title: Implementing a hypertension management programme in a rural area: local approaches and experiences from Ba-Vi district, Vietnam.
abstract: BACKGROUND
  Costly efforts have been invested to control and prevent cardiovascular diseases (CVD) and their risk factors but the ideal solutions for low resource settings remain unclear. This paper aims at summarising our approaches to implementing a programme on hypertension management in a rural commune of Vietnam.
  
  
  METHODS
  In a rural commune, a programme has been implemented since 2006 to manage hypertensive people at the commune health station and to deliver health education on CVD risk factors to the entire community. An initial cross-sectional survey was used to screen for hypertensives who might enter the management programme. During 17 months of implementation, other people with hypertension were also followed up and treated. Data were collected from all individual medical records, including demographic factors, behavioural CVD risk factors, blood pressure levels, and number of check-ups. These data were analysed to identify factors relating to adherence to the management programme.
  
  
  RESULTS
  Both top-down and bottom-up approaches were applied to implement a hypertension management programme. The programme was able to run independently at the commune health station after 17 months. During the implementation phase, 497 people were followed up with an overall regular follow-up of 65.6% and a dropout of 14.3%. Severity of hypertension and effectiveness of treatment were the main factors influencing the decision of people to adhere to the management programme, while being female, having several behavioural CVD risk factors or a history of chronic disease were the predictors for deviating from the programme.
  
  
  CONCLUSIONS
  Our model showed the feasibility, applicability and future potential of a community-based model of comprehensive hypertension care in a low resource context using both top-down and bottom-up approaches to engage all involved partners. This success also highlighted the important roles of both local authorities and a cardiac care network, led by an outstanding cardiac referral centre.
authors.affiliation: Department of Cardiology, Hanoi Medical University, 1 Ton-That-Tung Street, Dong-Da District, Hanoi, Vietnam. quangtm@gmail.com
authors.forename: Quang Ngoc
authors.initials: QN
authors.lastname: Nguyen
authors.forename: Son Thai
authors.initials: ST
authors.lastname: Pham
authors.forename: Viet Lan
authors.initials: VL
authors.lastname: Nguyen
authors.forename: Stig
authors.initials: S
authors.lastname: Wall
authors.forename: Lars
authors.initials: L
authors.lastname: Weinehall
authors.forename: Ruth
authors.initials: R
authors.lastname: Bonita
authors.forename: Peter
authors.initials: P
authors.lastname: Byass
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000517:prevention & control; D019058:Community Networks; D003430:Cross-Sectional Studies; D005260:Female; D006293:Health Promotion; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D016017:Odds Ratio; D016730:Program Development / Q000379:methods*; D012307:Risk Factors; D012424:Rural Population; D014744:Vietnam