Community-based interventions to promote blood pressure control in a developing country: a cluster randomized trial.
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.


METHODS
Cluster randomized, 2 x 2 factorial, controlled trial. (ClinicalTrials.gov registration number: NCT00327574)


METHODS
12 randomly selected communities in Karachi, Pakistan.


METHODS
1341 patients 40 years or older with hypertension (systolic blood pressure >or=140 mm Hg, diastolic blood pressure >or=90 mm Hg, or already receiving treatment).


METHODS
Reduction in systolic blood pressure from baseline to end of follow-up at 2 years.


METHODS
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).


CONCLUSIONS
Follow-up blood pressure measurements were missing for 22% of patients. No mechanism was detected by which interventions lowered blood pressure.


CONCLUSIONS
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.


BACKGROUND
Wellcome Trust.
Jafar
Tazeen H
TH
Aga Khan University, Karachi, Pakistan. tazeen.jafar@aku.edu
Hatcher
Juanita
J
Poulter
Neil
N
Islam
Muhammad
M
Hashmi
Shiraz
S
Qadri
Zeeshan
Z
Bux
Rasool
R
Khan
Ayesha
A
Jafary
Fahim H
FH
Hameed
Aamir
A
Khan
Ata
A
Badruddin
Salma H
SH
Chaturvedi
Nish
N
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D003150:Community Health Workers; D003906:Developing Countries; D004502:Education, Medical, Continuing; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010154:Pakistan; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000379:methods*; D010821:Physicians, Family; D012680:Sensitivity and Specificity
D000959:Antihypertensive Agents