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

Background

Hypertension (HT) is the leading cause of death and cardiovascular disease (CVD) worldwide and affects about one billion people. Despite the availability of robust evidence for over 2 decades that lowering blood pressure (BP) reduces CVD, the rates of treatment (~40%) and control are low (<15% in most middle income countries (MIC)). The reasons for these are multi-factorial and include micro- (patients and physicians) and macro- (systems) level barriers (inadequate human resources, lack, of systematic strategies, lack of access to inexpensive combination BP lowering drugs which are required in most people with HT to control BP, and complex treatment guidelines that are based on approaches in high income countries but not practicable in resource constrained settings).

Aims

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

Project plan

The overall objective of the Hypertension Phase in HOPE-4 was to develop and field-test a contextually appropriate model for hypertension detection, treatment and control. This program was evaluated in a cluster randomized control trial with a formative research strategy. More specifically, the program objectives included: (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.

Impact

The HOPE-4 intervention substantially reduced cardiovascular risk and improved blood pressure and cholesterol levels as well as adherence to medication. The intervention has also been successfully adapted and piloted in a high-income setting – Canada – with promising results.

In addition, the HOPE-4 curriculum was adapted for WHO’s HEARTS Technical Package.

Publications and output

To access publications and other outputs relating to this project, see our publications webpage and our case study.

GACD have also published an end-of-programme report, providing a comprehensive summary of the programme and outcomes. More information about the Hypertension report is available here.

This project has a related case study Hypertension detection, treatment, and control in Colombia and Malaysia.