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American Heart Association

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Final ID: MDP1684

Long-Term Effectiveness of a Community Health Worker-Led Blood Pressure Intervention on Cardiovascular Disease and Mortality

Abstract Body (Do not enter title and authors here): Background: Hypertension is the leading preventable risk factor for cardiovascular disease (CVD) and all-cause mortality worldwide. Community health worker (CHW)-led intervention has been effective in lowering blood pressure (BP) and CVD risk. However, the long-term effectiveness of CHW-led intervention is unknown.

Aim: We assessed the long-term effectiveness of a CHW-led intensive BP intervention on CVD incidence and all-cause mortality.

Methods: The China Rural Hypertension Control Project (CRHCP) involved 33,995 hypertensive individuals aged ≥40 years from 326 villages in rural China. A total of 163 villages were randomly assigned to a CHW-led intervention, while the other 163 villages were assigned to usual care. CHWs were trained village doctors who initiated and titrated antihypertensive medications using a simple stepped-care protocol according to ACC/AHA clinical guidelines. They also conducted health coaching and delivered free or discounted antihypertensive medications to participants. The primary effectiveness outcome was a composite of myocardial infarction, stroke, heart failure, or CVD death during the 48-month follow-up period. Secondary outcomes included CVD death and all-cause death. Safety outcomes were also assessed at 48 months.

Results: During a median follow-up of 48 months, 1,744 CVD events (2.6% per year) were documented in the intervention group, compared to 2,191 CVD events (3.5% per year) in the usual care group. The CHW-led intervention resulted in a 27% reduction in CVD (hazard ratio [HR] 0.73; 95% CI 0.69 to 0.78). Furthermore, CVD deaths were reduced by 24% (HR 0.76; 95% CI 0.68 to 0.84), and all-cause deaths were reduced by 14% (HR 0.86; 95% CI 0.80 to 0.94) in the intervention group compared to the usual care group. Participants in the intervention group had a significantly lower rate of serious adverse events compared to usual care participants (risk ratio 0.94; 95% CI: 0.91 to 0.98). However, there was no statistically significant difference in injurious falls, symptomatic hypotension, or syncope between the two groups.
Conclusion: This randomized cluster trial showed that a CHW-led intervention significantly reduced CVD risk and all-cause mortality over 48 months among rural residents in China. This feasible and effective BP intervention strategy should be scaled up in China and other low- and middle-income countries to reduce the burden of CVD worldwide.
  • Allouch, Farah  ( Tulane University , New Orleans , Louisiana , United States )
  • Chen, Jing  ( Tulane School of Public Health , New Orleans , Louisiana , United States )
  • Geng, Danxi  ( First Hospital of China Medical University , Shenyang , China )
  • Xie, Ziyi  ( First Hospital of China Medical University , Shenyang , China )
  • Yu, Yao  ( First Hospital of China Medical University , Shenyang , China )
  • Li, Zhi  ( First Hospital of China Medical University , Shenyang , China )
  • He, Jiang  ( Tulane University , New Orleans , Louisiana , United States )
  • Sun, Yingxian  ( First Hospital of China Medical University , Shenyang , China )
  • Ouyang, Nanxiang  ( First Hospital of China Medical University , Shenyang , China )
  • Sun, Guozhe  ( First Hospital of China Medical University , Shenyang , China )
  • Qiao, Lixia  ( First Hospital of China Medical University , Shenyang , China )
  • Wang, Chang  ( First Hospital of China Medical University , Shenyang , China )
  • Liu, Songyue  ( First Hospital of China Medical University , Shenyang , China )
  • Chen, Chung-shiuan  ( TULANE UNIVERSITY , New Orleans , Louisiana , United States )
  • Mills, Katherine  ( TULANE UNIVERSITY , New Orleans , Louisiana , United States )
  • He, Hua  ( Tulane University , New Orleans , Louisiana , United States )
  • Author Disclosures:
    Farah Allouch: DO NOT have relevant financial relationships | Jing Chen: DO NOT have relevant financial relationships | Danxi Geng: No Answer | Ziyi Xie: DO NOT have relevant financial relationships | Yao Yu: No Answer | zhi li: No Answer | Jiang He: DO NOT have relevant financial relationships | Yingxian Sun: DO NOT have relevant financial relationships | Nanxiang Ouyang: No Answer | Guozhe Sun: No Answer | Lixia Qiao: No Answer | Chang Wang: No Answer | Songyue Liu: No Answer | Chung-shiuan Chen: DO NOT have relevant financial relationships | Katherine Mills: DO NOT have relevant financial relationships | Hua He: DO NOT have relevant financial relationships
Meeting Info:

Scientific Sessions 2024

2024

Chicago, Illinois

Session Info:

Identifying and Addressing Health Inequity in Blood Pressure Control

Monday, 11/18/2024 , 11:10AM - 12:35PM

Moderated Digital Poster Session

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