An international study has found that a low-cost, multi-component intervention including home health care visits by healthcare workers can lead to meaningful blood pressure reductions in those with hypertension. Professor Tazeen H. Jafar from the Health Services and Systems Research Program at Duke-NUS Medical School, Singapore lead the study of home visits, which included blood pressure monitoring and lifestyle coaching, coupled with physician training in coordination with the public health care infrastructure.
The study, which is the first multi-country trial of its kind, is a randomized trial that evaluated the effectiveness of the multi-component intervention among 2,550 individuals with hypertension living in 30 rural communities in three South Asian countries over two years. Bangladesh, Pakistan, and Sri Lanka were all part of the study labeled Control of Blood Pressure and Risk Attenuation (COBRA-BPS). While there are differences in the health systems in the countries involved, BP control rates are poor in all of them. The study found that similar results were achieved in all three countries with standardized strategies, suggesting that health interventions could work in various settings.
By the conclusion of the study, it was found that that the decline in systolic BP was 5 mmHg greater in the intervention group versus the control group, which received the usual care. Reduction in diastolic BP and BP control (<140/90 mmHg) was also better in the intervention group. Researchers also found that the intervention increased compliance with taking antihypertensive medications and lipid-lowering medicines. It was also noted that some aspects of self-reported health were also improved. Additionally, in the intervention group, there was an indication of a reduction in deaths from cardiovascular diseases.
“A sustained 5 mmHg reduction in systolic BP at a community level historically translates into about a 30 per cent reduction in death and disability from cardiovascular disease,” said Professor Jafar, who is also a Professor of Global Health at the Duke Global Health Institute (DGHI), USA. “Our study demonstrates that an intervention led by community health workers and delivered using the existing healthcare systems in Bangladesh, Pakistan, and Sri Lanka can lead to clinically meaningful reductions in BP as well as confer additional benefits – all at a low cost.”
“Community health workers are an integral part of the primary care infrastructure for the successful door to door delivery of maternal and child healthcare in South Asia – as well as China, Mexico, and Africa,” Prof Jafar added. “Our findings show that community health workers can have an equally important role in managing hypertension.”
Leading Cause of Death
Uncontrolled hypertension is a leading cause of death globally. It is a major risk factor for cardiovascular and kidney diseases, along with many other health concerns. Studies show that in rural parts of low- and middle- income countries, particularly in Asia, one in four adults suffers from hypertension. Of those with hypertension, 70% is uncontrolled, leading to some of the highest death rates from both cardiovascular and kidney diseases.
Prof. H. Asita de Silva, the study’s country principal investigator in Sri Lanka and a co-author, said, “The public health implications of our findings are significant,” Prof Jafar added. “A low-cost program like ours could be adapted and scaled up in many other settings globally, using the existing healthcare infrastructure to reduce the growing burden of uncontrolled hypertension and potentially save millions of lives, as well as reduce suffering from heart attacks, strokes, heart failure and kidney disease.”