Hypertension is the leading cause of cardiovascular disease worldwide, causing about 7.5 million deaths, approximately 12.8 percent of the total of all deaths. It is also a major risk factor for coronary artery disease and stroke. Aside from cardiovascular diseases, hypertension or raised blood pressure has been linked to other complications, including peripheral vascular disease, retinal hemorrhage, heart failure, visual impairment, and kidney disease.
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Treating hypertension involves taking maintenance drugs to lower blood pressure and lifestyle modifications. However, despite the proven benefits of hypertension control, it remains poor, especially in communities.
Community-based health facilities are the front liners in providing care to many patients. Physicians and the healthcare team provides the needed care to prevent the surge of diseases at the community level. According to a new study published in The Lancet, a team of researchers found a considerable decrease in the risk of developing cardiovascular disease can be attained within just a year through a new comprehensive approach – non-physician health workers providing care for the patients.
The trial, called Hope 4, is a new approach involving non-physician health workers who are tasked to use a computer tablet to help in decision-making and working with doctors. The care provided by non-physician health workers was supported by counselling to improve the health behaviors of people with raised blood pressure. Along with counselling are the regular intake of two or more free blood pressure-lowering medicines, a statin, and help from family members or friends.
In the study’s trial, the approach helped reduce the blood pressure readings of the participants and the risk of a future heart attack or stroke by more than double the amount, compared to those who received only the treatment from physicians.
"Governments around the world have agreed on an ambitious goal to reduce cardiovascular mortality by 30% by 2030. But we will only achieve this goal if we can find novel ways to remove all barriers to cardiovascular risk reduction, such as access to care, compliance with taking medications, and adoption of healthy behaviours." Dr Jon-David Schwalm, from the McMaster University, Canada, said.
Responding to patients’ needs
The researchers conducted the trial, which included more than 1,300 adults who are 50 years old and above from 30 urban and rural communities from Colombia and Malaysia. The participants of the study had uncontrolled hypertension and a high risk of developing cardiovascular disease.
They divided the participants into two groups, a control and an intervention group. In the latter group, the team of non-physician health workers performed screening, detection, treatment, and control of cardiovascular risk factors. They responded to the needs of the participants through home visits, counselling sessions, and medication delivery. This way, the progress and compliance of the patients are strictly monitored. After community screening, the treatment included the use of tablet computer-based simplified management algorithms and counselling programs, free antihypertensive and statin medicines, and family support to improve adherence to medicines and practicing healthy behaviors.
To make sure the prescriptions are correct, local doctors checked them and agreed with what the care provider assessed and dispensed 93 percent of the time. Aside from these, the participants also received lifestyle counselling from the health workers, using a tablet-based application. In the support from family and friends, they notified and reminded the participants to take their medications and stick to their lifestyle modifications.
Lastly, the participants all received a free supply of medicines to help with compliance with the treatment regimen. On the other hand, the control group were recommended to visit their doctors as practiced.
A follow-up was conducted after 12 months of treatment. The researchers found that those who were treated with the comprehensive method had a reduced risk of developing cardiovascular disease in the next ten years by half. Aside from that, they had reduced low-density lipoprotein (LDL) cholesterol readings of about 0.5 mmol/L.
There was a 69 percent increase in the number of people who had a systolic blood pressure reading of less than 140 mmHg, compared to just 30 percent n the control group.
“The unique design of our strategy demonstrates the value of a comprehensive approach which actively involves family and friends as treatment supporters and cares being coordinated by trained non-physician health workers guided by a computer program on tablets for diagnosis and counselling," Prof. Patricio Lopez-Jaramillo from the University of Santander in Colombia, said in a statement.
The researchers hope that the study could influence and persuade governments to modify their action plan for the control of cardiovascular diseases. Community-based programs are more effective since the patients will be in touch with the health care providers more often, paving the way for more counselling, health teaching, and healthcare provider-patient relationship.
Schwalm, J., McCready, T., Lopez-Jaramillo, P., Yusoff,K., Attaran, A., Lamelas, P., Camacho, P., Majid, F., Bangdiwala, S., Thabane, L., Islam, S, McKee, M., Yusuf, S. (2019). A community-based comprehensive intervention to reduce cardiovascular risk in hypertension (HOPE 4): a cluster-randomised controlled trial. The Lancet. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31949-X/fulltext