Community health efforts improve quality of life for low-income hypertensive patients

Knowledge and treatment of hypertension in susceptible patients might be expanding in the U.S. and other developed countries, but research has shown that trend doesn’t translate across socioeconomic borders.

An original investigation published in the current issue of the Journal of the American Medical Association explored whether a community health worker-led multicomponent intervention could improve blood pressure control in a population of more than 1,000 low-income patients living in Argentina. All of the 1,357 studied individuals suffered from hypertension and were undergoing treatment within a national program that aims to provide medicine and healthcare to 17 million disadvantaged citizens for free.

Lead author Jiang He, MD, PhD, and a team of researchers divided the study population into two cohorts: those who would continue to receive routine care, and those who would take part in a multicomponent intervention, which included home care like health coaching and at-home blood pressure monitoring, a physician intervention and a text-messaging intervention, over the course of 18 months. He and colleagues conducted a cluster randomized trial in 18 centers—nine, which housed 743 patients, were randomized to the multicomponent intervention, and the other nine, comprising 689 patients, resumed routine care. All individuals were around 55 years old, and a slight majority were women.

The baseline mean systolic blood pressure (BP) was 151.7 mm Hg for the intervention group and 149.8 mm Hg for the usual care group, while the mean diastolic BP was 92.2 mm Hg for the intervention group and 90.1 mm Hg for the usual care group. Over 18 months, the intervention group saw a reduction in systolic BP of 19.3 mm Hg; the usual care cohort’s average dropped by 12.7 mm Hg. Diastolic BP decreased by 12.2 mm Hg in the intervention group and 6.9 mm Hg in the usual care group, creating a gap of 5.4 mm Hg between the two.

According to He and colleagues’ study, the 17 percent of patients with their hypertension under control at baseline jumped to 72.9 percent at 18 months in the intervention group. The usual care group saw improvement, too—a baseline 17.6 percent increased to 52.2 percent—but it was clear the increased attention to care benefitted the hypertensive patients in the former group, leading to a 21 percent absolute difference in the proportion of patients with controlled blood pressure.

“The study by He and colleagues addresses the large and growing problem of managing elevated blood pressure,” Mark D. Huffman, MD, MPH, and colleagues wrote in an editorial accompanying He’s study. “Estimates from the Global Burden of Disease 2015 Study suggest that nearly 1 billion adults 25 years or older have a systolic blood pressure of at least 140 mm Hg, which was associated with an estimated 7.8 million deaths in 2015. Despite this substantial burden of disease, data suggest that less than half of individuals who are aware of having a diagnosis of elevated blood pressure receive treatment, and among those who do receive treatment, only one-third have their blood pressure controlled. Thus, scalable, effective and multilevel strategies are needed to overcome key patient, clinician and health system barriers for hypertension treatment and control.”