RT Journal Article
SR Electronic
T1 Evaluation of the World Health Organization-HEARTS hypertension control package in Bangladesh: a quasi-experimental trial
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1090
OP 1098
DO 10.1136/heartjnl-2024-324253
VO 110
IS 17
A1 Abrar, Ahmad
A1 Hu, Xiao
A1 Akhtar, Jubaida
A1 Jubayer, Shamim
A1 Noor Nabi Sayem, Mohammad
A1 Sultana, Sarmin
A1 Al Mamun, Mohammad Abdullah
A1 Bhuiyan, Mahfuzur Rahman
A1 Malik, Fazila
A1 Amin, Mohammad Robed
A1 Alim, Abdul
A1 Gupta, Reena
A1 Zhao, Di
A1 Farrell, Margaret
A1 Banigbe, Bolanle
A1 Matsushita, Kunihiro
A1 Burka, Daniel
A1 Appel, Lawrence
A1 Moran, Andrew E
A1 Choudhury, Sohel Reza
YR 2024
UL http://heart.bmj.com/content/110/17/1090.abstract
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.