P041 COMMUNITY-BASED STRATEGIES TO IMPROVE HEALTH-RELATED OUTCOMES IN PEOPLE LIVING WITH HYPERTENSION IN LOW MIDDLE-INCOME COUNTRIES: A SYSTEMATIC REVIEW AND META-ANALYSIS

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Background and objective: Hypertension affects one billion people globally and is a major risk factor for cardiovascular diseases. Currently, it is estimated that high blood pressure (BP) is related to the deaths of more than 10 million people every year. Interventions to mitigate the looming hypertension crisis in low- and middle-income countries (LMIC) need strong community involvement whilst concurrently addressing access to care and quality of care issues. The objective of this systematic review was to evaluate community-level interventions to improve hypertension control among patients living in LMICs. Methods: Nine databases were searched (July 22, 2023) for randomized controlled trials (RCTs) and cluster randomized control trials (cRCTs) implementing community-level interventions in adults with hypertension in LMICs. Studies were included based on an explicit focus on BP control. Quality assessment was done using the Revised Cochrane Risk of Bias tool for randomized trials (ROBS 2). Results were presented following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Fixed-effect meta-analysis were conducted for studies that reported continuous outcome measures. Results: We identified and screened 7125 articles. Eighteen studies were included in the analysis, 7 RCTs and 11 cRCTs. The overall summary effect of BP control from the meta-analysis was significant, risk ratio = 1.48 (95%CI = 1.40–1.57, n=12). For the RCTs risk ratio was 1.68 (95%CI = 1.40–2.01, n=5), and for the cRCTs 1.46 (95% CI = 1.32 – 1.61, n=7). For studies that reported on the individual components of the composite interventions, the risk ratio was 1.27 (95%CI = 1.04–1.54, n=3). Conclusions: Community-based strategies are relevant in addressing the burden of hypertension in LMICs. Community-based interventions can help decentralize hypertension care in LMIC and address the access to care gap without diminishing the quality of hypertension control.