Comprehensive approach to hypertension control in Argentina

Background

Despite advances in hypertension prevention and treatment research, the prevalence of hypertension is high and increasing, while the proportions of hypertensive patients who are aware, treated, and controlled are low in populations, especially in low and middle income countries. There are limited data on the implementation of effective and affordable programs for hypertension control in these countries.

Aims

The primary research aim was to test whether a comprehensive intervention program within a national public primary healthcare system would improve hypertension control among uninsured hypertensive patients and their families in Argentina.

Project plan

The research objectives were to test whether a comprehensive intervention program would lower blood pressure and improve hypertension control among uncontrolled hypertensive patients over an 18-month period compared to usual care and to estimate the cost-effectiveness of the comprehensive intervention program compared to usual care. A cluster randomized trial design was used to randomize 18 public primary care clinics to the intervention and control groups. The trial aimed to recruit 2,000 clinic patients with uncontrolled hypertension, their spouses and hypertensive family members. The 18-month comprehensive intervention program aimed to target the primary care system through health care provider education, a home-based intervention among patients and their families (home delivery of antihypertensive medication, self-monitoring of blood pressure, health education for medical adherence and lifestyle modification) conducted by community health workers and a mobile health intervention.

Impact

Evidence from the project was used by the Ministry of Health of Argentina to plan a National Hypertension Programme, and for Argentina to join HEARTS initiative for the Americas.

Publications and output

GACD have published an end-of-programme report providing a comprehensive summary of the programme and outcomes.

The project team have also made the slides from the Annual Conference on the Science of Dissemination and Implementation in Health (2018) discussing potential scale-up.

Principal investigators

Vilma Irazola Instituto de Efectividad Clínica y Sanitaria, Argentina

Team members

Jiang He Instituto de Efectividad Clínica y Sanitaria, Argentina
Lydia Bazzano Instituto de Efectividad Clínica y Sanitaria, Argentina
Jing Chen Instituto de Efectividad Clínica y Sanitaria, Argentina
Marie Krousel-Wood Instituto de Efectividad Clínica y Sanitaria, Argentina
Adolfo Rubinstein Instituto de Efectividad Clínica y Sanitaria, Argentina
Lizheng Shi Tulane University, United States