One in four adults suffers from hypertension in rural communities with low or middle income. This is especially so in rural Asia where health systems are far from optimal and awareness of the disease is alarmingly lacking.
As many as 70 per cent go about their lives with uncontrolled hypertension, opening themselves to the risk of cardiovascular and kidney diseases which lead to some of the highest death rates.
However, a study led by Duke-NUS Medical School Professor Tazeen H Jafar from the Health Services and Systems Research Programme, showed that a turnaround is possible through implementing a multi-component intervention programme that is integrated with existing health systems.
Published in the New England Journal of Medicine, the study found that such an intervention programme can play a significant role in helping people with hypertension to lower their blood pressure (BP). The programme, which has the added advantage of being low-cost, involved community health workers conducting home visits to monitor BP and provide lifestyle coaching. Coupled with physician training and coordination with public healthcare infrastructure, the programme resulted in clinically meaningful reductions in BP.
The 24-month randomised controlled trial was conducted among 2,550 hypertensive adults from 30 rural communities in Bangladesh, Pakistan and Sri Lanka. Half the communities were randomised to a multi-component intervention. The other half received usual care.
At the end of the trial, the decline in mean systolic BP was 5 mm Hg greater in the intervention group versus the usual care group. There was also better reduction in mean diastolic BP and BP control (<140/90 mmHg) as well as fewer deaths from cardiovascular disease in the intervention group.
“A sustained 5 mmHg reduction in systolic BP at a community level historically translates into about a 30 per cent reduction in death and disability from cardiovascular disease,” explained Prof Jafar who is also a Professor of Global Health at the Duke Global Health Institute (DGHI), USA.
“Community health workers are an integral part of the primary care infrastructure for the successful door to door delivery of maternal and child healthcare in South Asia – as well as China, Mexico, and Africa. Our findings show that community health workers can have an equally important role in managing hypertension,” she said.
Their programme can be adapted and scaled up in many other settings globally, shared Prof Jafar. This could potentially save millions of lives as well as reduce suffering from heart attacks, strokes, heart failure and kidney disease.
Programme would cost less then US$11 per patient
Early estimates from a formal cost-effectiveness analysis, currently underway by Professor Eric Finkelstein, a health economist at Duke-NUS and DGHI, suggest that scaling up their intervention programme nationally in Bangladesh, Pakistan and Sri Lanka would cost less than US$11 per patient annually.
The study conducted in partnership with Dr Aliya Naheed from the International Centre for Diarrhoeal Diseases Research, Bangladesh (ICDDR, B), Dr Imtiaz Jehan from Aga Khan University, Pakistan, and Prof Asita de Silva from the University of Kelaniya, Sri Lanka, is funded by the Joint Global Health Trials scheme, which includes the Medical Research Council, the UK Department for International Development (DFID), the National Institute for Health Research (NIHR) and the Wellcome Trust. The Singapore Clinical Research Institute (SCRI) provided data management and statistical analysis support.
See press release.