The HOPE-4 study is a cluster randomized trial designed to evaluate whether a community-based, multifaceted intervention can improve the Framingham Risk Score at 12 months in 1,376 participants.
RCT (n=1,376)
cluster
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Does a community-based multifaceted intervention package reduce cardiovascular risk scores in people with hypertension compared to usual care?
This rationale and design paper outlines a cluster randomized trial evaluating a community-based intervention to reduce cardiovascular risk in patients with hypertension in low- and middle-income countries.
BACKGROUND: Cardiovascular disease is the leading cause of death throughout the world, with the majority of deaths occurring in low- and middle-income countries. Despite clear evidence for the benefits of blood pressure reduction and availability of safe and low-cost medications, most individuals are either unaware of their condition or not adequately treated. OBJECTIVE: The primary objective of this study is to evaluate whether a community-based, multifaceted intervention package primarily provided by nonphysician health workers can improve long-term cardiovascular risk in people with hypertension by addressing identified barriers at the patient, health care provider, and health system levels. METHODS/DESIGN: HOPE-4 is a community-based, parallel-group, cluster randomized controlled trial involving 30 communities (1,376 participants) in Colombia and Malaysia. Participants ≥50 years old and with newly diagnosed or poorly controlled hypertension were included. Communities were randomized to usual care or to a multifaceted intervention package that entails (1) detection, treatment, and control of cardiovascular risk factors by nonphysician health workers in the community, who use tablet-based simplified management algorithms, decision support, and counseling programs; (2) free dispensation of combination antihypertensive and cholesterol-lowering medications, supervised by local physicians; and (3) support from a participant-nominated treatment supporter (either a friend or family member). The primary outcome is the change in Framingham Risk Score after 12 months between the intervention and control communities. Secondary outcomes including change in blood pressure, lipid levels, and Interheart Risk Score will be evaluated. SIGNIFICANCE: If successful, the study could serve as a model to develop low-cost, effective, and scalable strategies to reduce cardiovascular risk in people with hypertension.
Schwalm et al. (Fri,) conducted a rct in hypertension (n=1,376). community-based, multifaceted intervention package vs. usual care was evaluated on change in Framingham Risk Score after 12 months. The HOPE-4 study is a cluster randomized trial designed to evaluate whether a community-based, multifaceted intervention can improve the Framingham Risk Score at 12 months in 1,376 participants.