With hypertension the leading global risk factor for mortality, new research from the LARK Hypertension Study presented at ESC Congress 2019 and simultaneously published in the Journal of the American College of Cardiology, suggests that community health workers equipped with tailored behavioral health strategies and mobile health technologies can make a difference in reducing blood pressure.

Rajesh Vedanthan, MD, MPH, FACC, et al., conducted a cluster randomized trial of 1,460 individuals (58 percent women) in western Kenya. Participants were assigned to usual care (standard training); "paper-based" care (tailored behavioral communication, using paper-based tools); and "smartphone" care (tailored behavioral communication, using smartphone technology). The primary outcomes were twofold and included linkage to care and change in systolic blood pressure (SBP). The average baseline SBP was 159.4 mm Hg. Follow-up measures of linkage were available for 1,128 (77 percent) and BP for 1,106 (76 percent) of participants.

In terms of primary endpoints, results showed linkage to care was 49 percent overall, with significantly greater linkage in the usual care and smartphone arms. Average overall follow-up SBP was 149.9 mm Hg. Researchers noted that participants in the smartphone arm experienced a modestly greater reduction in SBP compared with those assigned usual care (–13.1 mm Hg vs. –9.7), but this difference was not statistically significant. Mediation analysis also revealed that linkage to care contributed to SBP change.

Based on the results, Vedanthan and colleagues suggest further innovations are needed to improve hypertension control, particularly in low-resource settings around the world. "The global burden of hypertension and other noncommunicable diseases is substantial and increasing, especially in low- and middle-income countries," they write. "Each step in the clinical cascade, including linkage and retention to care, can benefit from improved implementation."

They continue, "The LARK Hypertension Study demonstrates that [community health workers] have the potential to improve linkage to care, which can contribute to improved blood pressure. Our study adds to the growing literature demonstrating that the infrastructure and strategies that have been established for the control of communicable diseases – including community-based screening, task redistribution within teams, partnerships with local providers, and medical informatics – can serve as a foundation for an integrated delivery system approach to the control of noncommunicable chronic conditions."

Clinical Topics: Cardiovascular Care Team, Prevention, Hypertension

Keywords: ESC 19, ESC Congress, Blood Pressure, Blood Pressure Determination, Community Health Workers, Risk Factors, Standard of Care, Hypertension, Hypotension, Medical Informatics, Telemedicine, Delivery of Health Care, Integrated

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