血压控制与风险降低：孟加拉国农村、巴基斯坦和斯里兰卡的一项公共卫生干预措施：可行性试验结果

Control of blood pressure and risk attenuation: a public health intervention in rural Bangladesh, Pakistan, and Sri Lanka: feasibility trial results.

作者信息

Jafar Tazeen H, Silva Asita de, Naheed Aliya, Jehan Imtiaz, Liang Feng, Assam Pryseley N, Legido-Quigley Helena, Finkelstein Eric A, Ebrahim Shah, Wickremasinghe Rajitha, Alam Dewan, Khan Aamir Hameed

机构信息

aProgram in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore bDuke Global Health Institute, Durham, North Carolina, USA cDepartment of Pharmacology, Faculty of Medicine, Clinical Trials Unit, University of Kelaniya, Kelaniya, Sri Lanka dInternational Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh eDepartment of Community Health Sciences, Aga Khan University, Karachi, Pakistan fSingapore Clinical Research Institute, Singapore, Singapore gSaw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore hLondon School of Hygiene and Tropical Medicine, London, UK iDepartment of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka jFaculty of Health, York University, Toronto, Ontario, Canada kDepartment of Medicine, Section of Cardiology, Aga Khan University, Karachi, Pakistan *Asita de Silva, Aliya Naheed, and Imtiaz Jehan contributed equally to the writing of this article.

出版信息

J Hypertens. 2016 Sep;34(9):1872-81. doi: 10.1097/HJH.0000000000001014.

DOI:10.1097/HJH.0000000000001014

PMID:27488552

Abstract

BACKGROUND

High blood pressure (BP) is the leading attributable risk for cardiovascular disease globally. There is little information on effective and sustainable public health system strategies for managing hypertension in South Asian countries. We conducted a feasibility study to gather preliminary data to optimize BP-lowering strategies for a public health intervention in rural communities in Bangladesh, Pakistan, and Sri Lanka.

METHODS

A mixed method feasibility study comprised a 3-month pre and postevaluation of a multicomponent intervention (MCI), including BP screening and home health education by trained government community health worker (CHW); providers trained in hypertension management, and compensation of CHW for additional services. Checklists were used to document care. Stakeholder interviews were also conducted. Individuals aged 40 years and above with high BP (systolic ≥140 mmHg or diastolic ≥90 mmHg based on two readings from 2 separate days, or receiving antihypertensive medications) were enrolled from rural communities in Bangladesh, Pakistan, and Sri Lanka. BP was measured at baseline and 3 months postintervention.

RESULTS

A total of 412 (90%) of the 454 eligible individuals were recruited. Of those recruited, 90% received home health education session by trained CHWs, 80% were referred to trained providers, of whom 83% completed the management checklist. A follow-up rate of 95.6% was achieved. The mean SBP declined significantly by 4.5 mmHg 95% confidence interval (2.3, 6.7) mmHg (P < 0.001) in the overall pooled analysis in three countries; however, it varied among countries. BP decline was 10.5 mmHg (8.1, 13.0 mmHg) (P < 0.001) in the pooled analysis of individuals with uncontrolled hypertension at baseline, and was also significant each of the three countries. All 98 stakeholders strongly supported upscaling the proposed MCI strategies.

CONCLUSION

The proposed MCI is feasible for implementation and requires long-term, large-scale evaluation in the rural public health infrastructure in South Asian countries to determine sustainability of health system changes and BP control. If these long-term effects are confirmed, MCI may be a long-term strategy for tackling rising rates of cardiovascular disease in low-resourced countries.Clintrial.gov NCT02341651.

摘要

背景

高血压是全球心血管疾病的主要可归因风险因素。关于南亚国家管理高血压的有效且可持续的公共卫生系统策略的信息很少。我们开展了一项可行性研究，以收集初步数据，优化孟加拉国、巴基斯坦和斯里兰卡农村社区公共卫生干预中的降血压策略。

方法

一项混合方法可行性研究包括对多组分干预措施（MCI）进行为期3个月的干预前后评估，该干预措施包括由经过培训的政府社区卫生工作者（CHW）进行血压筛查和家庭健康教育；对接受高血压管理培训的医疗服务提供者，以及对CHW提供额外服务给予补偿。使用检查表记录护理情况。还进行了利益相关者访谈。从孟加拉国、巴基斯坦和斯里兰卡的农村社区招募年龄在40岁及以上的高血压患者（基于2个不同日期的两次测量，收缩压≥140 mmHg或舒张压≥90 mmHg，或正在接受抗高血压药物治疗）。在基线和干预后3个月测量血压。

结果

454名符合条件的个体中，共招募了412名（90%）。在招募的人群中，90%接受了经过培训的CHW的家庭健康教育，80%被转诊至接受过培训的医疗服务提供者，其中83%完成了管理检查表。随访率达到95.6%。在三个国家的总体汇总分析中，平均收缩压显著下降了4.5 mmHg [95%置信区间（2.3，6.7）mmHg]（P<0.001）；然而，各国之间存在差异。在基线时血压未得到控制的个体的汇总分析中，血压下降了10.5 mmHg（8.1，13.0 mmHg）（P<0.001），在三个国家中每一个国家的情况也都如此。所有98名利益相关者都强烈支持扩大拟议的MCI策略。