Abstract
BackgroundHypertension is an important and modifiable cardiovascular risk factor that remains under-detected and under-treated, especially in the older individuals. Community-led interventions that integrate primary health care and local resources are promising approaches to improve awareness and management of hypertension and other cardiovascular risk factors. We aimed to evaluate the effect of a community-based Cardiovascular Health Awareness Program (CHAP) on participants’ blood pressure.MethodsThis study followed a cohort of community residents that participated in CHAP across 22 mid-sized Ontario communities over an 18-month period. The participants’ baseline risk factors, including blood pressure, and subsequent measures of blood pressure were recorded. We employed a bivariate linear mixed-effect model to estimate the change of systolic and diastolic blood pressure over time among the participants who attended more than two CHAP sessions.ResultsOf 13,596 participants, 2498 attended more than two CHAP sessions. For those repeated participants (attending more than two sessions) initially identified with high blood pressure, the average reduction of systolic blood pressure was from 142 to 123 mmHg over an 18-month period, a monthly rate ratio of 0.992 (95% CI: 0.991,0.994; p < 0.01). Similarly, the average reduction of diastolic blood pressure was from 78 to 69 mmHg, a monthly rate ratio of 0.993 (95% CI: 0.991,0.994; p < 0.01). The average blood pressure of the participants with normal baseline blood pressure remained controlled and unchanged. We also found that older adult participants who lived alone, were diagnosed with hypertension, reported healthier eating habits, and presented with a higher baseline systolic blood pressure had significantly greater odds of attending more than one session.ConclusionsCHAP was associated with a reduction in systolic and diastolic blood pressure for those participants who attended more than one session. The magnitude of blood pressure reductions was significant clinically and statistically.
Highlights
Hypertension is an important and modifiable cardiovascular risk factor that remains under-detected and under-treated, especially in the older individuals
The main barriers to optimal diagnosis, treatment and control include ‘white coat effect’ [9], ‘masked hypertension’ [10], co-morbidities [11,12], and non-adherence to both pharmacological treatments and lifestyle recommendations [13,14,15,16,17]. Both lifestyle and pharmacological treatments have been shown to be effective at reducing blood pressure (BP) and associated cardiovascular risk factors
We reported the estimate of BP change in rate ratio (RR), corresponding 95% confidence interval (CI) and p value
Summary
Hypertension is an important and modifiable cardiovascular risk factor that remains under-detected and under-treated, especially in the older individuals. Community-led interventions that integrate primary health care and local resources are promising approaches to improve awareness and management of hypertension and other cardiovascular risk factors. The main barriers to optimal diagnosis, treatment and control include ‘white coat effect’ [9], ‘masked hypertension’ [10], co-morbidities [11,12], and non-adherence to both pharmacological treatments and lifestyle recommendations [13,14,15,16,17] Both lifestyle and pharmacological treatments have been shown to be effective at reducing blood pressure (BP) and associated cardiovascular risk factors. A 10% decrease in the prevalence of hypertension would save more than $430 million per year in Canada [19] It would have a major impact on reducing cardiovascular morbidity and mortality
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