Effect of a Workplace-Based Multicomponent Intervention on Hypertension Control

Abstract

IMPORTANCEA workplace-based intervention could be an effective approach to managing high blood pressure (BP). However, few studies to date have addressed hypertension control among the Chinese working population.OBJECTIVE To assess the effect of a workplace-based, multicomponent intervention strategy on improving BP control. DESIGN, SETTING, AND PARTICIPANTSA cluster randomized clinical trial of a hypertension management program was conducted from January 2013 to December 2014 in 60 workplaces across 20 urban regions in China. Workplaces were randomized to either the intervention group (n = 40) or control group (n = 20). Employee participants in each workplace were asked to complete a cross-sectional survey. Data analysis on an evaluable population was conducted from January 2016 to January 2017. INTERVENTIONSThe 2-year intervention included 2 components: (1) a workplace wellness program for improving employees' cardiovascular health and (2) a guidelines-oriented hypertension management protocol with a community health center intervention accompanied by monthly visits for achieving BP control over a period of 24 months. MAIN OUTCOMES AND MEASURESThe primary outcome was the change in BP control rate from baseline to 24 months among employees with hypertension in the intervention and control groups. The secondary outcomes were the changes in BP level and lifestyle factors by the end of the trial. RESULTSOverall, 4166 participants (3178 in the intervention group and 988 in the control group) were included (mean [SD] age, 46.3 [7.6] years; 3451 men [82.8%]). Blood pressure control rate at baseline was 19.5% in the intervention group and 20.1% in the control group. After 24 months of the intervention, the BP control rate for the intervention group compared with the control group was significantly higher (66.2% vs 44.0%; odds ratio, 1.77; 95% CI, 1.58-2.00; P < .001). The intervention effect on systolic BP level was −5.8 mm Hg (95% CI, −6.8 to −4.9 mm Hg; P < .001) and on diastolic BP level was −3.6 mm Hg (95% CI, −4.4 to −2.9 mm Hg; P < .001). The BP control rate showed a gradual increment throughout the whole duration in the intervention group. Moreover, greater reduction was reported in the rates of drinking (−18.4%; 95% CI, −20.6% to −16.2%; P < .001), perceived stress (−22.9%; 95% CI, −24.8% to −21.1%; P < .001), and excessive use of salt (−32.0%; 95% CI, −33.7% to −30.4%; P < .001).CONCLUSIONS AND RELEVANCE This trial found that a workplace-based, multicomponent intervention appeared to be more effective than usual care, leading to measurable benefits such as lower blood pressure, improved hypertension control, and adoption of healthy lifestyle habits. The intervention can therefore be considered for large-scale use or inclusion in hypertension control programs in workplaces in China and other countries.

Current status and future direction of community-based management of hypertension in China

“…The hypertension control rate in the intervention group was 66.2%. [ 18 ] The study in rural community with good control is rare. Our team has been engaged in the prevention and treatment of hypertension in Chinese rural areas since 2003 and carried out cluster randomized trials in rural China.…”

The “Best of 2021 List” of Health Promotion Researchers

“…I included the Wang study as an award winner in this journal, in part, because the full manuscript of the study is open access, that is, available at no charge, on the JAMA Network web site. 12 You will see that even though the studied focused on blood pressure, other variables such as stress and drinking significantly improved.…”

“…Wang, Z, Wang, X, Shen, Y, Suning, L., Chen, Z., Zheng, C., Kang,Y., Jiang, L., Hao.G., Chang, C., Gao, R. 3…”

External Validity and Worksite Wellness: Lessons From China and Illinois

“…Foote and Erfurt came immediately to mind when I reviewed a workplace hypertension management RCT by Wang and colleagues published in 2020 in the Journal of the American Medical Association . 3 It’s noteworthy that Wang did not cite Foote’s research given the similarities between their interventions and methods, albeit, Foote studied American worksites and Wang’s study was conducted in 60 workplaces across 20 urban regions in China with a program that spanned a full 2 years and reached over 4,000 participants. Blood pressure control was a primary aim of the China study, but general health practices were also measured and affected.…”