Identifying Who Benefits the Most from a Community Health Worker-Led Multicomponent Intervention for Hypertension.

IF 1.9 4区医学 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Hypertension Pub Date : 2024-09-17 eCollection Date: 2024-01-01 DOI:10.1155/2024/6311938

Meng Pan, Andrea Beratarrechea, Rosana Poggio, Hua He, Chung-Shiuan Chen, Jing Chen, Vilma Irazola, Adolfo Rubinstein, Jiang He, Katherine T Mills

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引用次数: 0

Abstract

Background: Uncontrolled hypertension is a major public health challenge in low- and middle-income countries. The Hypertension Control Program in Argentina (HCPIA) showed that a community health worker-led multicomponent intervention was effective for blood pressure (BP) reduction in resource-limited settings, but whether the intervention was equally effective across participant subgroups is unknown.

Objective: To identify participants who benefit the most from the HCPIA BP control intervention.

Methods: This secondary analysis used data from HCPIA, a successful 18-month cluster-randomized trial in 18 health centers with 1,432 low-income hypertensive patients in Argentina. Fifteen baseline characteristics were used to define subgroups. The proportion of controlled BP (<140/90 mmHg) was estimated using generalized linear mixed models with arm-by-subgroup interaction terms. The distribution of trial BP response among intervention patient subgroups was assessed.

Results: Participants were 53.0% female, a mean age of 56 years, and 17.4% controlled BP at baseline. After the intervention, 72.9% of intervention and 52.2% of control participants had controlled BP. The intervention was more effective in physically inactive patients (OR = 2.76, 95% CI: 1.82 and 4.21; p for interaction = 0.04), moderately active patients (OR = 3.08, 95% CI: 1.90 and 4.99; p for interaction = 0.03), and those with uncontrolled BP at baseline (OR = 2.77, 95% CI: 2.15 and 3.57; p for interaction = 0.05). Among intervention participants, 20.2% had no BP response (BP change < -4 mmHg), 41.3% had a moderate BP response (BP change: -4 mmHg to -24 mmHg), and 38.5% had a high BP response (BP change > -24 mmHg). Women (p=0.01), those who were physically inactive (p=0.03), and those not taking antihypertensive medications at baseline (p=0.001) had the greatest BP response.

Conclusion: The effect of the intervention was consistent across many subgroups with some key groups showing a particularly strong intervention effect. These findings could be useful for planning future hypertension control programs in low- and middle-income countries.

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确定谁能从社区卫生工作人员主导的多成分高血压干预措施中获益最多。

背景：无法控制的高血压是中低收入国家面临的一项重大公共卫生挑战。阿根廷高血压控制计划（HCPIA）表明，在资源有限的环境中，由社区卫生工作者主导的多成分干预措施能有效降低血压，但该干预措施在不同参与者亚群中是否同样有效尚不清楚：目的：确定从 HCPIA 血压控制干预中获益最多的参与者：这项二次分析使用了 HCPIA 的数据。HCPIA 是一项为期 18 个月的集群随机试验，在阿根廷的 18 个医疗中心成功开展，共有 1432 名低收入高血压患者参与。15 个基线特征用于定义亚组。血压得到控制的比例（结果：53.0%的参与者为女性）：53.0%的参与者为女性，平均年龄为 56 岁，17.4%的参与者在基线时血压得到控制。干预后，72.9% 的干预参与者和 52.2% 的对照参与者血压得到控制。干预对身体不活跃的患者（OR = 2.76，95% CI：1.82 和 4.21；交互作用 p = 0.04）、中等活跃的患者（OR = 3.08，95% CI：1.90 和 4.99；交互作用 p = 0.03）和基线血压未控制的患者（OR = 2.77，95% CI：2.15 和 3.57；交互作用 p = 0.05）更有效。在干预参与者中，有 20.2% 的人没有血压反应（血压变化 -24 mmHg）。女性（p=0.01）、不运动者（p=0.03）和基线时未服用降压药者（p=0.001）的血压反应最大：结论：干预效果在许多亚群中都是一致的，一些关键群体的干预效果尤为显著。这些发现有助于中低收入国家规划未来的高血压控制计划。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Hypertension Medicine-Internal Medicine

CiteScore

4.00

自引率

5.30%

发文量

期刊介绍： International Journal of Hypertension is a peer-reviewed, Open Access journal that provides a forum for clinicians and basic scientists interested in blood pressure regulation and pathophysiology, as well as treatment and prevention of hypertension. The journal publishes original research articles, review articles, and clinical studies on the etiology and risk factors of hypertension, with a special focus on vascular biology, epidemiology, pediatric hypertension, and hypertensive nephropathy.