DREAM-GLOBAL: Diagnosing hypeRtension - Engaging Action and Management in Getting LOwer Bp in Aboriginal and LMIC

Background

Globally, 26.4% of the world adult population is estimated to have hypertension in the year 2020. The total number of adults with hypertension worldwide is expected to rise by 60% from 2000 to 2025, to a total of 1.56 billion. Hypertension control is important as it reduces both micro and macrovascular disease. The effective control of hypertension has been a focus of preventive efforts in Canada, and significant progress has been made. Despite this progress, regional disparities remain. This is particularly evident in socioeconomically disadvantaged, culturally isolated communities, such as Aboriginal communities. In a 2009 report, the highest rate of untreated hypertension in Canada is found in the Northern regions at 29.2%. Rates among Aboriginal communities are at 14% compared to 12.7% in the overall population in Canada. Hypertension control is a logical entry point to introduce the principles and practices of chronic disease management into primary care settings because it is relatively simple and driven by clear and concise clinical practice guidelines.

Untreated hypertension rates are similar in sub-Saharan Africa; the Millennium Village Project found a hypertension prevalence of 27.3% in Malawi and 26.8% in Mbola in Tanzania. The prevalence is even higher in the semi-urban areas, for example in urban Tanzania rates were up to 40%. Moshi, in Tanzania, has partnered with the DREAM-GLOBAL study. The barriers associated with hypertension control in LMIC’s include: lack of health delivery or public health infrastructure, cultural/ethnic isolation, lack of access to health related information, and poverty.

Aims

The primary objective of the study was to assess the effect of SMS messages on BP control in aboriginal people in Canada and rural Tanzania with hypertension. Secondary objectives included evaluating the efficacy of community BP measurement and SMS messaging for diagnosing hypertension in Aboriginal Canadian and rural Tanzanian people at risk of developing this health problem. A third objective was to document and explore associations between SMS messaging and community BP measurement with patient and healthcare provider satisfaction and interest in the program during the study.

Project plan

This was a prospective, randomised blinded allocation study of BP control with SMS messaging in patients with uncontrolled hypertension. The project was carried out in five Aboriginal communities in Canada and two rural communities in Tanzania. Adult patients with uncontrolled hypertension were enrolled into the BP control study, and those without hypertension but at high risk of developing this condition were enrolled into the BP screening study. Participants were screened prior to enrolment and underwent a follow-up period of at least 12 months.

The team introduced and tested the efficacy of an SMS (e-voucher) model of drug access/distribution in Tanzania through private partnerships with drug distributors.

Impact

The DREAM‐GLOBAL project showed that a programme combining innovations in health service delivery, mobile health technologies, and patient engagement, aiming to tackle raised blood pressure, could be implemented in First Nations communities. However, the study showed no impact of active text messaging on blood pressure levels.

Publications and output

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

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.

Principal investigators

Team members

Funding organisations

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