PT  - JOURNAL ARTICLE
AU  - Abrar, Ahmad
AU  - Hu, Xiao
AU  - Akhtar, Jubaida
AU  - Jubayer, Shamim
AU  - Noor Nabi Sayem, Mohammad
AU  - Sultana, Sarmin
AU  - Al Mamun, Mohammad Abdullah
AU  - Bhuiyan, Mahfuzur Rahman
AU  - Malik, Fazila
AU  - Amin, Mohammad Robed
AU  - Alim, Abdul
AU  - Gupta, Reena
AU  - Zhao, Di
AU  - Farrell, Margaret
AU  - Banigbe, Bolanle
AU  - Matsushita, Kunihiro
AU  - Burka, Daniel
AU  - Appel, Lawrence
AU  - Moran, Andrew E
AU  - Choudhury, Sohel Reza
TI  - Evaluation of the World Health Organization-HEARTS hypertension control package in Bangladesh: a quasi-experimental trial
AID  - 10.1136/heartjnl-2024-324253
DP  - 2024 Sep 01
TA  - Heart
PG  - 1090--1098
VI  - 110
IP  - 17
4099  - http://heart.bmj.com/content/110/17/1090.short
4100  - http://heart.bmj.com/content/110/17/1090.full
SO  - Heart2024 Sep 01; 110
AB  - Background The World Health Organization (WHO) promotes the HEARTS technical package for improving hypertension control worldwide, but its effectiveness has not been rigorously evaluated.Objective To compare hypertension outcomes in clinics implementing HEARTS versus clinics continuing usual hypertension care in rural Bangladesh.Methods A matched-pair cluster quasi-experimental trial in Upazila Health Complexes (UHCs; primary healthcare facilities) was conducted in rural Bangladesh. A total of 3935 patients (mean age 52.3 years, 70.5% female) with uncontrolled hypertension (blood pressure (BP) ≥140/90 mm Hg regardless of treatment history) were enrolled: 1950 patients from 7 HEARTS UHCs and 1985 patients from 7 matched usual care UHCs. The primary outcome was systolic BP at 6 months measured at the patient’s home; secondary outcomes were diastolic BP, hypertension control rate (<140/90 mm Hg) and loss to follow-up. Multivariable mixed-effects linear and Poisson models were conducted.Results Baseline mean systolic BP was 158.4 mm Hg in the intervention group and 158.8 mm Hg in the usual care group. At 6 months, 95.5% of participants completed follow-up. Compared with usual care, the intervention significantly lowered systolic BP (−23.7 mm Hg vs −20.0 mm Hg; net difference −3.7 mm Hg (95% CI −5.1 to –2.2)) and diastolic BP (−10.2 mm Hg vs −8.3 mm Hg; net difference −1.9 mm Hg (95% CI −2.7 to –1.1)) and improved hypertension control (62.0% vs 49.7%, net difference 12.3% (95% CI 9.0 to 16.8)). Rate of missed clinic visits was lower in the intervention group (8.8% vs 39.3%, p<0.001).Conclusions After WHO-HEARTS package implementation in rural Bangladesh, BP was lowered and hypertension control improved significantly compared with usual care.Trial registration number NCT04992039.Data are available on reasonable request. De-identified data from this study are available on reasonable request.