Jafar Tazeen H, Allen John C, Jehan Imtiaz, Hameed Aamir, Saffari Seyed Ehsan, Ebrahim Shah, Poulter Neil, Chaturvedi Nish
Program in Health Services & Systems Research and.
Department of Community Health Science and.
Clin J Am Soc Nephrol. 2016 Jun 6;11(6):1044-1053. doi: 10.2215/CJN.05300515. Epub 2016 May 19.
In the Control of Blood Pressure and Risk Attenuation trial, a 2×2 factorial design study (2004-2007), the combined home health education and trained general practitioner intervention delivered over 2 years was more effective than no intervention (usual care) in lowering systolic BP among adults with hypertension in urban Pakistan. We aimed to assess the effectiveness of the interventions on kidney function.
DESIGN, PARTICIPANTS, SETTINGS, & METHODS: In 2012-2013, we conducted extended follow-up of a total of 1271 individuals aged ≥40 years with hypertension (systolic BP ≥140 mmHg, diastolic BP ≥90 mmHg, or receipt of antihypertensive treatment) and serum creatinine measurements with 2 years in-trial and 5 years of post-trial period in 12 randomly selected low-income communities in Karachi, Pakistan. The change in eGFR from baseline to 7 years was assessed among randomized groups using a generalized estimating equation method with multiple imputation of missing values.
At 7 years of follow-up, adjusted mean eGFR remained unchanged, with a change of -0.3 (95% confidence interval [95% CI], -3.5 to 2.9) ml/min per 1.73 m(2) among adults randomly assigned to the combined home health education plus trained general practitioner intervention compared with a significant decline of -3.6 (95% CI, -5.7 to -2.0) ml/min per 1.73 m(2) in those assigned to usual care (P=0.01, modified intention-to-treat analysis). The risk for the combined intervention of death from kidney failure or >20% decline in eGFR relative to usual care was significantly reduced (risk ratio, 0.47; 95% CI, 0.25 to 0.89).
The combined home health education plus trained general practitioner intervention is beneficial in preserving kidney function among adults with hypertension in communities in Karachi. These findings highlight the importance of scaling up simple strategies for renal risk reduction in low- and middle-income countries.
在血压控制与风险降低试验（2004 - 2007年）中，一项2×2析因设计研究发现，在巴基斯坦城市地区，为期2年的家庭健康教育与训练有素的全科医生联合干预在降低高血压成年人收缩压方面比无干预（常规护理）更有效。我们旨在评估这些干预措施对肾功能的有效性。
设计、参与者、地点与方法：2012 - 2013年，我们在巴基斯坦卡拉奇12个随机选取的低收入社区对总共1271名年龄≥40岁的高血压患者（收缩压≥140 mmHg，舒张压≥90 mmHg，或接受抗高血压治疗）进行了延长随访，并在试验期2年和试验后5年进行了血清肌酐测量。使用广义估计方程法并对缺失值进行多重插补，评估随机分组组间从基线到7年的估算肾小球滤过率（eGFR）变化。
在7年随访时，随机分配到家庭健康教育加训练有素的全科医生联合干预组的成年人，调整后的平均eGFR保持不变，每1.73 m²变化为 -0.3（95%置信区间[95% CI]，-3.5至2.9）ml/min，而分配到常规护理组的成年人每1.73 m²显著下降 -3.6（95% CI，-5.7至 -2.0）ml/min（P = 0.01，修正意向性分析）。相对于常规护理，联合干预导致肾衰竭死亡或eGFR下降>20%的风险显著降低（风险比，0.47；95% CI，0.25至0.89）。
家庭健康教育加训练有素的全科医生联合干预有利于保护卡拉奇社区高血压成年人的肾功能。这些发现凸显了在低收入和中等收入国家扩大简单的肾脏风险降低策略的重要性。
