The workplace: An avenue for hypertension management?

A workplace-based hypertension management programme conducted in China resulted in improved blood pressure (BP) control and reduced hypertension rates.

“[I]mplementation of a workplace intervention strategy that combines health promotion and management of hypertension along with [community health centre (CHC)] intervention and monthly visits may significantly improve BP control,” noted the authors.

Between January 2013 and December 2014, 60 workplaces in China – comprising 4,166 participants aged 18–60 years with primary hypertension (mean age 46.3 years, 82.8 percent male, mean baseline BP 145.0/91.9 mm Hg) – were randomized 2:1 to either the intervention or control group for 2 years. Individuals with a history of stroke, acute myocardial infarction, pregnancy, or childbirth in the past 3 months, and those with <2 years life expectancy were excluded.

The intervention comprised two components – a workplace-based wellness programme to improve employee cardiovascular (CV) health and a guidelines-based hypertension management protocol plus monthly visits to designated CHCs where the participants were treated and monitored by physicians.

The wellness programme included health education, diet and physical activity (eg, healthier options in the cafeteria and exercise breaks during working hours), stress management (eg, monthly relaxation activities), environmental changes (eg, modifications to office layout to reduce sedentary behaviour), and tobacco cessation (eg, workplace smoking prohibition).

Participants in the control group visited CHCs at baseline and programme end and received routine care.

At baseline, BP control rate (mean <140/90 mm Hg while on treatment) was 19.5 and 20.1 percent in the intervention and control groups, respectively.

At 24 months, BP control rate was significantly higher in the intervention vs the control group (66.2 percent vs 44.0 percent; odds ratio [OR], 1.77, 95 percent confidence interval, 1.58–2.00; p<0.001). [JAMA Cardiol 2020;doi:10.1001/jamacardio.2019.6161]

Reductions in BP levels were greater in the intervention vs the control group for systolic BP (-10.5 vs -4.7 mm Hg) and diastolic BP (-7.3 vs -3.6 mm Hg), with intervention effects of -5.8 and -3.6 mm Hg, respectively (p<0.001 for both). There were significant reductions in stage 1 and stage 3 hypertension in the intervention vs control group (OR, 0.82 and OR, 0.54, respectively; p<0.001 for both).

There were also improvements from baseline in lifestyle factors in the intervention vs control group including reductions in alcohol consumption (-18.4 percent vs -3.6 percent; OR, 0.88; p=0.02), perceived stress (-22.9 percent vs -15.2 percent; OR, 0.53; p<0.001), and excessive salt intake rates (-32.0 percent vs -29.0 percent; OR, 0.86; p=0.03), and increase in exercise (34.0 percent vs 8.2 percent; OR, 2.10; p<0.001).

No serious treatment-related adverse events (AEs) occurred. Drug-related AEs affected 4.0 and 1.0 percent of participants in the intervention and control arms, respectively, while CV events affected 1.5 and 2.3 percent of the participants, respectively. Twelve deaths occurred in the intervention group.

The repeat assessments may have played a role in the improvements in the intervention group, said the authors. “[R]epeated exposure to BP measurements may have reinforced self-management behaviours and promoted positive lifestyle changes. [R]egular follow-up and modification for drug treatment resulted in a larger improvement in BP control rate compared with BP monitoring and patient education alone.” This raises the question as to whether the findings were due to repeat assessments or the workplace intervention, they said.

The authors recommended the inclusion of improvements in health literacy in workplace hypertension management programmes. They noted limitations including the potential for recall bias in the control group and generalizability of the results given the male-majority study population.