Studies Highlight Impacts of Local and Global Efforts to Achieve Equity in Prevention

Findings from several studies presented during a dedicated Late-Breaking Science session at AHA 2023 offer insights into local and global efforts that are helping to achieve equity in prevention.

In the randomized ESPRIT study out of China, intensive blood pressure (BP) lowering treatment targeting a systolic BP goal of <120 mmHg for three years in 11,255 hypertensive patients with high risk of cardiovascular disease and normal or mildly-reduced renal function, resulted in a 12% lower incidence of major vascular events, a 39% reduction in cardiovascular mortality, and a 12% reduction in all-cause mortality." There was no significant difference in serious adverse events of low [BP], electrolyte abnormality, fall resulting in an injury, acute kidney injury or renal failure.

Compared with standard treatment of <140 mmHg, lead study author Jing Li, MD, PhD, said the "results provide evidence that intensive hypertension treatment focused on achieving systolic BP of less than 120 mmHg is beneficial and safe for individuals with high [BP] and increased cardiovascular risk factors." He added: "Implementing this intensive treatment strategy for high-risk adults has the potential to save more lives and reduce the public health burden of heart disease worldwide."

In a second SUPER LIPID Program study, researchers looked at two randomized controlled trials that assessed the use of "nudges" to encourage referrals to centralized pharmacy services for evidence-based lipid management and statin initiation in high-risk patients. Researchers assessed two strategies for integrating centralized pharmacy services into clinician workflow that included visit-based intuitive, pop-up notifications in electronic health records (EHRs) or non-visit-based, asynchronous automated orders.

Results found an asynchronous strategy of orders to a centralized pharmacy placed for cosign increased prescriptions of any statin by 16 percentage points compared with usual care, and of appropriate dose statin by 17 percentage points. The interruptive EHR notification strategy had a smaller effect on statin prescriptions and no effect on appropriate dose statin prescription, researchers said.

A multi-level hypertension program led by community health works in Nigeria was the focus of a third study. Early results showed BPs improved significantly and substantially over the study period. Specifically, researchers observed a significant increase in the three-month rolling average treatment and control rates from baseline to October 2023, but the changes in slope were greater in the pre-implementation period.

Study authors noted that "mixed methods assessments of implementation, implementation cost, normalization into routine care, and sustainability are ongoing" and that efforts are underway to "scale-up of the program across Nigeria's six geopolitical regions in collaboration with the Federal Ministry of Health and National Primary Care Board Development Agency."

In the U.S., a fourth study aimed to test the effectiveness and implementation outcomes of a multifaceted strategy for intensive BP intervention in low-income patients with uncontrolled hypertension receiving care at Federally Qualified Health Centers (FQHCs) in Louisiana and Mississippi.

Roughly 12,000 patients were enrolled in the study, which used a stepped-care protocol adapted from the SPRINT intensive-treatment algorithm to achieve a target systolic BP <120 mmHg. Overall findings showed that mean systolic and diastolic BP decreased by -16.0 and -9.3 mmHg from baseline to 18 months in intervention and by -9.1 and -5.1 mmHg in control, respectively, with a net difference of -7.0 mmHg for systolic and -4.2 mmHg for diastolic BP. Researchers noted that at 18 months, the proportion of patients who achieved systolic BP <120 mmHg was 22.9% in intervention and 15.7% in control (p=0.013 for group difference). The proportion of patients who achieved systolic BP <130 mmHg was 50.3% in intervention and 38.1% in control (p<0.001 for group difference).

"This effective and scalable implementation strategy could be widely adopted to improve hypertension control among low-income populations with hypertension in the U.S. and other countries," said Jiang He, MD, in presenting the findings.

Clinical Topics: Prevention, Hypertension

Keywords: American Heart Association, AHA23, Cardiovascular Diseases, Hypertension, Antihypertensive Agents, Statins

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