A community health worker-based intervention increased hypertension control rates from 33% at baseline to 75.2% (95% CI: 72.2-77.9) after 12 months in Colombian municipalities.
Does a community health worker-based intervention improve blood pressure control in hypertensive adults?
A community-based intervention utilizing health workers and free single-pill combination therapy achieved a 75.2% hypertension control rate at 12 months in a Colombian population.
Absolute Event Rate: 75.2% vs 33%
Objective: Hypertension management guidelines recommend the inclusion of health care models based on community health workers (CHWs) for hypertension detection and control. In the HOPE-4 study, an intervention with CHWs, standardizing antihypertensive treatment with free access to a single pill combination reached 69% of hypertension control versus 30% in usual care. In the present implementation study, we evaluate the effectiveness of a hypertension control model based on CHWs in Colombia. Design and method: RE-HOPE is a mixed methods sequential study developed in centers of primary health of 13 municipalities of the department of Santander, Colombia. De novo, uncontrolled (blood pressure > 140/90 mmHg) or nonadherent to cardiovascular risk programs hypertensive adults received an attention model based on CHW, including active search in the community, derivation to the primary health services and domiciliary visits every 3 months, with education on blood pressure measure, healthy lifestyles and medication adherence. In addition, the sanitary workers (physicians, nurses, technicians) received training on the World Health Organization hypertension management guidelines. Generalized linear mixed model evaluated changes in systolic and diastolic blood pressure (SBP and DBP) and hypertension control (PAS < 140 mmHg) after a 12-month follow-up period. Results: The study screened 10300 participants, detecting and recruiting 3477 hypertensive patients with mean (SD) age of 61 (13) years old, 62% women, 20% diabetics, 4.9% smokers, and 27.8 (4.8) BMI. Mean (SD) baseline BP was 144(16)/86(10), and 33% have well controlled hypertension. After 12 months of follow-up, 82% of participants continued in the intervention, CHW made 14912 domiciliary visits, offering 63929 counseling on smoking reduction (9%), alcohol consumption (10%), physical activity (19%), medication adherence (18%), stress reduction (21%) and salt consumption (23%), training 657 sanitary workers. The mean SBP was 131.3 mmHg (95%CI: 130.5-132), DBP 81.7 mmHg (95%CI: 81.2-82.2), and hypertension control was 75.2% (95%CI: 72.2 - 77.9). Conclusions: An intervention focused on home visits carried out by CHWs, free access to standardized treatment with a single pill combination, articulated with primary care services, achieved a clinically significant reduction in SBP and a sustained increase in hypertension control rates in communities in Colombia.
López-Jaramillo et al. (Fri,) conducted a other in Hypertension (n=3,477). Community health worker-based hypertension control model vs. Baseline (uncontrolled pre-post design) was evaluated on Changes in systolic and diastolic blood pressure and hypertension control (PAS < 140 mmHg) (95% CI 72.2-77.9). A community health worker-based intervention increased hypertension control rates from 33% at baseline to 75.2% (95% CI: 72.2-77.9) after 12 months in Colombian municipalities.