Village doctor-led intervention reduces CVD, all-cause mortality in hypertension
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CHICAGO — A village doctor-led intervention for hypertension control reduced all-cause mortality and CVD in a low-resource setting, a speaker reported at the American Heart Association Scientific Sessions.
“The objectives of this trial were to test the effectiveness of a village doctor-led blood pressure intervention compared to usual care on cardiovascular disease outcomes among rural residents in China,” Jiang He, MD, PhD, professor and the Joseph S. Copes Chair of Epidemiology in the School of Public Health and Tropical Medicine at Tulane University and director of the Tulane University Translational Science Institute, said during a presentation. “And to test the effectiveness of an intensive blood pressure treatment goal with systolic less than 130 mm Hg and diastolic less than 80 mm Hg on cardiovascular disease outcomes in the general population with hypertension.”
The study included participants with a mean untreated systolic BP of at least 140 mm Hg and/or diastolic BP of at least 90 mm Hg or mean treated systolic BP of at least 130 mm Hg and/or diastolic BP of at least 80 mm Hg from six measures on two different days; patients with a history of CVD, chronic kidney disease or diabetes and mean systolic BP of at least 130 mm Hg and/or diastolic BP of at least 80 mm Hg were also eligible.
For the cluster-randomized trial, 163 villages with 17,407 participants were assigned to a stepped-care protocol designed to achieve a target systolic BP less than 130 mm Hg and diastolic BP less than 80 mm Hg, and 163 villages with 16,588 participants were assigned to usual care. For the intervention group, village doctors initiated and titrated antihypertensive medications based on treatment protocol, delivered discounted and free medications to patients, instructed patients on home BP monitoring and conducted health coaching.
As Healio previously reported, at 18 months, the intervention group achieved BP control to a greater degree than the usual care group.
He presented 36-month outcomes, including the primary outcome of a composite of MI, HF requiring hospitalization, CVD death or stroke and secondary outcomes including the individual components of the primary composite outcome and all-cause mortality.
The between-group differences in systolic and diastolic BP were –23.1 and –9.9 mm Hg (P < .0001), respectively, both favoring the intervention group, at 36 months.
The rate of the primary outcome was 1.98% per year in the intervention group and 2.85% per year in the usual care group (HR = 0.69; 95% CI, 0.63-0.76; P < .0001), He said during the presentation.
Compared with usual care, the intervention was also associated with reduced risk for stroke (HR = 0.67; 95% CI, 0.6-0.75; P < .0001), HF (HR = 0.61; 95% CI, 0.43-0.86; P = .005), CVD death (HR = 0.76; 95% CI, 0.65-0.89; P = .0004) and all-cause mortality (HR = 0.85; 95% CI, 0.75-0.96; P = .009), and the MI results numerically favored the intervention group (HR = 0.83; 95% CI, 0.68-1.01; P = .06), He said.
The results did not vary by age or by level of CVD risk, according to the researchers.
The mean age of participants was 63 years and 61% were women.
“This cluster-randomized trial demonstrated that a village doctor-led intervention for hypertension control in a low-resource setting is effective in reducing cardiovascular disease and all-cause mortality,” He said during the presentation. “Furthermore, it showed that treating all hypertensive adults to a lower blood pressure target is both feasible and beneficial for cardiovascular disease risk reduction.”
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Keith C. Ferdinand, MD, FACC, FAHA, FASPC, FNLA
This study analyzed an intervention led by village doctors who would go into the community to give participants medications and to counsel them on diet, and the researchers were able to show significant reductions in BP. Participants started with mean BPs of about 151 mm Hg or 152 mm Hg, and the intervention was able to significantly lower BP in the community setting.
My question to Dr. He was, “Is this portable to the United States?” It is difficult to say, but the study does show that medications help because they decrease CV events and mortality, and accomplishing that doesn’t necessarily mean the magic 15-minute doctor visit every 3 to 4 months. In fact, I think that’s a barrier, because in between those doctor visits, patients often are nonadherent, and they often lose interest many times when they come back and the BP is still where it was 3 months prior.
Tulane University School of Medicine
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He J, et al. LBS.04: Mindful Disruption of Chronic Hypertension Management. Presented at: American Heart Association Scientific Sessions; Nov. 5-7, 2022; Chicago (hybrid meeting).
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