Key result
A multicomponent intervention led to a greater increase in the therapeutic intensity score of antihypertensive medications compared with usual care (mean difference 0.08; 95% CI 0.03-0.12; P=0.002).
Why the study?
Inadequate hypertension treatment is widespread, especially in South Asian countries with high cardiovascular disease mortality rates.
Does a multicomponent intervention increase antihypertensive medication intensification in rural South Asian adults with hypertension?
RCT (n=2,645)
cluster-randomized
Yes
Does a multicomponent intervention increase antihypertensive medication intensification in rural South Asian adults with hypertension?
Mean Difference: 0.08 (95% CI 0.03–0.12)
Absolute Event Rate: 0.11% vs 0.03%
p-value: p=0.002
A multicomponent intervention in rural South Asia significantly increased the intensification of antihypertensive therapy compared to usual care.
Supports scaling CHW-led programs to close treatment gaps in rural South Asia; extends the parent RCT by confirming intensification as a mechanism.
BACKGROUND: Inadequate treatment of hypertension is a widespread problem, especially in South Asian countries where cardiovascular disease mortality rates are high. We aimed to explore the effect of a multicomponent intervention (MCI) on antihypertensive medication intensification among rural South Asians with hypertension. METHODS: A post hoc analysis of a 2-year cluster-randomized controlled trial including 2,645 hypertensives aged ≥40 years from 30 rural communities, 10 each, in Bangladesh, Pakistan, and Sri Lanka. Independent assessors collected information on participants' self-reports and physical inspection of medications. The main outcomes were the changes from baseline to 24 months in the following: (i) the therapeutic intensity score (TIS) for all (and class-specific) antihypertensive medications; (ii) the number of antihypertensive medications in all trial participants. RESULTS: At 24 months, the mean increase in the TIS score of all antihypertensive medications was 0.11 in the MCI group and 0.03 in the control group, with a between-group difference in the increase of 0.08 (95% confidence interval (CI, 0.03, 0.12); P = 0.002). In MCI compared with controls, a greater increase in the TIS of renin-angiotensin-aldosterone system blockers (0.05; 95% CI (0.02, 0.07); P < 0.001) and calcium channel blockers (0.03; 95% CI (0.00, 0.05); P = 0.031), and in the number of antihypertensive medications (0.11, 95% CI (0.02, 0.19); P = 0.016) was observed. CONCLUSIONS: In rural communities in Bangladesh, Pakistan, and Sri Lanka, MCI led to a greater increase in antihypertensive medication intensification compared with the usual care among adults with hypertension. CLINICAL TRIALS REGISTRATION: Trial Number NCT02657746.
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Feng et al. (2021) conducted an RCT in hypertension (n=2,645). Multicomponent intervention vs. Usual care was evaluated on Change from baseline to 24 months in the therapeutic intensity score (TIS) for all antihypertensive medications (MD 0.08, 95% CI 0.03, 0.12, p=0.002). A multicomponent intervention led to a greater increase in the therapeutic intensity score of antihypertensive medications compared with usual care (mean difference 0.08; 95% CI 0.03-0.12; P=0.002).
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