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Community-based BP intervention successful in South Asia
A multicomponent intervention implemented in rural communities in Pakistan, Bangladesh and Sri Lanka led to greater BP reductions in participants with hypertension compared with usual care, according to data from the COBRA-BPS trial published in The New England Journal of Medicine.
“The unique feature of our trial is the rural-centric nature of the intervention wherein regular BP monitoring and health promotion are brought to the individual proactively by the trained community health worker rather than wait for the individual to seek medical attention,” Tazeen H. Jafar, MD, MPH, professor of health services and systems research at Duke-NUS Medical School in Singapore, told Healio. “We show that this approach coupled with other components of the intervention has substantial benefit on BP reduction.”
Multicomponent intervention
Researchers analyzed data from 2,645 participants with hypertension from 30 rural villages in Pakistan, Sri Lanka and Bangladesh. Villages were assigned to a multicomponent intervention (n = 1,330; mean age, 59 years; 66% women; mean systolic BP at baseline, 146.7 mm Hg) or usual care (n = 1,315; mean age, 59 years; 63% women; mean systolic BP at baseline, 144.7 mm Hg).
The following were components of the intervention:
- BP monitoring and checklists to guide referrals and monitoring;
- home health education with government community health workers;
- training physicians in BP monitoring, hypertension management and checklist use;
- designated hypertension care coordinator and triage reception desk at government clinics; and
- compensation for targeted subsidies and additional health services.
“A program like ours led by community health workers would be highly applicable to the South Asian diaspora — one of the fastest-growing immigrant populations in the U.S. and U.K,” Jafar told Healio. “The strategies in a program like ours can be culturally and linguistically modified to other settings for minorities, including the African Americans, Hispanics and other uninsured or underinsured families at high risk of uncontrolled hypertension. Such efforts would complement the existing services such as federally funded rural health clinics, as well as other nontraditional models of hypertension care.”
Villages assigned usual care were treated with existing services in the community and routine home visits.
BP was assessed at home every 6 months in both groups. The primary outcome was a mean change in systolic BP from baseline to 24 months.
At 24 months, the intervention group had a greater reduction in mean systolic BP compared with the control group (9 mm Hg vs. 3.9 mm Hg; mean reduction, 5.2 mm Hg; 95% CI, 3.2-7.1). The intervention group also had 2.8 mm Hg greater reduction in diastolic BP compared with the control group (95% CI, 1.7-3.9).
More participants from villages assigned the intervention achieved BP control of less than 140/90 mm Hg compared with those assigned the control (53.2% vs. 43.7%; RR = 1.22; 95% CI, 1.1-1.35).
All-cause mortality occurred in 2.9% of participants from villages assigned the intervention vs. 4.3% in those assigned the control (P = .06).
Clinical implications
“The clinical practices need to reconfigure and offer proactive community outreach care including BP monitoring and lifestyle coaching by trained nonphysician health professionals to the patients, especially those with poorly controlled hypertension, and referrals to physicians who then prescribe and titrate antihypertensive medications and underscore adherence to antihypertensive medications to achieve BP control,” Jafar said in an interview. – by Darlene Dobkowski
For more information:
Tazeen H. Jafar, MD, MPH, can be reached at tazeen.jafar@duke-nus.edu.sg.
Disclosures: The authors report no relevant financial disclosures.
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