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Multicomponent intervention controls BP in low-income patients
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Systolic and diastolic BP decreased more in low-income patients who underwent a community health worker-led multicomponent intervention compared with those who received the usual care, according to a study published in JAMA.
“This study showed that community health workers can play an important role in hypertension control among low-income communities,” Jiang He, MD, PhD, Joseph S. Copes Chair of Epidemiology and professor at Tulane University School of Public Health and Tropical Medicine, and colleagues wrote.
Patient, physician training
Researchers analyzed data from 1,432 patients with uncontrolled BP from 18 primary health care centers in poor urban areas in Argentina. Nine centers (n = 743; mean age, 56 years; 53% women) were randomly assigned to implement a multicomponent intervention program, which included training patients and their family members on healthy lifestyles and BP monitoring and educating primary care physicians on hypertension management. The other nine centers (n = 689; mean age, 56 years; 53% women) followed usual care procedures.
Patients in the multicomponent intervention group were visited by community health workers monthly for the first 6 months then every other month after that. Those in the control group had in-office follow-up visits monthly after BP treatment was initiated and every 3 to 6 months for those whose BP was controlled.
The outcomes of interest included systolic and BP changes within both groups from baseline to the end of follow-up. Secondary outcomes included changes such as the number of patients with controlled hypertension and antihypertensive medication adherence.
At baseline, patients in the intervention group had a higher systolic (151.7 mm Hg) and diastolic (92.2 mm Hg) BP vs. the control group (149.8/90.1 mm Hg).
Decreased BP
Systolic BP decreased by 19.3 mm Hg (95% CI, 17.9-20.8) in the intervention group and 12.7 mm Hg in the control group (95% CI, 11.3-14.2), with a net difference of 6.6 mm Hg (95% CI, 4.6-8.6; P < .001). Patients in the intervention group lowered their diastolic BP by 12.2 mm Hg (95% CI, 11.2-13.2) vs. 6.9 mm Hg in the control group (95% CI, 5.9-7.8), for a net difference of 5.4 mm Hg (95% CI, 4-6.8; P < .001).
The number of patients in the intervention group with controlled hypertension increased from 17% at baseline to 72.9% at 18 months, whereas the number in the control group increased from 17.6% to 52.2%. The difference between the two groups was 20.6% (95% CI, 15.4-25.9; P < .001).
No adverse events were reported in either group.
“Further research is needed to assess generalizability and cost-effectiveness of this intervention and to understand which components may have contributed most to the outcome,” He and colleagues wrote.
“The direction and magnitude of the effect of this intervention reported by He et al are similar to behavioral strategies (eg, healthful eating pattern, physical activity) or individual drugs that have been demonstrated to lower blood pressure,” Mark D. Huffman, MD, MPH, associate professor of epidemiology and cardiology at Northwestern University Feinberg School of Medicine, and colleagues wrote in a related editorial. “However, the nature of this community health worker-led, home-based intervention lies closer to the health-system level rather than solely to the individual level, which can also potentially strengthen the health system.” – by Darlene Dobkowski
Disclosures: He reports no relevant financial disclosures. Huffman reports he receives funding from the World Heart Federation, which is funded by Boehringer Ingelheim and Novartis and previously supported by AstraZeneca and Bupa. Please see the study and editorial for all other authors’ relevant financial disclosures.
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