The MoH collaborates with development partners, especially United Nations agencies, mostly leveraging their technical expertise to develop health system priorities and improve the delivery of care.10
Provincial health ministries implement national health policy and regulate and manage all PHC institutions, as well as some secondary- and tertiary-level institutions that provide ambulatory primary care services. The PHC system is primarily divided into two categories: preventive healthcare institutions and curative healthcare institutions.10 Although different medical facilities may be designed to prioritise a certain clinical objective, all facilities provide a combination of preventive and curative medical care within their resource capabilities. PHC institutions range from divisional hospitals and primary medical care units to remote ambulatory clinics (Figure 2). All government healthcare institutions and ambulatory programmes provide services and medications free of charge to patients. Patients are required to attend clinics every month to receive their free prescriptions. In the public sector, generally, no referrals are needed for patients to see physicians.
Current Approaches to Community Hypertension Screening and Management
The WHO’s HEARTS technical package for CVD management in PHC outlines five key components required to achieve successful community-based HTN control: formal treatment protocols that are easy to follow and deliver; community-based care with healthcare team-based task sharing; reliable quality-assured supply of medications and BP monitors; patient-centred services to improve access to care, treatment compliance and patient education; and reliable information systems for real-time clinical feedback and programme improvement.12
To address these components, Sri Lanka’s national MoH has been working towards a better-integrated, publicly funded PHC system, which includes developing national guidelines, additional healthcare worker training and expanding the clinical capacity of its PHC institutions for HTN and NCD screening. The MoH also partnered with the Ceylon College of Physicians and the global non-profit organisation Resolve to Save Lives to publish national guidelines for HTN diagnosis and management for PHC providers in 2021.13,14 These guidelines incorporate the HEARTS technical package recommendations and include easy-to-use treatment protocols for primary care providers (Figure 3).
The NCD unit of the MoH initiated healthy lifestyle centres (HLC) nationwide in 2011 to address the lack of a structured NCD screening service through the lowest level of PHC institutions. This was the first such initiative in the Southeast Asian region to promote the early detection and management of NCDs. The HLCs are currently operated by the primary medical care unit system, mostly within clinics of smaller divisional and district hospitals. The main service objective of HLCs is to reduce the risk of NCDs among people aged >35 years through early risk factor detection and by improving access to specialist consultations for those at higher risk of CVD. Although available to the country’s entire population, the programme aims to especially support communities with limited access to healthcare and financial constraints.15 The mobile clinics that had been used previously for NCD screening among less accessible communities have been primarily replaced by HLCs.
With the establishment of HLCs, island-wide training programmes were conducted to teach healthcare workers risk assessment protocols and record keeping. A paper-based data management system is currently used, with quarterly monitoring and evaluation of the programmes by the NCD directorate.16 The criteria for screening at HLCs include: all people aged ≥35 years without a previous diagnosis of NCD; or adults aged 20–34 years with HTN (BP ≥140/90 mmHg), tobacco smoking, elevated BMI or central obesity, symptoms of diabetes or a family history of either premature CVD, diabetes or dyslipidaemia.4 The screened clients are managed at the HLC based on a total-risk approach in reference to their 10-year CVD risk. The WHO/International Society of Hypertension (ISH) risk prediction chart (in particular, the WHO/ISH Southeast Asia Region B chart, which has been validated in a Sri Lankan population) is used, although it has been found to better predict risk in men.17
Secondary- and tertiary-level institutions also provide primary care and specialised ambulatory care clinics, which patients can freely access without referral.10 Opportunistic HTN screening occurs in these settings, but less time is spent on patient education due to high patient volumes and constraints on physician time.18 At a smaller scale, opportunistic screening also occurs in preconception and well woman clinics, during foreign employment physical examinations, occupational health inspections by the MoH, work-related medical assessments and community-led NCD health promotion programmes. As a norm in the clinics, physicians perform clinical assessments, whereas nurses are primarily involved in clinic administration. There are no system-wide regular HTN education programmes for patients or the communities at large.
The private healthcare sector provides a significant portion of ambulatory primary care health services across socioeconomic strata, including low-income populations.19 Like the public sector, no referrals are needed for patients to access physicians in the private sector. It is estimated that nearly 50% of ambulatory care visits occur in the private sector, yet most of the chronic disease management still takes place in the public sector. The overall quality of medical management is similar between the systems because physicians typically practice in both sectors and almost all have trained and apprenticed in the public sector. However, the private sector allows for longer physician–patient interactions and more patient education. It also offers reliable continuity of care with the same physician (a standard the public sector aims to achieve), resulting in greater patient satisfaction with these aspects of care.18 However, the private sector is loosely regulated, and its broader impact on HTN management and related long-term public health outcomes is unclear.
Health System and Demographic Factors Affecting Community Hypertension Care
Hypertension care in Sri Lanka is shaped by the complex interplay of a resource-constrained healthcare system and the diverse needs of its population. This section highlights a selection of issues affecting care delivery that seemed particularly significant or widely observed in the literature. Some notable topics regarding PHC institutions include low HLC usage, health workforce challenges and the need to leverage digital technology. Notable population variables were rural residency and personal out-of-pocket healthcare expenses, alongside the general need for public awareness and education.
Healthcare System
Healthy Lifestyle Centres: Low Service Usage and Low Public Engagement
Sri Lanka’s PHC initiative aimed to register patients nationwide within regional primary medical care institutions with unique patient health numbers for continuity of care, to facilitate referrals and for long-term chronic disease management. Attempts to register people within a catchment population have been difficult, with only a minority being enrolled. Insufficient staff support, a lack of procedural knowledge, passive clinic-centred registration and unreliable monitoring mechanisms were noted challenges to enrolment.20
The NCD directorate reports 1016 HLCs as operating within PHC institutions.4 Unfortunately, very few of the eligible target population have been screened at these centres. At their peak, up to 10% of the target population was screened at HLCs in 2018. During the COVID-19 pandemic and subsequently, there has been a precipitous and persistent decline in annual screening to approximately 1.5–2% of the targeted population. Severe underutilisation has been a key factor in the limited effectiveness of HLCs.21
The HLCs are expected to operate at least once per week between 8 am and 12 pm. A recent community-based survey identified that awareness of HLCs among the target population was only 42%, and men, especially, did not believe there was any benefit in the screening process.15 The same survey found that the HLCs needed to be more accessible, because many people walked there and the limited operating hours did not allow for employed people to attend, as most were day-wage earners who could not afford to lose income. The most significant factors driving HLC usage among both men and women were a favourable opinion of the benefits of screening and concerns regarding personal vulnerability to developing NCDs.15 Having family and community support also favourably influenced the likelihood of attending HLCs. Unfortunately, thus far, providing a free medical service has yielded little benefit in this setting, because the population served generally does not perceive its value or does not attend due to competing socioeconomic variables.
Even in well-attended clinics in larger hospitals, most patients have poor medication adherence; this can be mostly attributed to a lack of reliable systematic reminders, a lack of knowledge, poor communication from health professionals, a lack of medications, too many medications to coordinate or excessive medication costs.22 Using proven cost-effective fixed-combination medications to improve adherence is not an option because these are not yet available in the public sector for free prescription.23,24 Overall, the value of preventative medical care is not sufficiently established in the general culture. Patients often seek medical advice only when they are symptomatic and are susceptible to medication non-adherence when feeling well.
Clinician Work Stress and Workforce Shortages
In public hospital clinics, hundreds of patients are seen daily, which does not support optimal HTN management or education. The WHO advocates a cost-effective multidisciplinary team-based approach for HTN management by addressing some of the systemic constraints of a small healthcare workforce in LMICs.25 This is a challenge in Sri Lanka’s underfunded health system with overburdened clinicians.
Increased occupational stress causing clinician burnout and loss of resilience has been identified as a major concern in the Sri Lankan healthcare system, even before the COVID-19 pandemic.26,27 Junior medical doctors with long work hours and a considerable work burden are committing more medical errors. Female nurses and female clinicians are especially vulnerable given multiple sociocultural demands in addition to their heavy workload.
During the COVID-19 pandemic, in a survey involving multiple COVID-19 care units, more than 65% of physicians and approximately 73% of nurses reported at least one form of burnout.28 The high workload in the public sector causes severe occupational stress, as well as a greater risk of medical errors and compromised healthcare.29 It may contribute to nearly 30% of persistent HTN in the community, from therapeutic inertia, where physicians do not make the required medication adjustments despite regular clinic visits.30 Significant emigration of the healthcare workforce from Sri Lanka due to increasing economic and political instability further compounds occupational stress for those remaining. An estimated 500 doctors emigrated from Sri Lanka in 2022 alone.31
The community healthcare worker experience was reflected in a recent, detailed 17-country survey (including Sri Lanka).32 In that survey, the main barriers to healthcare workers providing HTN care were reported to be inadequate training (83%), regulatory issues limiting scope of practice (76%) and resistance from patients (56%), physicians (42%) and nurses (40%). Opportunities to improve treatment included the use of treatment algorithms (94%), technology (92%) and adequate healthcare worker compensation (80%).32
Furthermore, the Sri Lankan government intentionally keeps wages low in the public sector to limit state costs and has facilitated private sector work instead. This has significantly magnified the competition for human resources between the public and private sectors.19
Underutilisation of Digital Technology
The WHO provides recommendations to strengthen health systems by integrating digital technologies to improve communication, support clinical decision-making, track client progress and support healthcare worker training.33 Mobile technology is potentially more cost-effective in fragile health systems. Despite data security and accessibility constraints, mobile health strategies have shown significant utility in HTN and NCD screening, disease surveillance, treatment compliance, clinic attendance, improved communication and the opportunity to integrate patient care across sectors.34 There is emerging evidence of the feasibility of CVD risk stratification and management using mobile technology, with task shifting to healthcare workers in geographically diverse rural communities in LMICs.35–37
Sri Lanka is still quite early in its experience with digital health technology (and mostly in acute care settings), but is working to develop its integration.38 Currently, there is no integration of patient health information between the private and public sectors. Patients carry their outpatient health records in book form to their appointments in both sectors. Currently, there are no established programmes integrating mobile health technology for HTN care. The NCD directorate and the MoH Health Information Bureau (www.youtube.com/@healthpromotionbureau6006/videos) provide some educational materials through websites and social media for disease prevention and lifestyle modification.39 Unfortunately, with minimal views and no documented population impact from these interventions, further strategic work is needed.
Sri Lanka’s Telecommunications Regulatory Commission reports that more than 29 million mobile telephone subscriptions were active in 2024.40 This far exceeds the 22 million people living in Sri Lanka, suggesting multiple subscriptions for some users. Importantly, this establishes that digital cellular technology is widely accessible and well-integrated into Sri Lanka’s social norm and could be harnessed to raise public awareness and engagement in community HTN care.
Rural Residency Affecting Community Hypertension Care
Sri Lankans mostly live in rural communities. Knowledge related to HTN management is generally low in rural areas. Patients report poor healthcare facilities, a shortage of medical supplies, a shortage of medications, increasing medical costs, very brief interactions with physicians, long clinic wait times and the distance to clinics as significant barriers to accessing health services. These challenges were noted especially at PHC levels and in government hospitals.41,42 In contrast, those receiving care in tertiary care hospital clinics report greater satisfaction with the education received and demonstrated a higher personal degree of disease-based knowledge, even if they were less aware of their own disease status or had suboptimal medication adherence.22,43–45
In rural communities, patients with HTN seem to have particularly poor BP control. Jafar et al. reported that nearly 57% of those surveyed did not have adequate BP control, and this was more often seen in individuals with a lower wealth index, who were single, who were less adherent to BP medications or who had impaired renal function.46 Furthermore, among Sri Lanka’s rural communities, an estimated 25% of those with HTN also have additional cardiometabolic comorbidities, underscoring the importance of comprehensive risk management.47 Rural patients with HTN seem to be especially vulnerable to prediabetes/diabetes due to several sociodemographic factors.48
In a cluster randomised controlled trial involving rural communities in Sri Lanka, Bangladesh and Pakistan before COVID-19, the COBRA-BPS Study Group reported that multicomponent healthcare worker-driven screening programmes could significantly improve BP control compared with usual care (53.2% versus 43.7%, respectively) in existing public healthcare infrastructures.49 The components of the healthcare worker-driven screening programmes included healthcare worker training, home-based patient education by healthcare workers, physician training on BP monitoring and checklist-based management, a dedicated HTN triage nurse at government clinics and extra wages for healthcare workers at the discretion of the district office.49 Sixty-six per cent of participants in the intervention group were female. Anyone who could not travel to the medical clinic was excluded from the study, and the proportion of individuals with HTN who were excluded by this screening criterion is unclear. In subsequent analyses, it was concluded this type of intervention was generally acceptable to key stakeholders (healthcare workers, patients and physicians), with a potential for cost-effective national scale-up at an estimated per capita cost in Sri Lanka of approximately US$1.50,51 This warrants further consideration in Sri Lanka’s post-COVID-19 pandemic healthcare environment.
A more recent meta-analysis of community-based strategies to manage HTN in LMICs identified multicomponent interventions as being effective and that decentralising community HTN care was pivotal to addressing current healthcare gaps.52 Culturally sensitive education provided by healthcare workers, home BP monitoring and self-management strategies were important.52
Out-of-pocket Healthcare Expenses
Despite the state covering approximately 50% of outpatient services, 90% of inpatient admissions and nearly all preventive services free of charge to patients, nearly 44% of Sri Lanka’s overall healthcare expenditure comes from patients’ personal spending.19,53 A greater share of out-of-pocket expenses come from private sector outpatient consultations.19
A survey evaluating patients’ personal out-of-pocket expenses in chronic disease management across a spectrum of urban to deep rural communities identified HTN as being the most common chronic disease, followed by diabetes and asthma.9 Increased outpatient clinic costs were seen for patients with a lower income, along with the need for recurrent clinical follow-up. Costs were notably higher in the private sector. Catastrophic health expenditure, defined as spending over 15% of the monthly income, was seen in nearly 20% of outpatient clinic visits, with approximately 6% of these patients spending more than 40% of their monthly income to access outpatient services.9 Other additional costs were accrued by seeking private sector services that were not available in the public sector.9 Sri Lanka’s rapidly ageing population faces a growing burden of HTN and NCDs. The need for long-term repeated access to health services will increase the personal financial burden, making it a greater challenge to reduce the population burden of HTN and its complications.
Recommendations to Improve Community Hypertension Management
Sri Lanka’s MoH has made considerable efforts to establish a decentralised HLC infrastructure island-wide for HTN management, but the HLCs remain severely underutilised. The concept of preventative medicine also remains largely unfamiliar to the broader population. There are opportunities within the current healthcare system to improve community HTN management and support normalising preventative healthcare overall. These opportunities include: improving HLC operations, team workflow and the HTN referral system; reducing patients’ financial costs and supporting self-management; and developing civic and corporate partnerships for HTN care and public health education.
Healthy Lifestyle Centre Operations, Team Workflow and the Hypertension Referral System
To increase the use of the HLC network, these centres should tailor their operating hours to community needs, including evening clinics. This may require increased wages for staff on evening duties or partnerships with the private sector to provide a clinical service. A subsidised fee for HLC evening access may be acceptable for patients, especially if at a lower cost than private sector fees. The MoH must ensure effective medications are reliably available to all HLCs and to the population at large, even for those paying for the medications themselves.
Currently, patients carry their own medical record books to clinic visits in both the public and private sectors, with clinicians documenting information at their discretion. Long-term HTN management requires a reliable and easy tracking process. A standardised HTN therapeutics chart and checklist attached to each patient’s record could improve continuity of care, encourage guideline-directed medical therapy and reduce therapeutic inertia. Reliable patient registries are also needed to monitor interventions, assess therapeutic progress and inform future research.
Community management of HTN is best achieved with a consistent multidisciplinary team approach. It is important that each member of the multidisciplinary team uses their skills optimally for effectiveness, to reduce clinician fatigue and to improve patient experience. Currently, nurses in public sector clinics perform administrative duties with little direct clinical care. Instead, the team could include dedicated clerical staff for registration and administrative functions so nurses can perform BP and screening checks and provide clinic-based HTN education sessions. Because hundreds of patients are seen daily in government clinics, using a nursing care algorithm for stable patients will streamline management and allow physicians to focus on more complex cases. If nurses regularly perform BP checks in a wider range of speciality clinics, this would increase opportunistic diagnosis of HTN, with the potential to identify over 25% of patients who may have otherwise gone unrecognised, especially men.54 The added cost of wages for clerical staff may be well offset by the incremental benefits of recovering clinical nursing skills and improving workflow.
The composition of the HTN care team should be tailored to geographical needs and must encourage patients to be active participants in their own healthcare journey (Figure 4). Streamlining workflow within the clinical care team and improving individual workload could better sustain community-based HTN care in the public sector, while importantly supporting clinicians’ wellbeing and empowering patient self-management.
The current referral system for HTN management is a unidirectional path from primary care to specialists for complex cases. Because most patients currently do not use HLCs, a bidirectional referral process is needed for hospital clinics to refer patients with newly diagnosed HTN (or those at risk) to HLCs for ongoing management (Figure 4). A bidirectional referral process to and from HLCs will establish their fundamental role in community HTN management, even if patients are first diagnosed in secondary or tertiary care clinics. Over time, this may increase the likelihood of patients preferentially seeking medical treatment at the HLCs, as the MoH intends.
Reducing Patients’ Expenses and Supporting Self-management
With nearly 44% of the country’s current healthcare expenditure coming from patients’ personal spending, strategies to reduce the personal financial burden for accessing preventative long-term healthcare should be a government priority.53 Although this review cannot resolve these complex socioeconomic disparities, a few operational adjustments may help to meaningfully reduce patients’ personal healthcare expenses. For instance, if the MoH can consistently supply medications for medically optimised patients throughout the year, then reducing routine medication renewal visits to three or four times per year (instead of monthly) would save patients time and greatly reduce the clinical workload. This could also potentially reduce patients’ travel expenses by more than 60% and lessen the loss of income because of work absenteeism.
Herath et al. demonstrated in Sri Lanka that empowering community support groups to design and implement community-based activities for NCD risk factor screening improved understanding of personal risk, increased the use of HLCs by nearly 30% and increased positive lifestyle modifications.55 To effectively support this, healthcare workers should be trained to build tailored and simple HTN education programmes in collaboration with community leaders for greater local buy-in. Because chronic disease management is labour intensive, healthcare worker workloads should be suitably balanced along with equitable wage compensation.
Civic Partnerships and Shared Health Advocacy
Because the private health sector provides a substantial portion of outpatient HTN and primary care, the MoH should partner with these providers to deliver protocolised systematic HTN management within their private infrastructure, including systems for monitoring and impact assessments. The MoH could also partner with the corporate sector to strategically integrate routine HTN screening programmes in work settings, particularly to capture the male population that is typically missed in the community clinics. The MoH could collaborate with technology industries to explore integrative applications to improve team-based care between clinics and to improve healthcare worker–patient communication in rural settings. It is also important to encourage social entrepreneurship and support businesses with direct or indirect aims of improving healthcare access and delivery.
Health advocacy to prevent and manage HTN must become a cultural norm. Such concepts should be included in health education curricula from an early stage and should be reflected in government policy to support society at large. Efforts to improve public engagement through social media and other avenues should come from strategies built in partnership with young adults, community leaders, patient advocates, media experts, corporate strategists and other stakeholders.
Conclusion
Sri Lanka has a population of 22 million people, most of whom live in rural communities. The prevalence of HTN in Sri Lanka’s population is approximately 35%, with most patients not having achieved treatment goals. In the public sector, the HLCs for HTN treatment are grossly underutilised, whereas secondary and tertiary hospital clinics are overloaded. However, there are avenues to improve clinical workflow and patient engagement within the public system while also exploring collaborations with the corporate sector and broader civic society to support long-term population health.
Clinical Perspective
- Sri Lanka’s efforts to reduce the prevalence of HTN with nationwide healthy lifestyle centres and a protocolised HTN care model encountered significant operational challenges and a widespread lack of public engagement.
- Increasing population awareness, improving clinician–patient interactions and reducing patients’ personal health expenses could increase patients’ HLC utilisation and improve their own healthcare management.
- In the public sector, a well-supported multidisciplinary HTN care team could capitalise on individual expertise to collaboratively improve patient outcomes.