title: Community-based interventions to promote blood pressure control in a developing country: a cluster randomized trial.
abstract: 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.
authors.affiliation: Aga Khan University, Karachi, Pakistan. tazeen.jafar@aku.edu
authors.forename: Tazeen H
authors.initials: TH
authors.lastname: Jafar
authors.forename: Juanita
authors.initials: J
authors.lastname: Hatcher
authors.forename: Neil
authors.initials: N
authors.lastname: Poulter
authors.forename: Muhammad
authors.initials: M
authors.lastname: Islam
authors.forename: Shiraz
authors.initials: S
authors.lastname: Hashmi
authors.forename: Zeeshan
authors.initials: Z
authors.lastname: Qadri
authors.forename: Rasool
authors.initials: R
authors.lastname: Bux
authors.forename: Ayesha
authors.initials: A
authors.lastname: Khan
authors.forename: Fahim H
authors.initials: FH
authors.lastname: Jafary
authors.forename: Aamir
authors.initials: A
authors.lastname: Hameed
authors.forename: Ata
authors.initials: A
authors.lastname: Khan
authors.forename: Salma H
authors.initials: SH
authors.lastname: Badruddin
authors.forename: Nish
authors.initials: N
authors.lastname: Chaturvedi
mesh_terms: 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
chemical_list: D000959:Antihypertensive Agents