Effectiveness of a scalable group-based education and monitoring program, delivered by health workers, to improve control of hypertension in rural India: A cluster randomised controlled trial

作者：Dilan Giguruwa Gamage, Michaela A. Riddell, Rohina Joshi, Kavumpurathu R. Thankappan, Clara K Chow, Brian Oldenburg, Roger G. Evans, Ajay Mahal, Kartik Kalyanram, Kamakshi Kartik, Oduru Suresh, Nihal Thomas, GK Mini, Pallab K Maulik, Velandai Srikanth, Simin Arabshahi, Ravi Prasad Varma, Rama Guggilla, Fabrizio D’Esposito, Thirunavukkarasu Sathish, Mohammed Alim, Amanda G. Thrift · 发表于：PLoS Medicine · 年份：2020 · DOI：10.1371/journal.pmed.1002997 · 被引用次数：91 · 研究领域：Blood Pressure and Hypertension Studies、Global Maternal and Child Health、Sodium Intake and Health

BACKGROUND: New methods are required to manage hypertension in resource-poor settings. We hypothesised that a community health worker (CHW)-led group-based education and monitoring intervention would improve control of blood pressure (BP). METHODS AND FINDINGS: We conducted a baseline community-based survey followed by a cluster randomised controlled trial of people with hypertension in 3 rural regions of South India, each at differing stages of epidemiological transition. Participants with hypertension, defined as BP ≥ 140/90 mm Hg or taking antihypertensive medication, were advised to visit a doctor. In each region, villages were randomly assigned to intervention or usual care (UC) in a 1:2 ratio. In intervention clusters, trained CHWs delivered a group-based intervention to people with hypertension. The program, conducted fortnightly for 3 months, included monitoring of BP, education about hypertension, and support for healthy lifestyle change. Outcomes were assessed approximately 2 months after completion of the intervention. The primary outcome was control of BP (BP < 140/90 mm Hg), analysed using mixed effects regression, clustered by village within region and adjusted for baseline control of hypertension (using intention-to-treat principles). Of 2,382 potentially eligible people, 637 from 5 intervention clusters and 1,097 from 10 UC clusters were recruited between November 2015 and April 2016, with follow-up occurring in 459 in the intervention group and 1,012 in UC. M...