A strategy combining group medical visits and microfinance for patients with diabetes or hypertension in Kenya may result in clinically meaningful systolic blood pressure (BP) reductions associated with cardiovascular benefit, according to results of the BIGPIC trial published April 19 in the Journal of the American College of Cardiology. However, the "significance threshold was not met in hypothesis testing."

Rajesh Vedanthan, MD, FACC, et al., looked at 2,890 individuals (69.9% women) in Kenya, at least 35 years of age, enrolled in the Academic Model Providing Access to Healthcare Partnership chronic disease management program who had diabetes, impaired fasting glucose, or increased risk of developing diabetes. Patients were divided into four arms and 24 clusters: 1) usual care; 2) usual care plus microfinance; 3) group medical visits; and 4) group medical visits plus microfinance. The primary outcome was one-year change in systolic BP.

Results showed that average baseline systolic BP was 157.5 mmHg and mean systolic BP declined -11.4, -14.8, -14.7, and -16.4 mmHg in the usual care, usual care plus microfinance, group medical visit, and group medical visit plus microfinance groups, respectively. Adjusted estimates and multiplicity-adjusted confidence intervals showed that relative to usual care, the systolic BP reduction was 3.9 mmHg, 3.3 mmHg, and 2.3 mmHg greater in group medical visit plus microfinance, group medical visit, and microfinance groups, respectively. Of note, women saw greater benefits from trial arms utilizing group medical visits.

According to the researchers, this study demonstrates that incorporating social determinants of health into care delivery for chronic diseases, including cardiovascular disease, has the potential to improve outcomes, especially for subgroups of patients.

In an accompanying editorial comment, Tazeen H. Jafar, MD, MPH, and Catherine Kyobutungi, PhD, add, "an adequately powered longer-term trial is warranted to conclusively evaluate the effectiveness, cost-effectiveness, affordability, and acceptability of [microfinance] and [group medical visit] strategies, with some modifications, to prevent cardiovascular disease in patients with hypertension or diabetes in [sub-Saharan Africa]. Until then, the findings based on the innovative approaches in BIGPIC remain hypothesis generating. But it's a good start."

Clinical Topics: Prevention, Hypertension

Keywords: ACC International, Kenya, Social Determinants of Health, Hypertension, Diabetes Mellitus, Delivery of Health Care, Chronic Disease, Disease Management

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