Finding cost-effective ways of lowering blood pressure among adults living in rural Southeast Asia

Researchers from the Duke Global Health Institute and their international collaborators are launching a study to find cost-effective ways of lowering blood pressure in adults living in rural in South Asia.

Hypertension, or high blood pressure, is a major risk factor for heart attack, stroke, and other vascular diseases that are often under-recognized in developing countries. Lowering blood pressure is thought to be the single most important way to reduce deaths and disabilities from heart attacks and strokes.

The study -- funded by the UK Department for International Development, Medical Research Council and Wellcome Trust -- will test low-cost strategies by health workers and doctors to lower blood pressure among adults in Bangladesh, Pakistan and Sri Lanka - where the burden of hypertension is growing rapidly.

The trial, called COBRA-BPS (Control of Blood Pressure and Risk Attenuation - Bangladesh, Pakistan and Sri Lanka), is led by Tazeen Jafar of Duke-National University of Singapore and Duke Global Health Institute with co-investigators based in the three countries. The study will enroll 2,500 people in 30 rural communities.

The strategies include:

•Providing education in patients' homes about lowering their blood pressure through diet and exercise;

•Improving referrals to trained doctors using simple checklists;

•Training doctors and nurses to manage hypertension, including using low-cost medicines;

•And having special counters at health clinics to provide assistance for patients with high blood pressure.

The researchers will compare these strategies to those provided in regular health care settings to determine if they lower blood pressure among people with hypertension, and if they are cost-effective.

All three South Asian countries have recently made addressing non-communicable diseases like heart disease a priority, and the study will inform policymakers on how to address rising rates of hypertension among their populations.

Non-communicable diseases account for nearly two-thirds of global deaths. This growing epidemic is a particular problem in South Asia, where people tend to get heart disease at a younger age, causing a greater loss of productive years and serious economic consequences. The World Health Organization says that the social and economic costs of non-communicable diseases make their prevention and control a major priority for the 21st century.

"High blood pressure is the leading risk factor for premature deaths globally," said Jafar. "The findings from COBRA-BPS are likely to provide a roadmap for effective blood pressure-lowering strategies that are sustainable and can be integrated in the public health care systems in the three countries, and have the potential for saving millions of lives and reducing human suffering in South Asia and possibly beyond."