Hypertension control within the HEARTS program of south-west Trinidad: a longitudinal mixed-effects analysis.

Abstract

Objective: To describe blood pressure trajectories and hypertension control among patients enrolled in the HEARTS program in south-west Trinidad.

Methods: This retrospective longitudinal cohort study used routinely collected HEARTS program data from 31 public primary health centers in the South-West Regional Health Authority, Trinidad and Tobago. Eligible patients initiated HEARTS between 1 April and 31 October 2023, with a baseline program record and at least one follow-up blood pressure measurement. Follow-up was categorized as month-1 to month-5. McNemar's test assessed paired baseline versus month-5 control status; linear and generalized linear mixed-effects models assessed blood pressure trajectories and hypertension control.

Results: The analytic cohort included 548 patients; 63.3% were female and mean age was 61.4 ± 11.0 years. At baseline, 80.7% had uncontrolled hypertension. Mean baseline systolic blood pressure was 155 ± 22 mmHg and diastolic 86 ± 14 mmHg. Among 502 patients with paired baseline and month-5 data, more patients transitioned from uncontrolled to controlled hypertension than the reverse (70 vs 41; McNemar OR 1.71, 95% CI [1.16, 2.51], p = 0.006). In mixed-effects analyses, month was associated with lower systolic blood pressure. Odds of hypertension control were higher at month-2 and month-5 relative to baseline, while higher body mass index (BMI) was associated with lower odds of control.

Conclusions: Among patients with available follow-up data, the HEARTS program was associated with improved hypertension control in routine primary care, while higher BMI was associated with lower odds of control. These findings should be interpreted as observational program outcomes rather than evidence of a causal program effect.