Effect of community health worker-provided targeted education with regular follow-up of hypertensive patients on blood pressure control: 24-month results of a longitudinal study in Bangladesh

Context: Sustainability of blood pressure (BP) control by trained community health workers (CHWs) in a low awareness setting is yet to be explored. Aim: The aim of this study is to assess the effect of CHW-provided targeted education with regular follow-up of hypertensive patients on BP control. Materials and Methods: We conducted a longitudinal study on hypertension in a semi-urban and a rural district in Bangladesh. Adult hypertensive individuals (n = 287) were identified. Trained CHWs regularly followed up and provided specific health messages on BP control through quarterly group meetings and individual counseling. We assessed mean BP changes and control status (systolic BP [SBP] <140 mmHg and diastolic BP [DBP] <90 mmHg) at around every 6 months for 24 months. A subgroup of hypertensive patients (n = 118) age >40 years was compared with an unmatched comparison group (n = 226) under usual care. Results: Both SBP and DBP of hypertensive patients under intervention were significantly reduced compared to baseline. The intervention subgroup had a significant lower SBP (149.1 ± 17.7 mmHg vs. 141.3 ± 20.34 mmHg; P = 0.004) and DBP (86.7 ± 13.32 mmHg vs. 91.31 ± 13.54 mmHg; P = 0.003) compared to comparison group. Proportion achieved BP control was higher (44.1% vs. 26.7%, P = 0.001) in the intervention subgroup. Patients who visited qualified providers within a year were 2 times more likely to be under better BP control. Conclusion: Targeted education with regular follow-up of hypertensive patients by trained CHWs has the potential to reduce BP and enhance BP control in settings with low awareness.