Abstract
Hypertension management is suboptimal in the primary-care setting of developing countries, where the burden of both hypertension and cardiovascular disease is huge. Therefore, we conducted a government-expert joint intervention in a resource-constrained primary setting of Emin, China, between 2014 and 2016, to improve hypertension management and reduce hypertension-related hospitalization and mortality. Primary-care providers were trained on treatment algorithm and physicians for specialized management. Public education was delivered by various ways including door-to-door screening. Program effectiveness was evaluated using screening data by comparing hypertension awareness, treatment, and control rates and by comparing hypertension-related hospitalization and total cardiovascular disease (CVD) and stroke mortality at each phase. As results, 313 primary-health providers were trained to use the algorithm and 3 physicians attended specialist training. 1/3 of locals (49490 of 133376) were screened. Compared to the early phase, hypertension awareness improved by 9.3% (58% vs. 64%), treatment by 11.4% (39% vs. 44%), and control rates by 33% (10% vs. 15%). The proportion of case/all-cause hospitalization was reduced by 35% (4.02% vs. 2.60%) for CVD and by 17% (3.72% vs. 3.10%) for stroke. The proportion of stroke/all-cause death was reduced by 46% (21.9% in 2011–2013 vs. 15.0% in 2014–2016). At the control area, the proportion of case/all-cause mortality showed no reduction. In conclusion, government-expert joint intervention with introducing treatment algorithm may improve hypertension control and decrease related hospitalization and stroke mortality in underresourced settings.
Highlights
About 80% of mortality from cardiovascular disease (CVD) occurs in low- and middle-income countries [1], mainly due to the increased prevalence of risk factors including elevated blood pressure (BP) and due to relatively lacking access to medical care in these underresourced countries [2]
(1) Hypertension was set as a priority by distributing an official statement and by establishing a cross-sectoral steering committee; (2) medical staff education; (3) an evidence-based antihypertensive treatment algorithm was introduced to help health-care providers (Figure 1); (4) raising public awareness through various ways including door-to-door screening and public education programs; and (5) contextualizing some parts: materials including books, printed algorithm, and slices were prepared, and training was prepared in 4 languages (Han, Uygur, Kazakh, and Mongolian); considering the cultural and linguistic background, local trusted teachers and hypertensive volunteers delivered health-related information to the general public
Training concentrated on treatment algorithm including components on follow-up guided by algorithm and BP and counselling on healthy life style (Figure 1)
Summary
About 80% of mortality from cardiovascular disease (CVD) occurs in low- and middle-income countries [1], mainly due to the increased prevalence of risk factors including elevated blood pressure (BP) and due to relatively lacking access to medical care in these underresourced countries [2]. Prevalence and mortality rates for ischemic cerebrovascular disease, ischemic heart disease, and hypertensive heart disease in Xinjiang, an underdeveloped province located in Northwestern China, are higher than the national average [5, 6]. In Xinjiang, hypertension is affecting 35.0–40.7% of adults aged ≥35 years [8, 9] and 52.6% of some population [8], higher than national average (41.9%) [10], whereas the treatment (28.8% vs 34.4%) and control rates (10.9% vs 15.3%) are lower [8, 10], as in a recent nationwide. It showed that control of hypertension in population aged ≥18 years from less-developed regions including Xinjiang is about 8% [3].
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