Village doctor-led intervention for hypertension treatment improves BP control in rural China

AHA 2021 In a cluster trial of villages, BP control was significantly improved by a village doctor-led intervention for hypertension treatment compared to usual care among hypertensive residents in rural China.

Presented at the American Heart Association’s Scientific Sessions 2021 by: Prof. Jiang He - New Orleans, LA, USA.

Introduction and methods

Background

Prevalence of hypertension is high and rising in China. In 2014, it was estimated that 27.8% of Chinese adults had hypertension (defined as BP≥140/90 mmHg). And only 5.5% of hypertensive patients had controlled BP (<140/90 mmHg) in rural China. Village doctors (also known as ‘barefoot doctors’) provide basic primary healthcare in rural China. It was hypothesized that village doctors who received appropriate training can improve BP control in rural China.

In this study the effectiveness of a village doctor-led multifaceted intervention on BP control was examined compared to usual care over 18 months among residents with hypertension in rural China.

Study design

163 Villages were randomized to the village doctor-led intervention and 163 villages to control. In this cluster trial, 33,995 men and women ≥40 years with uncontrolled hypertension were recruited.

To achieve target BP <130/80 mmHg, a simple stepped-care protocol for hypertension treatment (adapted from the 2017 ACC/AHA hypertension guidelines) was implemented. Villages doctors in the intervention group were trained, initiated and titrated antihypertensive medications, provided coaching on lifestyle changes and medication adherence and did follow-up of patients. They were supervised by primary-care physicians and specialists. Also, patients in the intervention villages received discounted or free antihypertensive medications, home BP monitors and health coaching.

Primary outcome

The primary outcome was the proportion of patients with BP<130/80 mmHg at 18 months.

Main results

• The proportion of patients with BP<130/80 mmHg at 18 months was 57.0% (95%CI:55.3-58.7) in the intervention group and 19.9% (95%CI:18.7-21.2) in the usual care group (net difference of 37.0%, 95%CI:34.9-39.1, P<0.001).
• In the intervention group, the proportion of patients with BP<140/90 mmHg at 18 months was 77.3% (95%CI:75.8-78.8). This was 44.5% (95%CI:43.0-46.1) in the usual care group (net difference was 32.7, 95%CI:30.6-34.9, P<0.001).
• Change in SBP from baseline to 18 months was -26.3% (95%CI:-27.1 to -25.4) in the intervention group and -11.8% (95%CI:-12.6 to -11.0) in the usual care group (net difference of 14.5, 95%CI: 13.3 to 15.7, P<0.001).
• Change in DBP from baseline to 18 months was -14.6% (95%CI:-15.1 to -14.2) in the intervention group and -7.5% (95%CI:--7.9 to -7.2) in the usual care group (net difference of 7.1, 95%CI: 6.5 to 7.7, P<0.001).

Conclusion

After 18 months, a village doctor-led intervention for hypertension treatment resulted in significantly improved BP control compared to usual care among hypertensive residents in rural China. The investigators conclude that this strategy is feasible, effective and sustainable and could be scaled up in rural China and other low-resource settings for BP control.

• Our reporting is based on the information provided at the American Heart Association’s Scientific Sessions 2021 -

Watch a video by prof. Keith on the CRHC Project