title: The impact of a cardiovascular health awareness program (CHAP) on reducing blood pressure: a prospective cohort study.
abstract: BACKGROUND
  Hypertension is an important and modifiable cardiovascular risk factor that remains under-detected and under-treated, especially in the older individuals. Community-led interventions that integrate primary health care and local resources are promising approaches to improve awareness and management of hypertension and other cardiovascular risk factors. We aimed to evaluate the effect of a community-based Cardiovascular Health Awareness Program (CHAP) on participants' blood pressure.
  
  
  METHODS
  This study followed a cohort of community residents that participated in CHAP across 22 mid-sized Ontario communities over an 18-month period. The participants' baseline risk factors, including blood pressure, and subsequent measures of blood pressure were recorded. We employed a bivariate linear mixed-effect model to estimate the change of systolic and diastolic blood pressure over time among the participants who attended more than two CHAP sessions.
  
  
  RESULTS
  Of 13,596 participants, 2498 attended more than two CHAP sessions. For those repeated participants (attending more than two sessions) initially identified with high blood pressure, the average reduction of systolic blood pressure was from 142 to 123 mmHg over an 18-month period, a monthly rate ratio of 0.992 (95% CI: 0.991,0.994; p < 0.01). Similarly, the average reduction of diastolic blood pressure was from 78 to 69 mmHg, a monthly rate ratio of 0.993 (95% CI: 0.991,0.994; p < 0.01). The average blood pressure of the participants with normal baseline blood pressure remained controlled and unchanged. We also found that older adult participants who lived alone, were diagnosed with hypertension, reported healthier eating habits, and presented with a higher baseline systolic blood pressure had significantly greater odds of attending more than one session.
  
  
  CONCLUSIONS
  CHAP was associated with a reduction in systolic and diastolic blood pressure for those participants who attended more than one session. The magnitude of blood pressure reductions was significant clinically and statistically.
authors.forename: Chenglin
authors.initials: C
authors.lastname: Ye
authors.forename: Gary
authors.initials: G
authors.lastname: Foster
authors.forename: Janusz
authors.initials: J
authors.lastname: Kaczorowski
authors.forename: Larry W
authors.initials: LW
authors.lastname: Chambers
authors.forename: Ricardo
authors.initials: R
authors.lastname: Angeles
authors.forename: Francine
authors.initials: F
authors.lastname: Marzanek-Lefebvre
authors.forename: Stephanie
authors.initials: S
authors.lastname: Laryea
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. ldolovic@mcmaster.ca.
authors.forename: Lisa
authors.initials: L
authors.lastname: Dolovich
mesh_terms: D000368:Aged; D001794:Blood Pressure; D005260:Female; D006266:Health Education / Q000379:methods*; D006801:Humans; D006973:Hypertension / Q000517:prevention & control*; D008297:Male; D015397:Program Evaluation; D011446:Prospective Studies; D012307:Risk Factors