Proactive home visits effective in managing hypertension in rural setting

A multicomponent intervention for hypertension care, which is based on proactive home visits by trained government community health workers and delivered through the existing public healthcare infrastructure, leads to improved blood pressure (BP) control in rural communities in South Asia, a recent study reports.

Researchers performed a cluster-randomized, controlled trial in 30 communities in rural districts across Bangladesh, Pakistan and Sri Lanka. They randomly assigned 2,645 hypertensive adults to either a multicomponent intervention (intervention group) or usual care (control group). The intervention comprised home visits by trained health workers for BP monitoring and counseling, training of physicians, and care coordination in the public sector.

Mean baseline systolic BP was 146.7 mm Hg in the intervention group and 144.7 mm Hg in the control group. These values dropped by 9.0 and 3.9 mm Hg, respectively, at month 24, with a significant 5.2-mm Hg difference in favour of the intervention (p<0.001).

Diastolic BP in the intervention group likewise decreased significantly more than in the control group (mean difference, 2.8 mm Hg).

Accordingly, the proportion of patients who achieved BP control (<140/90 mm Hg) was greater in the intervention group (53.2 percent vs 43.7 percent; relative risk, 1.22, 95 percent confidence interval, 1.10–1.35). All-cause mortality was also lower than in the control group (2.9 percent vs 4.3 percent).

The findings may have important public health implications, given that the cardiovascular mortality remains high in low- and middle-income countries, especially in rural areas characterized by poverty and fragmented health systems, the researchers explained.

If scaled up, the low-cost intervention implemented in the trial (<$11 per patient annually) might yield substantial reductions in premature deaths and disability, as well as social and economic returns, they added.