TY - JOUR
T1 - Community-based interventions to promote blood pressure control in a developing country
T2 - A cluster randomized trial
AU - Jafar, Tazeen H.
AU - Hatcher, Juanita
AU - Poulter, Neil
AU - Islam, Muhammad
AU - Hashmi, Shiraz
AU - Qadri, Zeeshan
AU - Bux, Rasool
AU - Khan, Ayesha
AU - Jafary, Fahim H.
AU - Hameed, Aamir
AU - Khan, Ata
AU - Badruddin, Salma H.
AU - Chaturvedi, Nish
PY - 2009/11/3
Y1 - 2009/11/3
N2 - Background: Despite convincing evidence that lowering blood pressure decreases cardiovascular morbidity and mortality, the hypertension burden remains high and control rates are poor in developing countries. Objective: To assess the effectiveness of 2 community-based interventions on blood pressure in hypertensive adults. Design: Cluster randomized, 2 x 2 factorial, controlled trial. (ClinicalTrials. gov registration number: NCT00327574) Setting: 12 randomly selected communities in Karachi, Pakistan. Patients: 1341 patients 40 years or older with hypertension (systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or already receiving treatment). Measurements: Reduction in systolic blood pressure from baseline to end of follow-up at 2 years. Intervention: Family-based home health education (HHE) from lay health workers every 3 months and annual training of general practitioners (GPs) in hypertension management. Results: The age, sex, and baseline blood pressure-adjusted decrease in systolic blood pressure was significantly greater in the HHE and GP group (10.8 mm Hg [95% CI, 8.9 to 12.8 mm Hg]) than in the GP-only, HHE-only, or no intervention groups (5.8 mm Hg [CI, 3.9 to 7.7 mm Hg] in each; P < 0.001). The interaction between the main effects of GP training and HHE on the primary outcome approached significance (interaction P = 0.004 in intention-to-treat analysis and P = 0.044 in per-protocol analysis). Limitations: Follow-up blood pressure measurements were missing for 22% of patients. No mechanism was detected by which interventions lowered blood pressure. Conclusion: Family-based HHE delivered by trained lay health workers, coupled with educating GPs on hypertension, can lead to significant blood pressure reductions among patients with hypertension in Pakistan. Both strategies in combination may be feasible for upscaling within the existing health care systems of Indo-Asian countries. Primary Funding Source: Wellcome Trust.
AB - Background: Despite convincing evidence that lowering blood pressure decreases cardiovascular morbidity and mortality, the hypertension burden remains high and control rates are poor in developing countries. Objective: To assess the effectiveness of 2 community-based interventions on blood pressure in hypertensive adults. Design: Cluster randomized, 2 x 2 factorial, controlled trial. (ClinicalTrials. gov registration number: NCT00327574) Setting: 12 randomly selected communities in Karachi, Pakistan. Patients: 1341 patients 40 years or older with hypertension (systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or already receiving treatment). Measurements: Reduction in systolic blood pressure from baseline to end of follow-up at 2 years. Intervention: Family-based home health education (HHE) from lay health workers every 3 months and annual training of general practitioners (GPs) in hypertension management. Results: The age, sex, and baseline blood pressure-adjusted decrease in systolic blood pressure was significantly greater in the HHE and GP group (10.8 mm Hg [95% CI, 8.9 to 12.8 mm Hg]) than in the GP-only, HHE-only, or no intervention groups (5.8 mm Hg [CI, 3.9 to 7.7 mm Hg] in each; P < 0.001). The interaction between the main effects of GP training and HHE on the primary outcome approached significance (interaction P = 0.004 in intention-to-treat analysis and P = 0.044 in per-protocol analysis). Limitations: Follow-up blood pressure measurements were missing for 22% of patients. No mechanism was detected by which interventions lowered blood pressure. Conclusion: Family-based HHE delivered by trained lay health workers, coupled with educating GPs on hypertension, can lead to significant blood pressure reductions among patients with hypertension in Pakistan. Both strategies in combination may be feasible for upscaling within the existing health care systems of Indo-Asian countries. Primary Funding Source: Wellcome Trust.
UR - http://www.scopus.com/inward/record.url?scp=70450220304&partnerID=8YFLogxK
U2 - 10.7326/0003-4819-151-9-200911030-00004
DO - 10.7326/0003-4819-151-9-200911030-00004
M3 - Article
C2 - 19884620
AN - SCOPUS:70450220304
SN - 0003-4819
VL - 151
SP - 593
EP - 601
JO - Annals of Internal Medicine
JF - Annals of Internal Medicine
IS - 9
ER -