Comprehensive Approach for Hypertension Control in Low-Income Populations: Rationale and Study Design for the Hypertension Control Program in Argentina

Abstract

Although the efficacy and effectiveness of lifestyle modifications and antihypertensive pharmaceutical treatment for the prevention and control of hypertension and concomitant cardiovascular disease have been demonstrated in randomized controlled trials, this scientific knowledge has not been fully applied in the general population, especially in low-income communities. This paper summarizes interventions to improve hypertension management and describes the rationale and study design for a cluster randomized trial testing whether a comprehensive intervention program within a national public primary care system will improve hypertension control among uninsured hypertensive men and women and their families. We will recruit 1,890 adults from 18 clinics within a public primary care network in Argentina. Clinic patients with uncontrolled hypertension, their spouses and hypertensive family members will be enrolled. The comprehensive intervention program targets the primary care system through health care provider education, a home-based intervention among patients and their families (home delivery of antihypertensive medication, self-monitoring of blood pressure, health education for medication adherence and lifestyle modification) conducted by community health workers, and a mobile health intervention. The primary outcome is net change in systolic blood pressure from baseline to month 18 between intervention and control groups among hypertensive study participants. The secondary outcomes are net change in diastolic blood pressure, blood pressure control, and cost-effectiveness of the intervention. This study will generate urgently needed data on effective, practical, and sustainable intervention programs aimed at controlling hypertension and concomitant cardiovascular disease in underserved populations in low- and middle-income countries.

Comparative Effectiveness of Implementation Strategies for Blood Pressure Control in Hypertensive Patients

“…Despite strong evidence that antihypertensive medications and lifestyle modifications reduce BP and subsequent cardiovascular disease morbidity and mortality, hypertension control rates are low worldwide (5). The US Institute of Medicine and the National Heart Lung and Blood Institute have both called for research focusing on integrating evidence-based strategies into routine health care for hypertension control (20,21).…”

“…Despite these proven-effective BP interventions, only 13.8% of adults with hypertension and 37.1% of patients with treated hypertension had their BP controlled worldwide in 2010 (1). Barriers to hypertension control at health care system, health care provider, and patient levels have been identified (5). For example, limited health care resources, lack of performance standards, and limited reimbursement for health coaching are major barriers to BP control at the health care system level; lack of adherence to clinical guidelines is a major barrier to BP control at the health care provider level; and lack of adherence to prescribed medications and lifestyle modifications are major barriers at the patient level (5).…”

Comportamentos em saúde e exames preventivos entre adultos filiados ou não a planos de saúde na Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil, 2003-2010

“…Uma vez que já se atingiu altos níveis de cobertura da aferição da pressão arterial e do colesterol, o desafio passa a ser o desenvolvimento de novos marcadores de controle e acompanhamento do tratamento 47,48,49 .…”

Effect of a Community Health Worker–Led Multicomponent Intervention on Blood Pressure Control in Low-Income Patients in Argentina

“…Details of the trial’s design and analysis plan have been published previously. 9 The Institutional Review Boards of Tulane University and Hospital Italiano de Buenos Aires in Argentina approved the study. Informed consent was signed by all participants during screening.…”