Key result
Simplified antihypertensive treatment algorithm linked to a ~34% reduction in stroke and NCD death.
Why the study?
Hypertension management is poor in developing country primary care settings, where 75% of hypertensive individuals live, prompting the need to explore simplified treatment algorithms to improve management and reduce stroke and CVD death.
Does a simplified antihypertensive treatment algorithm improve hypertension management and reduce stroke and CVD death in resource-constricted primary care settings?
Observational
Yes
Does a simplified antihypertensive treatment algorithm improve hypertension management and reduce stroke and CVD death in resource-constricted primary care settings?
Implementing a simplified antihypertensive treatment algorithm using affordable agents significantly improves blood pressure control and reduces stroke mortality in resource-limited primary care settings.
May support simplified algorithms for hypertension control in primary care; leaves open causal stroke mortality benefits pending randomized trials.
Hypertension management is poor in primary care settings of developing countries, where 75% of hypertensives are living. Exploring better ways to improve hypertension management and to decrease stroke and CVD death is needed such as introducing treatment algorithm. Therefore, we selected intervention counties from Xinjiang, an underdeveloped region in China, and introduced antihypertensive treatment algorithm, comprising locally available and affordable agents, to primary health providers since 1998. Program effects were evaluated using the data collected in various ways including cross-sectional screenings to population ≥30 years between 1998 and 2015 by comparing treatment and control rates of hypertension, changes in blood pressure (BP) levels and distribution, and proportion of case/total and NCD death for CVD and stroke. Compared to 1998–2000, treatment rate was improved by 2.78 fold (11.2% vs. 32.1%, <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mi>P</a:mi> </a:math> < 0.001), and the overall and treated control rate were improved by 53.5 fold (0.2% vs. 10.7%, <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mi>P</c:mi> </c:math> < 0.001) and by 16.8 fold (2.0% vs. 33.5%, <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mi>P</e:mi> </e:math> < 0.001), respectively, in 2015. Mean SBP and DBP showed a net reduction by 33.7 mmHg (181.3 vs. 147.6 mmHg) and 21.3 mmHg (106.3 vs. 85.0 mmHg), respectively, in 2015, compared to 1998–2000 ( <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"> <g:mi>P</g:mi> </g:math> < 0.001), and stage III hypertension was reduced by 75.2% (33.5 vs. 8.3%, <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M5"> <i:mi>P</i:mi> </i:math> < 0.001). Compared to 1997–1999, stroke/NCD death was reduced by 34.1% in 2015–2017 (31.7 vs. 20.9%, <k:math xmlns:k="http://www.w3.org/1998/Math/MathML" id="M6"> <k:mi>P</k:mi> </k:math> = 0.006) in the intervention counties whereas by 7.5% in control county. Introduction of treatment algorithm helps improve hypertension management and reduce stroke death in resource-constricted primary settings.
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Heizhati et al. (2021) conducted an observational in Hypertension. Simplified antihypertensive treatment algorithm vs. Control county was evaluated on Stroke/NCD death reduction (p=0.006). Introduction of a simplified antihypertensive treatment algorithm reduced stroke/NCD death by 34.1% in intervention counties compared to 7.5% in control counties (P=0.006).
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