Lora Mantilla A J, Parra Gomez L A, Camacho-López P A, Otero-Wandurraga J, Novella B, González-Medina A, Valdez-Tiburcio O, Lanas F, Rocha-Lezama M C, Alonzo-Arias J, Rivilla-Piñango C, Cáceres-Ramírez C, Villabona-Flórez S J, Giraldo-Castrillón Y M, López-Jaramillo P
Directorate of Research, Development and Technological Innovation, Ophthalmological Foundation of Santander (FOSCAL), Floridablanca, Colombia.
Masira Research Institute, School of Health Sciences, University of Santander (UDES), Bucaramanga, Colombia.
Heliyon. 2025 Jan 10;11(2):e41726. doi: 10.1016/j.heliyon.2025.e41726. eCollection 2025 Jan 30.
Cardiovascular diseases are the leading cause of death and morbidity worldwide, with a significantly higher burden in low- and middle-income countries. Hypertension, a major risk factor for cardiovascular morbidity and mortality, remains under-diagnosed and poorly controlled, especially in regions such as Latin America. The HOPE-4 study demonstrated that the involvement of non-physician health workers (NPHWs), the use of standardized treatment algorithms, the provision of free antihypertensive drugs and home follow-up can significantly improve hypertension control and reduce cardiovascular risk, as demonstrated in Colombia and Malaysia. On this basis, the COTRACO study aims to address the barriers to hypertension treatment in low- and middle-income countries by implementing a similar standardized treatment approach delivered by non-specialist health workers.
The COTRACO study is a quasi-experimental, parallel-group, non-randomized, before-and-after study. A community-based model will be implemented in 600 patients in Colombia and the Dominican Republic, involving NPHWs to: 1) apply standardized treatment algorithms, 2) promote adherence to healthy lifestyles, and 3) provide standardized pharmacological treatment. Propensity Score Matching will be used to select 300 patients in Chile and 1200 in Spain for comparison with standard care in these populations.
The primary outcome at 12 months of follow-up is the percentage of patients achieving controlled hypertension (defined as systolic BP < 140 mmHg and diastolic BP < 90 mmHg, or < 130 mmHg, and diastolic BP < 80 mmHg for diabetic patients), ensuring it is not inferior to that achieved in the control countries. Secondary outcomes include changes in BP levels, cholesterol levels, BMI, handgrip strength, waist-to-hip ratio, smoking status, Interheart risk score, diet, and physical activity at 6 and 12 months.
If this model demonstrates superior outcomes compared to usual care, it is recommended that health authorities in low- and middle-income regions adopt and implement this approach. Using non-medical health professionals, standardized treatment algorithms and free access to antihypertensive medications, these regions can significantly improve awareness, diagnosis and management of hypertension. This strategy has the potential to reduce cardiovascular morbidity and mortality, thereby improving overall public health outcomes.
心血管疾病是全球死亡和发病的主要原因，在低收入和中等收入国家负担明显更高。高血压是心血管发病和死亡的主要危险因素，其诊断不足且控制不佳，尤其是在拉丁美洲等地区。HOPE - 4研究表明，非医师卫生工作者（NPHWs）的参与、标准化治疗算法的使用、免费抗高血压药物的提供以及家庭随访可以显著改善高血压控制并降低心血管风险，哥伦比亚和马来西亚的情况就是如此。在此基础上，COTRACO研究旨在通过实施由非专科卫生工作者提供的类似标准化治疗方法，解决低收入和中等收入国家高血压治疗的障碍。
COTRACO研究是一项准实验性、平行组、非随机、前后对照研究。将在哥伦比亚和多米尼加共和国的600名患者中实施基于社区的模式，让非医师卫生工作者：1）应用标准化治疗算法，2）促进对健康生活方式的依从性，3）提供标准化药物治疗。倾向得分匹配将用于在智利选择300名患者，在西班牙选择1200名患者，以便与这些人群中的标准治疗进行比较。
随访12个月时的主要结果是实现高血压控制的患者百分比（定义为收缩压<140 mmHg且舒张压<90 mmHg，或糖尿病患者收缩压<130 mmHg且舒张压<80 mmHg），确保其不低于对照国家的水平。次要结果包括6个月和12个月时血压水平、胆固醇水平、BMI、握力、腰臀比、吸烟状况、Interheart风险评分、饮食和身体活动的变化。
如果该模式与常规治疗相比显示出更好的结果，建议低收入和中等收入地区的卫生当局采用并实施这种方法。通过使用非医学卫生专业人员、标准化治疗算法以及免费获取抗高血压药物，这些地区可以显著提高高血压的知晓率、诊断率和管理水平。这种策略有可能降低心血管发病率和死亡率，从而改善总体公共卫生结果。
