Department of Health Policy and Management, School of Public Health, Fudan University, China.
Research Institute of Health Development Strategies, Fudan University, China.
J Glob Health. 2022 Dec 17;12:11013. doi: 10.7189/jogh.12.11013.
We aimed to evaluate the effectiveness of a community-based integrative programme in reducing hypertension incidence among populations at high risk for hypertension in Shanghai, Eastern China.
We conducted a cluster-randomized intervention trial with a total of 607 participants (intervention, n = 303; control, n = 304) between October 2019 and October 2020. A total of 605 participants (intervention, n = 302; control, n = 303) completed the follow-up survey. The intervention group received an integrative programme that included health education, physician follow-up, and self-management, while the control group received usual care only. We used questionnaires to investigate risk factors, knowledge, attitudes, and behaviours regarding hypertension prevention for all participants at baseline and follow-up. We measured the incidence of hypertension according to the predefined protocol based on the national definition during the four follow-ups (only applicable to the intervention group) and the physical examination at the end of the intervention/programme/study. The difference-in-difference (DID) effects of the intervention were estimated using Generalized Estimating Equations.
There were no significant differences in age group, gender, and educational level between intervention and control groups at baseline. The integrative programme reduced the incidence of hypertension in the intervention group compared to the control group (odds ratio (OR) = 0.27, 95% confidence interval (CI) = 0.12-0.61). The DID analysis found that the one-year intervention has improved the level of hypertension-related knowledge and attitudes regarding diagnostic criteria, complications of hypertension, and lifestyle modification (P < 0.05). The intervention was also associated with a 3.7% increase in the behaviour change rate of "not smoking" (OR = 2.50, 95% CI = 1.45-4.30) and a 34.8% increase in the rate of "monitoring blood pressure regularly" (OR = 29.61, 95% CI = 13.02-67.35).
The integrative programme could reduce the risk for hypertension and improve the level of hypertension-related knowledge and attitudes, affecting the formation of healthy behaviours in high-risk populations. The community-based management for high-risk groups should be scaled up and incorporated into national hypertension control programmes, which may potentially reduce the substantial burden of hypertension and cardiovascular disease in China.
ISRCTN registration number: ISRCTN74154693.
本研究旨在评估基于社区的综合干预方案在降低中国东部上海市高血压高危人群高血压发病率方面的有效性。
本研究采用整群随机对照试验设计，共纳入 607 名参与者（干预组 303 名，对照组 304 名），于 2019 年 10 月至 2020 年 10 月进行干预，其中 605 名参与者（干预组 302 名，对照组 303 名）完成了随访调查。干预组接受了包括健康教育、医生随访和自我管理在内的综合干预方案，而对照组仅接受常规护理。我们使用问卷在基线和随访时调查所有参与者高血压预防的危险因素、知识、态度和行为。根据国家定义，在四次随访期间（仅适用于干预组）和干预/方案/研究结束时的体格检查，我们按照预设方案测量高血压的发病率。使用广义估计方程估计干预的差值（DID）效应。
在基线时，干预组和对照组在年龄组、性别和教育水平方面无显著差异。与对照组相比，综合干预方案降低了干预组的高血压发病率（比值比（OR）=0.27，95%置信区间（CI）=0.12-0.61）。DID 分析发现，为期一年的干预提高了参与者对高血压相关知识和诊断标准、高血压并发症以及生活方式改变的态度（P<0.05）。干预还与“不吸烟”行为改变率提高 3.7%（OR=2.50，95%CI=1.45-4.30）和“定期监测血压”率提高 34.8%（OR=29.61，95%CI=13.02-67.35）相关。
综合干预方案可降低高危人群的高血压发病风险，并提高高血压相关知识和态度水平，影响高危人群健康行为的形成。应扩大基于社区的高危人群管理，并将其纳入国家高血压控制项目，这可能会降低中国高血压和心血管疾病的巨大负担。
ISRCTN 注册号：ISRCTN74154693。
