Abstract
Hypertension is a major global public health problem. Elevated blood pressure can cause cardiovascular and kidney diseases. We assessed the effectiveness of health education sessions and home support programs in reducing blood pressure among patients with uncontrolled hypertension in a suburban community of Nepal. We conducted a community-based, open-level, parallel-group, cluster randomized controlled trial in Birendranagar municipality of Surkhet, Nepal. We randomly assigned four clusters (wards) into intervention and control arms. We provided four health education sessions, frequent home and usual care for intervention groups over six months. The participants of the control arm received only usual care from health facilities. The primary outcome of this study was the proportion of controlled systolic blood pressure (SBP). The analysis included all participants who completed follow-up at six months. 125 participants were assigned to either the intervention (n = 63) or the control (n = 62) group. Of them, 60 participants in each group completed six months follow-up. The proportion of controlled SBP was significantly higher among the intervention participants compared to the control (58.3% vs. 40%). Odds ratio of this was 2.1 with 95% CI: 1.01-4.35 (p = 0.046) and that of controlled diastolic blood pressure (DBP) was 1.31 (0.63-2.72) (p = 0.600). The mean change (follow-up minus baseline) in SBP was significantly higher in the intervention than in the usual care (-18.7 mmHg vs. -11.2 mmHg, p = 0.041). Such mean change of DBP was also higher in the intervention (-10.95 mmHg vs. -5.53 mmHg, p = 0.065). The knowledge score on hypertension improved by 2.38 (SD 2.4) in the intervention arm, which was significantly different from that of the control group, 0.13 (1.8) (p<0.001). Multiple health education sessions complemented by frequent household visits by health volunteers can effectively improve knowledge on hypertension and reduce blood pressure among uncontrolled hypertensive patients at the community level in Nepal. ClinicalTrial.gov: NCT02981251.
Highlights
Hypertension is one of the leading causes of cardiovascular diseases, kidney diseases, and premature death worldwide, increasingly affecting developing countries [1]
Multiple health education sessions complemented by frequent household visits by health volunteers can effectively improve knowledge on hypertension and reduce blood pressure among uncontrolled hypertensive patients at the community level in Nepal
At six months of intervention, 3 participants either migrated, lost the phone or discontinued on the intervention group and 2 participants were lost to follow-up because of the same reasons in the control arm
Summary
Hypertension is one of the leading causes of cardiovascular diseases, kidney diseases, and premature death worldwide, increasingly affecting developing countries [1]. It was estimated that 1.13 billion people had hypertension in 2015 worldwide, the majority of them were in low-and middle-income countries [1]. The prevalence of hypertension is increasing in developing countries such as Nepal. From 2007 to 2013, the prevalence of hypertension increased from 18.1% to 25.2% [5, 6]. Despite the increasing trend of hypertension, only about 4–8% of hypertensive patients have well-controlled blood pressure [5, 8]. Elevated blood pressure can cause cardiovascular and kidney diseases.
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