Home visits helped reduce blood pressure in rural Bangladesh, Pakistan, Sri Lanka

Home visits by government community health workers led to reductions in systolic blood pressure in rural Bangladesh, Pakistan and Sri Lanka, according to a study presented in a Late-Breaking Science session during Scientific Sessions.

The visits were part of a multicomponent intervention integrated with existing health systems.

“Hypertension is responsible for one-third of age-standardized deaths in South Asia, and less than 20% have controlled blood pressure, leading to substantial deaths and disability from CVD,” said Tazeen Jafar, MBBS, MPH, professor of health services and systems research at DUKE-NUS Medical School in Singapore.

Gaps in knowledge and practices of physicians managing hypertension exist in rural areas, Jafar said. This is compounded by poor health literacy of the population and limited services for counseling on risk factors and the importance of taking medicines. Thus, BP control is poor and death rates from cardiovascular disease are high.

Jafar and colleagues conducted a 24-month randomized controlled trial among hypertensive adults from rural communities in Bangladesh, Pakistan and Sri Lanka. Half the communities were randomized to a multicomponent intervention consisting of home visits for BP monitoring, counseling by health workers and physicians, and coordination with the public health care infrastructure. The other half received usual care.

At the end of the study, the decline in mean systolic BP was 5 mm Hg greater in the intervention group versus the usual care group, Jafar said. Reduction in mean diastolic BP and BP control (<140/90 mmHg) was also better in the intervention group.

“The public health implications of our findings are significant,” Jafar said. “A program like ours could be adapted and scaled up in many other settings globally using their existing infrastructure to reduce the growing burden of uncontrolled hypertension and related morbidity and mortality.”