Dissemination and Advocacy of COBRA-BPS Trial Findings to Improve BP Control and Reduce CVD Risk in Rural South Asia
Medical Research Foundation
Duke-NUS Medical School
Hypertension affects up to one in three adults in South Asia and less than 20% have controlled blood pressure, despite availability in treatment guidelines. Serious gaps in knowledge and practices of physicians in the management of hypertension exist in rural areas, and regular monitoring of BP in hypertensive patients is often not done during clinic visits. This is compounded by poor health literacy of the population, and limited services for counselling on risk factors and the importance of taking medicines. Thus, BP control is poor and death rates from cardiovascular disease are high. We conducted a 24-month randomized controlled trial among 2,645 hypertensive adults from 30 randomly selected rural communities (10 communities each in Bangladesh, Pakistan and Sri Lanka). Half the communities were randomized to multicomponent intervention consisting of home visits for BP monitoring and counseling by trained health workers and coordination with the public health care infrastructure. The other half received usual care. At the end of the study, the decline in mean systolic and diastolic BP was significantly greater by 5 mm Hg in the intervention group versus the usual care group. Blood pressure control (<140/90 mmHg) was better also for the intervention group, with 51.7% achieving control versus 42.5% for the usual care group. Scaling-up the intervention was projected to cost less than $2 per capita annually. Our findings demonstrate that home visits by government community health workers integrated with the existing health system led to reductions in blood pressure (BP) in rural Bangladesh, Pakistan and Sri Lanka. A low-cost program like ours could be adapted to many other settings globally to reduce the growing burden of uncontrolled hypertension and related morbidity and mortality.
7.1 Individual care needs