NEW ORLEANS, LA – Community health workers can play a vital role in controlling hypertension in residents of low-income communities, new research suggests[1].
In the study conducted in Argentina, community health workers, using proactive strategies including home health coaching and home blood-pressure monitoring, were more successful in helping patients get their blood pressure under control over 18 months than clinicians using traditional approaches.
“Community health worker–led intervention is an effective, affordable, and sustainable implementation strategy for hypertension control in other low-income countries as well as in low-income populations in the United States,” Dr Jiang He (Tulane University School of Public Health and Tropical Medicine, New Orleans, LA) told theheart.org | Medscape Cardiology.
The study was published in the September 19, 2017 issue of the Journal of the American Medical Association.
The researchers tested a multicomponent intervention in 18 community health centers in Argentina, providing free healthcare to 1432 uninsured, low-income patients with uncontrolled hypertension.
Participants were divided into two groups: a control group receiving usual care or an intervention group that received coaching on healthy lifestyle, home blood-pressure monitoring, and blood-pressure audit and weekly text messaging from a trained community health worker, who visited the patient monthly for the first 6 months and then every other month thereafter.
Average blood pressure at baseline was 151.7/92.2 mm Hg in the intervention group and 149.8/90.1 mm Hg in the usual-care control group. Over 18 months, patients in the intervention group saw a greater reduction in systolic and diastolic blood pressure than their peers in the control group.
Overall Mean Change in Systolic and Diastolic Blood Pressure With Intervention vs Control
| End point | Intervention | Control | Net difference (95% CI) |
|---|---|---|---|
| SBP | -19.3 | -12.7 | -6.6 (-8.6 to -4.6) |
| DBP | -12.2 | -6.9 | -5.4 (-6.8 to -4.0) |
The proportion of patients with controlled blood pressure (BP <140/90 mm Hg) increased from 17.0% at baseline to 72.9% at 18 months in the intervention group and from 17.6% to 52.2% in the usual-care group, an absolute difference of 20.6% (95% CI 15.4%–25.9%, P<0.001). This result is “remarkable,” note the authors of an accompanying editorial[2].
Adherence to antihypertensive medication increased from 31.1% at baseline to 66.1% at 18 months in the intervention group, while in the control group, adherence to antihypertensive medication rose from 38.0% to 53.0%, a significant between-group difference of 13.1% (P<0.001).
The average total cost per patient over 18 months was $178.6 in the intervention group and $67.6 in the control group, a difference of $102.7.
The investigators conclude that “widespread scaling-up of this proven-effective intervention in low- and middle-income countries should result in a substantial reduction in uncontrolled hypertension and related cardiovascular disease.”
Effective Intervention
In their editorial, Dr Mark Huffman (Northwestern University Feinberg School of Medicine, Chicago, IL) and colleagues note that a goal of the World Health Organization is to reduce the risk of premature death from noncommunicable diseases, including cardiovascular disease, by 25% by 2025. This goal includes reducing the prevalence of hypertension by 25% and achieving 50% treatment of eligible individuals with drug therapy and counseling to prevent MI and stroke.
This new study demonstrates “an effective, scalable community health worker–led intervention that will need to be part of any national health system package to achieve such ambitious targets, including in high-income countries,” they write.
“As researchers, patients, community health workers, physicians, and policy makers in Argentina and around the world discuss these results in a wider context, the next—and perhaps more challenging—steps appear to be how to scale, adapt, and sustain this type of intervention and underlying health systems to move from reducing blood pressure to reducing premature death and disability from cardiovascular diseases,” they conclude.
The study was funded by the National Institutes of Health. The authors and editorialists have no relevant financial relationships.
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