A Community-Based Intervention for Managing Hypertension in Rural South Asia

BACKGROUND: The global burden of hypertension is steadily increasing, and the rates of blood pressure control remain notably poor, particularly in low- and middle-income countries. Consequently, cardiovascular mortality is significantly elevated in rural regions of these nations.

METHODS: We executed a cluster-randomized, controlled trial across rural districts in Bangladesh, Pakistan, and Sri Lanka. A total of 30 distinct communities were randomly allocated to either a multicomponent intervention group or a usual care control group. The intervention comprised several key elements: home visits by trained government community health workers for regular blood-pressure monitoring and counseling, targeted training for physicians, and enhanced care coordination within the public health sector. In total, 2645 adults diagnosed with hypertension were enrolled in the study. The primary outcome measured was the reduction in systolic blood pressure after a 2-year period.

RESULTS: After 2 years, the mean (±SD) net reduction in systolic blood pressure in the intervention group, when compared to the control group, was 4.7±1.1 mm Hg (P<0.001). A reduction of at least 10 mm Hg was achieved by 42.1% of participants in the intervention group, versus 18.9% in the control group (risk ratio, 2.23; 95% confidence interval [CI], 1.77 to 2.82; P<0.001). The proportion of participants who achieved controlled blood pressure was 47.3% in the intervention group, as opposed to 19.3% in the control group (risk ratio, 2.45; 95% CI, 1.93 to 3.10; P<0.001). Furthermore, the rate of major cardiovascular events was significantly lower in the intervention group at 2.7 events per 1000 person-years, compared to 6.0 events per 1000 person-years in the control group (hazard ratio, 0.45; 95% CI, 0.29 to 0.68; P<0.001). The intervention proved to be cost-effective, with a scaled-up cost of $13.79 per person per year. No major safety concerns were identified throughout the study.

CONCLUSIONS: A comprehensive, community-based intervention designed for hypertension management in rural areas of South Asia resulted in a significantly greater reduction in systolic blood pressure, improved blood-pressure control rates, and a lower incidence of major cardiovascular events compared to standard usual care

BACKGROUND: The global burden of hypertension is steadily increasing, and the rates of blood pressure control remain notably poor, particularly in low- and middle-income countries. Consequently, cardiovascular mortality is significantly elevated in rural regions of these nations.

METHODS: We executed a cluster-randomized, controlled trial across rural districts in Bangladesh, Pakistan, and Sri Lanka. A total of 30 distinct communities were randomly allocated to either a multicomponent intervention group or a usual care control group. The intervention comprised several key elements: home visits by trained government community health workers for regular blood-pressure monitoring and counseling, targeted training for physicians, and enhanced care coordination within the public health sector. In total, 2645 adults diagnosed with hypertension were enrolled in the study. The primary outcome measured was the reduction in systolic blood pressure after a 2-year period.

RESULTS: After 2 years, the mean (±SD) net reduction in systolic blood pressure in the intervention group, when compared to the control group, was 4.7±1.1 mm Hg (P<0.001). A reduction of at least 10 mm Hg was achieved by 42.1% of participants in the intervention group, versus 18.9% in the control group (risk ratio, 2.23; 95% confidence interval [CI], 1.77 to 2.82; P<0.001). The proportion of participants who achieved controlled blood pressure was 47.3% in the intervention group, as opposed to 19.3% in the control group (risk ratio, 2.45; 95% CI, 1.93 to 3.10; P<0.001). Furthermore, the rate of major cardiovascular events was significantly lower in the intervention group at 2.7 events per 1000 person-years, compared to 6.0 events per 1000 person-years in the control group (hazard ratio, 0.45; 95% CI, 0.29 to 0.68; P<0.001). The intervention proved to be cost-effective, with a scaled-up cost of $13.79 per person per year. No major safety concerns were identified throughout the study.

CONCLUSIONS: A comprehensive, community-based intervention designed for hypertension management in rural areas of South Asia resulted in a significantly greater reduction in systolic blood pressure, improved blood-pressure control rates, and a lower incidence of major cardiovascular events compared to standard usual care