TY - JOUR
T1 - Effect of a Multicomponent Intervention on Antihypertensive Medication Intensification in Rural South Asia
T2 - Post Hoc Analysis of a Cluster RCT
AU - Feng, Liang
AU - Jehan, Imtiaz
AU - De Silva, H. Asita
AU - Naheed, Aliya
AU - Khan, Aamir H.
AU - Kasturiratne, Anuradhani
AU - Clemens, John D.
AU - Lim, Ching Wee
AU - Hughes, Alun D.
AU - Chaturvedi, Nish
AU - Jafar, Tazeen H.
N1 - Publisher Copyright:
© 2021 American Journal of Hypertension, Ltd 2021. All rights reserved.
PY - 2021/9/1
Y1 - 2021/9/1
N2 - Background: Inadequate treatment of hypertension is a widespread problem, especially in South Asian countries where cardiovascular disease mortality rates are high. We aimed to explore the effect of a multicomponent intervention (MCI) on antihypertensive medication intensification among rural South Asians with hypertension. Methods: A post hoc analysis of a 2-year cluster-randomized controlled trial including 2,645 hypertensives aged ≥40 years from 30 rural communities, 10 each, in Bangladesh, Pakistan, and Sri Lanka. Independent assessors collected information on participants' self-reports and physical inspection of medications. The main outcomes were the changes from baseline to 24 months in the following: (i) the therapeutic intensity score (TIS) for all (and class-specific) antihypertensive medications; (ii) the number of antihypertensive medications in all trial participants. Results: At 24 months, the mean increase in the TIS score of all antihypertensive medications was 0.11 in the MCI group and 0.03 in the control group, with a between-group difference in the increase of 0.08 (95% confidence interval (CI, 0.03, 0.12); P = 0.002). In MCI compared with controls, a greater increase in the TIS of renin-angiotensin-aldosterone system blockers (0.05; 95% CI (0.02, 0.07); P < 0.001) and calcium channel blockers (0.03; 95% CI (0.00, 0.05); P = 0.031), and in the number of antihypertensive medications (0.11, 95% CI (0.02, 0.19); P = 0.016) was observed. Conclusions: In rural communities in Bangladesh, Pakistan, and Sri Lanka, MCI led to a greater increase in antihypertensive medication intensification compared with the usual care among adults with hypertension. Clinical trials registration: Trial Number NCT02657746.
AB - Background: Inadequate treatment of hypertension is a widespread problem, especially in South Asian countries where cardiovascular disease mortality rates are high. We aimed to explore the effect of a multicomponent intervention (MCI) on antihypertensive medication intensification among rural South Asians with hypertension. Methods: A post hoc analysis of a 2-year cluster-randomized controlled trial including 2,645 hypertensives aged ≥40 years from 30 rural communities, 10 each, in Bangladesh, Pakistan, and Sri Lanka. Independent assessors collected information on participants' self-reports and physical inspection of medications. The main outcomes were the changes from baseline to 24 months in the following: (i) the therapeutic intensity score (TIS) for all (and class-specific) antihypertensive medications; (ii) the number of antihypertensive medications in all trial participants. Results: At 24 months, the mean increase in the TIS score of all antihypertensive medications was 0.11 in the MCI group and 0.03 in the control group, with a between-group difference in the increase of 0.08 (95% confidence interval (CI, 0.03, 0.12); P = 0.002). In MCI compared with controls, a greater increase in the TIS of renin-angiotensin-aldosterone system blockers (0.05; 95% CI (0.02, 0.07); P < 0.001) and calcium channel blockers (0.03; 95% CI (0.00, 0.05); P = 0.031), and in the number of antihypertensive medications (0.11, 95% CI (0.02, 0.19); P = 0.016) was observed. Conclusions: In rural communities in Bangladesh, Pakistan, and Sri Lanka, MCI led to a greater increase in antihypertensive medication intensification compared with the usual care among adults with hypertension. Clinical trials registration: Trial Number NCT02657746.
KW - South Asia
KW - blood pressure
KW - community health workers
KW - hypertension
KW - medications intensification
KW - multicomponent intervention
KW - physicians
UR - http://www.scopus.com/inward/record.url?scp=85117274480&partnerID=8YFLogxK
U2 - 10.1093/ajh/hpab072
DO - 10.1093/ajh/hpab072
M3 - Article
C2 - 34013966
AN - SCOPUS:85117274480
SN - 0895-7061
VL - 34
SP - 981
EP - 988
JO - American Journal of Hypertension
JF - American Journal of Hypertension
IS - 9
ER -