Log in to MyACC
Community-Based Intervention for Managing Hypertension in Rural South Asia
Study Questions:
Is an intervention including community health workers effective for improving hypertension (HTN) among rural communities in South Asia?
Methods:
COBRA-BPS was a cluster-randomized, controlled trial conducted in rural Bangladesh, Pakistan, and Sri Lanka. A total of 30 communities were randomly assigned to a multicomponent intervention or usual care. Randomization was stratified by country. The intervention comprised home visits conducted by trained government community health workers who monitored blood pressure (BP) and counseled patients regarding BP management. BP was measured in the home every 3 months. Participants were referred to a physician if systolic blood pressure (SBP) was ≥160 mm Hg or diastolic blood pressure (DBP) was ≥100 mm Hg. Physicians were also trained in proper BP measurement and guideline-based HTN management. A designated HTN triage reception desk and care coordinator were included at government clinics, and compensation for additional health services for community health workers was made available as part of the intervention. Adults with HTN, age ≥40 years were eligible for the study. The primary outcome was reduction in SBP at 24 months.
Results:
A total of 11,510 adults were screened, of which 2,645 (mean age 58.5 years, 64.3% women) were enrolled between April 2016 and February 2017. Prevalence of chronic conditions among the participants included diabetes (25.8%) and chronic kidney disease (41.9%). Rates of BP control were low, with 69.6% of participants having uncontrolled BP, and 29.6% were very poorly controlled. Follow-up at 24 months was completed for >90% of the participants. At baseline, the mean SBP was 146.7 mm Hg in the intervention group and 144.7 mm Hg in the control group. At 24 months, the mean SBP was reduced by 9.0 mm Hg in the intervention group and by 3.9 mm Hg in the control group; the mean reduction was 5.2 mm Hg greater with the intervention (95% confidence interval [CI], 3.2-7.1; p < 0.001). The mean reduction in DBP was 2.8 mm Hg greater in the intervention group than in the control group (95% CI, 1.7-3.9). BP control (<140/90 mm Hg) was achieved in 53.2% of the participants in the intervention group, as compared with 43.7% of those in the control group (relative risk, 1.22; 95% CI, 1.10-1.35). All-cause mortality was 2.9% in the intervention group and 4.3% in the control group. The estimated cost of scale-up per eligible patient with hypertension in rural areas in Bangladesh, Pakistan, and Sri Lanka was $10.70, $10.50, and $4.70 (US dollars), respectively.
Conclusions:
The investigators concluded that in rural communities in Bangladesh, Pakistan, and Sri Lanka, a multicomponent intervention that was centered on proactive home visits by trained government community health workers who were linked with existing public health care infrastructure led to a greater reduction in BP than usual care among adults with HTN.
Perspective:
These data support the use of multicomponent interventions which included use of community health workers and practice facilitation for management of cardiovascular risk factors such as HTN. The results of this study have significant public health implications given the rates of conditions such as HTN in many rural areas across the world.
Clinical Topics: Cardiovascular Care Team, Prevention, Hypertension
Keywords: Blood Pressure, Blood Pressure Determination, Community Health Workers, Diabetes Mellitus, Health Services, House Calls, Hypertension, Kidney Diseases, Monitoring, Physiologic, Primary Prevention, Public Health, Rural Population
< Back to Listings
