Ahmad Abrar, Xiao Hu, Jubaida Akhtar, Shamim Jubayer, Mohammad Noor Nabi Sayem, Sarmin Sultana, Mohammad Abdullah Al Mamun, Mahfuzur Rahman Bhuiyan, Fazila Malik, Mohammad Robed Amin, Abdul Alim, Reena Gupta, Di Zhao, Margaret Farrell, Bolanle Banigbe, Kunihiro Matsushita, Daniel Burka, Lawrence Appel, Andrew E Moran, Sohel Reza Choudhury
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A total of 3935 patients (mean age 52.3 years, 70.5% female) with uncontrolled hypertension (blood pressure (BP) ≥140/90 mm Hg regardless of treatment history) were enrolled: 1950 patients from 7 HEARTS UHCs and 1985 patients from 7 matched usual care UHCs. The primary outcome was systolic BP at 6 months measured at the patient's home; secondary outcomes were diastolic BP, hypertension control rate (<140/90 mm Hg) and loss to follow-up. Multivariable mixed-effects linear and Poisson models were conducted.</p><p><strong>Results: </strong>Baseline mean systolic BP was 158.4 mm Hg in the intervention group and 158.8 mm Hg in the usual care group. At 6 months, 95.5% of participants completed follow-up. Compared with usual care, the intervention significantly lowered systolic BP (-23.7 mm Hg vs -20.0 mm Hg; net difference -3.7 mm Hg (95% CI -5.1 to -2.2)) and diastolic BP (-10.2 mm Hg vs -8.3 mm Hg; net difference -1.9 mm Hg (95% CI -2.7 to -1.1)) and improved hypertension control (62.0% vs 49.7%, net difference 12.3% (95% CI 9.0 to 16.8)). 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引用次数: 0
摘要
背景：世界卫生组织（WHO世界卫生组织（WHO）在全球推广HEARTS技术包以改善高血压控制，但其有效性尚未得到严格评估：比较孟加拉国农村地区实施 HEARTS 的诊所与继续采用常规高血压治疗方法的诊所的高血压治疗效果：方法：在孟加拉国农村地区的Upazila Health Complexes (UHCs; 初级医疗保健机构)开展了一项配对群组准实验试验。共有 3935 名未得到控制的高血压患者（平均年龄 52.3 岁，70.5% 为女性）（血压（BP）≥ 140/90 mm Hg，无论有无治疗史）被纳入其中：其中 1950 名患者来自 7 家 HEARTS 统一健康中心，1985 名患者来自 7 家匹配的常规医疗统一健康中心。主要结果是在患者家中测量 6 个月时的收缩压；次要结果是舒张压和高血压控制率（结果：干预组的基线平均收缩压为 158.4 mm Hg，常规护理组为 158.8 mm Hg。6 个月时，95.5% 的参与者完成了随访。与常规治疗相比，干预措施明显降低了收缩压（-23.7 mm Hg vs -20.0 mm Hg；净差-3.7 mm Hg (95% CI -5.1至-2.2)）和舒张压（-10.2 mm Hg vs -8.3 mm Hg；净差-1.9 mm Hg (95% CI -2.7至-1.1)），并改善了高血压控制（62.0% vs 49.7%，净差12.3% (95% CI 9.0至16.8)）。干预组的漏诊率较低（8.8% 对 39.3%，P 结论：在孟加拉国农村地区实施WHO-HEARTS一揽子计划后，与常规治疗相比，血压降低了，高血压控制也得到了显著改善：NCT04992039.
Evaluation of the World Health Organization-HEARTS hypertension control package in Bangladesh: a quasi-experimental trial.
Background: The World Health Organization (WHO) promotes the HEARTS technical package for improving hypertension control worldwide, but its effectiveness has not been rigorously evaluated.
Objective: To compare hypertension outcomes in clinics implementing HEARTS versus clinics continuing usual hypertension care in rural Bangladesh.
Methods: A matched-pair cluster quasi-experimental trial in Upazila Health Complexes (UHCs; primary healthcare facilities) was conducted in rural Bangladesh. A total of 3935 patients (mean age 52.3 years, 70.5% female) with uncontrolled hypertension (blood pressure (BP) ≥140/90 mm Hg regardless of treatment history) were enrolled: 1950 patients from 7 HEARTS UHCs and 1985 patients from 7 matched usual care UHCs. The primary outcome was systolic BP at 6 months measured at the patient's home; secondary outcomes were diastolic BP, hypertension control rate (<140/90 mm Hg) and loss to follow-up. Multivariable mixed-effects linear and Poisson models were conducted.
Results: Baseline mean systolic BP was 158.4 mm Hg in the intervention group and 158.8 mm Hg in the usual care group. At 6 months, 95.5% of participants completed follow-up. Compared with usual care, the intervention significantly lowered systolic BP (-23.7 mm Hg vs -20.0 mm Hg; net difference -3.7 mm Hg (95% CI -5.1 to -2.2)) and diastolic BP (-10.2 mm Hg vs -8.3 mm Hg; net difference -1.9 mm Hg (95% CI -2.7 to -1.1)) and improved hypertension control (62.0% vs 49.7%, net difference 12.3% (95% CI 9.0 to 16.8)). Rate of missed clinic visits was lower in the intervention group (8.8% vs 39.3%, p<0.001).
Conclusions: After WHO-HEARTS package implementation in rural Bangladesh, BP was lowered and hypertension control improved significantly compared with usual care.
期刊介绍：
Heart is an international peer reviewed journal that keeps cardiologists up to date with important research advances in cardiovascular disease. New scientific developments are highlighted in editorials and put in context with concise review articles. There is one free Editor’s Choice article in each issue, with open access options available to authors for all articles. Education in Heart articles provide a comprehensive, continuously updated, cardiology curriculum.
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