Cardiovascular risk management and its impact on hypertension control in primary care in low-resource settings: a cluster-randomized trial.
OBJECTIVE
To evaluate a simple cardiovascular risk management package for assessing and managing cardiovascular risk using hypertension as an entry point in primary care facilities in low-resource settings.


METHODS
Two geographically distant regions in two countries (China and Nigeria) were selected and 10 pairs of primary care facilities in each region were randomly selected and matched. Regions were then randomly assigned to a control group, which received usual care, or to an intervention group, which applied the cardiovascular risk management package. Each facility enrolled 60 consecutive patients with hypertension. Intervention sites educated patients about risk factors at baseline and initiated treatment with hydrochlorothiazide at 4 months in patients at medium risk of a cardiovascular event, according to a standardized treatment algorithm. Systolic blood pressure change from baseline to 12 months was the primary outcome measure.


RESULTS
The study included 2397 patients with baseline hypertension: 1191 in 20 intervention facilities and 1206 in 20 control facilities. Systolic and diastolic blood pressure decreased more in intervention patients than in controls. However, at 12 months more than half of patients still had uncontrolled hypertension (systolic blood pressure > 140 mmHg and/or diastolic blood pressure > 90 mmHg). Behavioural risk factors had improved among intervention patients in Nigeria but not in China. Only about 2% of hypertensive patients required referral to the next level of care.


CONCLUSIONS
Even in low-resource settings, hypertensive patients can be effectively assessed and managed in primary care facilities.
Department of Chronic Disease and Health Promotion, World Health Organization, 20 avenue Appia, CH-1211, Geneva 27, Switzerland. mendiss@who.int
Shanthi
S
Mendis
S Claiborne
SC
Johnston
Wu
W
Fan
Olulola
O
Oladapo
Ali
A
Cameron
Mohammed F
MF
Faramawi
D000328:Adult; D000368:Aged; D000465:Algorithms; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D002681:China / Q000453:epidemiology; D016000:Cluster Analysis; D005260:Female; D005843:Geography; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use; D006973:Hypertension / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D011320:Primary Health Care / Q000191:economics / Q000379:methods*; D012307:Risk Factors; D012308:Risk Management; D013223:Statistics as Topic; D013599:Systole
D000959:Antihypertensive Agents; D006852:Hydrochlorothiazide