Fielding School of Public Health, Department of Environmental Health Sciences, University of California, Los Angeles, Los Angeles, CA, United States.
Fielding School of Public Health, Department of Epidemiology, University of California, Los Angeles, Los Angeles, CA, United States.
Front Public Health. 2021 Jun 23;9:683655. doi: 10.3389/fpubh.2021.683655. eCollection 2021.
Cardiovascular disease is becoming increasingly prevalent in low and middle-income countries (LMIC), and high blood pressure (BP) is one of the main risk factors. The efficacy and sustainability of worksite health promotion (WHP) programs for BP reduction in LMIC have yet to be determined. This non-randomized company-based trial evaluated 6- and 12-months effects of a WHP intervention on BP among 2,002 participating workers from seven Mexican companies. Intervention and control groups were assigned at the company level. The intervention included nutrition counseling, physical exercise, and stress management components. Mixed models assessed differences in BP change between intervention and control companies in intent-to-treat (ITT), per-protocol (PerP), and as-treated (AsTr) analyses, and also within-group changes stratified by company, intervention component, and baseline cardiovascular risk factor levels. All analyses were adjusted for potential confounders. We accounted for missing data and loss to follow-up using inverse probability of censoring weighting. ITT analyses revealed mean BP change differences of -1.1 mmHg at 12 months (95% CI: -2.9; 0.6) in intervention companies relative to control companies. PerP and AsTr analyses confirmed this finding. Within-group analyses showed consistent BP reductions at both 6 and 12 months. Substantial differences in BP changes ranging from diastolic -6.1 mmHg, (95% CI: -11.2; -1.2) to systolic -13.0 mmHg (95% CI: -16.0; -10.1) were found among individuals with diabetes at baseline in intervention companies relative to control companies. After 1 year, WHP was associated with modest but uncertain BP reductions. Substantial reductions were mainly observed among diabetic workers.
心血管疾病在中低收入国家（LMIC）日益流行，高血压（BP）是主要危险因素之一。工作场所健康促进（WHP）计划降低 LMIC 血压的效果和可持续性尚未确定。这项非随机公司为基础的试验评估了 7 家墨西哥公司的 2002 名参与工人在 6 个月和 12 个月的 WHP 干预对血压的影响。干预组和对照组是在公司层面分配的。干预包括营养咨询、体育锻炼和压力管理组成部分。混合模型评估了意向治疗（ITT）、方案治疗（PerP）和实际治疗（AsTr）分析中干预组和对照组之间的血压变化差异，以及按公司、干预组成部分和基线心血管危险因素水平分层的组内变化。所有分析均调整了潜在混杂因素。我们使用逆概率 censoring 加权法对缺失数据和随访丢失进行了处理。ITT 分析显示，干预组与对照组相比，12 个月时的平均血压变化差异为-1.1mmHg（95%CI：-2.9；0.6）。PerP 和 AsTr 分析证实了这一发现。组内分析显示，6 个月和 12 个月时血压均持续下降。在基线时有糖尿病的个体中，干预组与对照组之间的血压变化差异很大，从舒张压-6.1mmHg（95%CI：-11.2；-1.2）到收缩压-13.0mmHg（95%CI：-16.0；-10.1）不等。一年后，WHP 与适度但不确定的血压降低相关。主要观察到糖尿病患者的血压有较大幅度的降低。
