Key result
Community health worker linkage to primary care increased optimal blood pressure control from 26% at baseline to 38% at 2 years (absolute increase 12%; 95% CI 10.2-13.9).
Why the study?
Hypertension control is poor with heterogeneous blood pressure control across population subgroups, warranting evaluation within India's NPCDCS framework to estimate optimal control and identify factors linked to uncontrolled hypertension.
Does a community health worker-based intervention improve optimal blood pressure control in individuals with hypertension in urban slums?
Cohort (n=1,571)
Yes
Does a community health worker-based intervention improve optimal blood pressure control in individuals with hypertension in urban slums?
A community health worker-based intervention linking hypertensive patients to primary care in urban Indian slums modestly improved optimal blood pressure control over two years.
Limited control gains under existing NPCDCS caution against high expectations now; leaves open trials of enhanced community or pharmacologic strategies.
Background: Hypertension (HTN) is a leading cause of cardiovascular diseases and its control is poor. There is heterogeneity in levels of blood pressure control among various population subgroups. The present study was conducted within the framework of the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) in India. It aims to estimate the proportion of optimal blood pressure control and identify factors associated with uncontrolled HTN consequent to initial screening. Materials and Methods: We assembled a cohort of individuals with HTN confirmed in a baseline screening in sixteen urban slum clusters of Bhopal (2017-2018). Sixteen accredited social health activists were trained from within these slums. Individuals with HTN were linked to primary care providers and followed up for the next two years. Obtaining optimal blood pressure control (defined as SBP <140 and DBP <90 mm of Hg) was a key outcome. Results: Of a total of 6174 individuals, 1571 (25.4%) had HTN, of which 813 were previously known and 758 were newly detected during the baseline survey. Two-year follow-up was completed for 1177 (74.9%). Blood pressure was optimally controlled in 301 (26%) at baseline and in 442 (38%) individuals at two years (an absolute increase of 12%; 95% CI 10.2-13.9). Older age, physical inactivity, higher body mass index, and newly diagnosed HTN were significantly associated with uncontrolled blood pressure. Conclusion: We found about six of every ten individuals with HTN were on treatment, and about four were optimally controlled. These findings provide a benchmark for NPCDCS, in terms of achievable goals within short periods of follow-up.
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Pakhare et al. (2023) conducted a cohort in Hypertension (n=1,571). Community health worker linkage to primary care vs. Baseline was evaluated on Optimal blood pressure control (SBP <140 and DBP <90 mm of Hg) (absolute increase 12%, 95% CI 10.2-13.9). Community health worker linkage to primary care increased optimal blood pressure control from 26% at baseline to 38% at 2 years (absolute increase 12%; 95% CI 10.2-13.9).
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