Leading research collaborations on chronic diseases


Hypertension Research Programme - HT02

Developing an innovative strategy for hypertension detection, treatment and control in two middle income countries, HOPE-4

Project locations: Colombia and Malaysia

Project duration: 2012 - 2017

Funding organisations

HT02 project video

Primary research aim

The primary research aim is to evaluate the effect of a cardiovascular disease risk detection, treatment, and control program on blood pressure.

Research objectives and methodology

The overall objective of the Hypertension Phase in HOPE-4 is to develop and field-test a contextually appropriate model for hypertension detection, treatment and control. This program will be evaluated in a cluster randomized control trial with a formative research strategy. More specifically, the program objectives will include: (a) simplified algorithms implemented by non-physician health workers; (b) single pill, fixed dose, combination therapy (polypill); and (c) treatment supporters and e-health technology to optimize long-term medication and lifestyle adherence. If the results in this phase of the research study are shown to be effective, we will provide the necessary support and knowledge translation to: (a) expand our research to include other countries; and (b) implement our model to fit within each country’s respective health system.

Current status

The HOPE-4 study is well underway. To date, we have identified individual and system barriers to implementing strategies for CVD risk detection, treatment and control. We have published two systematic reviews on Health Systems and Patient/Physician Barriers to hypertension/cardiovascular disease assessment and management in PloS One 2013, 2014. We have also completed a Health Systems Inventory and Appraisal in Colombia and Malaysia, led by the London School of Hygiene and Tropical Medicine. At this point, the study protocols have been finalized, the WHO-supported curriculum used to train non-physician health workers in the assessment and management of cardiovascular disease has been successfully piloted and translated for use in Colombia and Malaysia. In Colombia, non-physician health workers have successfully completed training on this curriculum and will shortly be deploying participant screening in three pilot communities. Finally, the HOPE-4 project has received approval from Colombia and Malaysia regulatory authorities to begin importing the single pill, fixed dose, combination treatment medication.

Project contact: Tara McCready - tara.mccredy [at] phri.ca



  1. Khatib R, Schwalm JD, Yusuf S, Haynes RB, McKee M, Khan M, et al. Patient and healthcare provider barriers to hypertension awareness, treatment and follow up: a systematic review and meta-analysis of qualitative and quantitative studiesPLoS One.2014; 9(1): e84238
  2. Legido-Quigley H, Camacho Lopez PA, Balabanova D, Perel P, Lopez-Jaramillo P, Nieuwlaat R, et al. Patients’ Knowledge, Attitudes, Behaviour and Health Care Experiences on the Prevention, Detection, Management and Control of Hypertension in Colombia: A Qualitative Study. PLoS ONE 2015; 10(4): e0122112. doi:10.1371/journal.pone.0122112
  3. Maimaris W, Paty J, Perel P, Legido-Quigley H, Balabanova D, Nieuwlaat R, et al. The influence of health systems on hypertension awareness, treatment, and control: a systematic literature review. PLoS Med. 2013; 10(7): e1001490 
  4. Risso-Gill I, Balabanova D, Majid F, Ng KK, Yusoff K, Mustapha F et al. Understanding the modifiable health systems barriers to hypertension management in Malaysia: a multi-method health systems appraisal approach. BMC Health Services Research 2015,15:254 doi:10.1186/s12913-015-0916-y
  5. Yusuf S, Attaran A, Bosch J, Joseph P, Lonn E, McCready T, et al. Combination pharmacotherapy to prevent cardiovascular disease: present status and challenges.European Heart Journal. 2014; 35(6): 353-64