Family member-based supervision of patients with hypertension: a cluster randomized trial in rural China

Abstract

Empirical evidence has suggested that social support from family can help patients take their medicines correctly. This study aims to evaluate the role of a family member-based supervision package in the management of hypertension using a cluster randomized trial in rural China. We recruited patients with hypertension from four villages in Yangzhong and randomly allocated them to the control group (n=288) and the intervention group (n=266). A family member-based supervision package was applied to the intervention group, while the usual service was applied to the controls. Patients were followed for 12 months and completed face-to-face interviews at the end of 6 and 12 months. The primary outcomes were patients' medication adherence and frequency of blood pressure measurement. Secondary outcomes included changes in blood pressure, altered risk behaviours and occurrence of hypertension-related complications. To control for the effects of cluster randomization, multilevel mixed-effects regression models were used to compare group changes. We observed that the intervention improved patients' blood pressure measurement frequency (OR: 9.00, 95% CI: 4.52–17.91) and adherence to antihypertensive treatment (OR: 1.74, 95% CI: 0.91–3.32). Its effect on the blood pressure control rate was significant at the mid-term investigation (OR: 0.67, 95% CI: 0.40–0.93), but the long-term effect was not significant (OR: 0.89, 95% CI: 0.64–1.26). After 6 months of intervention, either systolic or diastolic blood pressure was significantly decreased in the intervention group. However, this difference was not significant at the final investigation. Findings from this study revealed that the family member-based supervised therapy may have positive effects on patients' adherence to blood monitoring and hypertensive medications.

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“…Table provides an overview of the 48 included studies . Nine studies reported two comparisons (designated as different follow‐up duration and intervention intensity). A total of 14 568 participants from 20 provinces or regions were included.…”

Determinants of Uncontrolled Hypertension in Rural Communities in South Asia—Bangladesh, Pakistan, and Sri Lanka

“… 32 Strategies of engaging family members in hypertension management have shown promising results in rural China, must be encouraged in South Asia. 33 …”

Evaluation of antihypertensive adherence and its determinants at primary healthcare facilities in rural South Africa

“…The greatest prevalence worldwide for hypertension is in the African Region, where up to 46% of adults aged 25 or over in 2008 had hypertension [2], with up to three quarters or more of hypertensive patients currently failing to achieve target blood pressure (BP) goals [7−12]. It is perceived that a lack of adherence to medication is the major causative factor for uncontrolled hypertension [1,4,[6][7][8][11][12][13][14][15][16]. Non-adherence to medicines affects up to 30-50% of patients or more with chronic conditions including hypertension [8,17,18], with poor adherence levels seen even in the first year of treatment [12,19,20].…”