Comprehensive approach to hypertension control lowers BP

NEW ORLEANS — Implementation of a multilevel comprehensive intervention program was associated with reductions in BP at 18 months among low-income patients with hypertension in Argentina, according to data presented at the American Heart Association Scientific Sessions.

“Hypertension is a leading global modifiable risk factor for CV disease and premature death,” Jiang He, MD, from the department of cardiology at Tulane University School of Public Health and Tropical Medicine and the Institute for Clinical Effectiveness and Health Policy in Buenos Aires, Argentina, said here. “Implementation of effective, adoptable and sustainable programs for hypertension control is a public health priority for low- and middle-income countries.”

Researchers enrolled 1,950 patients at 18 clinics participating in the Remediar+Redes Program in Argentina to determine whether such a program would lower systolic BP over 18 months and also improve hypertension control among those with uncontrolled hypertension. Eligible participants were aged 21 years and older (mean age, 56 years) and had systolic BP ≥ 140 mm Hg (mean, 151.7 mm Hg in intervention group; 149.8 mm Hg in control group) and/or diastolic BP ≥ 90 mm Hg (mean, 92.1 mm Hg in intervention group; 90.1 mm Hg in the control group) on at least two separate visits. At baseline, 86% of patients in the intervention group and 83.5% in the control group were using antihypertensive medications.

The comprehensive intervention included:

stepped-care BP management using standard treatment algorithms based on hypertension guidelines;
BP audit and feedback;
community health worker-led health education and counseling at the patient’s home (home BP monitoring, medication adherence, lifestyle modification); and
weekly individualized text messages to promote lifestyle modification and medication adherence.

To obtain repeated BP measures, nurses conducted two visits at baseline and two visits at 18 months. During each visit, the nurses used an auto-BP cuff to obtain three BP measurements; the mean of the three readings was used for this analysis. In addition, nurses also obtained titration or addition of new medications and assessed adherence using the Morisky Medication Adherence Sale.

The primary outcome was net change in systolic BP. At 18 months, the mean systolic BP reduction from baseline was 19.3 mm Hg in the intervention group vs. 12.7 mm Hg in the control group (net reduction, 6.6; P < .001).

In other results, the mean diastolic BP reductions from baseline to 18 months were 12.2 mm Hg and 6.9 mm Hg, respectively (net reduction, 5.4; P < .001).

At 18 months, the proportion of patients with controlled hypertension was 72.9% in the intervention group vs. 52.3% in the control group (net difference, 20.6; P < .001). Adherence to medication was also higher at 18 months in the intervention group (66.2% vs. 53.1%; net difference, 13.1; P < .001). the proportion of patients who required intensification of BP medication from baseline to 18 months was 66.3% in the intervention group vs. 54.3% in the control group (net difference, 12.1; P < .001).

“This study indicates that this multilevel comprehensive intervention program is effective for BP control among low-income hypertensive patients,” He said. – by Dave Quaile

Reference:

He J, et al. Clinical Science Special Reports 3. Presented at: American Heart Association Scientific Sessions; Nov. 12-16, 2016; New Orleans.

Disclosure: He reports no relevant financial disclosures.