Effect of a multicomponent intervention on antihypertensive medication intensification in rural south Asia: Post-hoc analysis of a cluster RCT
Community Health Sciences; Cardiology; Nephrology
Background: Inadequate treatment of hypertension is a widespread problem, especially in South Asian countries where cardiovascular disease mortality rates are high. We aimed to explore the effect of a multicomponent intervention (MCI) on antihypertensive medication intensification among rural South Asians with hypertension.
Methods: A post-hoc analysis of a two-year cluster-randomized controlled trial including 2645 hypertensives aged≥ 40 years from 30 rural communities, 10 each, in Bangladesh, Pakistan, and Sri Lanka. Independent assessors collected information on participants' self-reports and physical inspection of medications. The main outcomes were the changes from baseline to 24 months in the following: 1) the therapeutic intensity score (TIS) for all (and class specific) antihypertensive medications; 2) the number of antihypertensive medications in all trial participants.
Results: At 24 months, the mean increase in the TIS score of all antihypertensive medications was 0.11 in the MCI group and 0.03 in the control group, with a between-group difference in the increase of 0.08 (95% CI (0.03, 0.12); P=0.002). In MCI compared to controls, a greater increase in the TIS of renin angiotensin-aldosterone system blockers (0.05; 95% CI (0.02, 0.07); P<0.001) and calcium channel blockers (0.03; 95% CI (0.00, 0.05);p=0.031) , and in the number of antihypertensive medications (0.11, 95% CI (0.02, 0.19);P=0.016) was observed.
Conclusions: In rural communities in Bangladesh, Pakistan, and Sri Lanka, MCI led to a greater increase in antihypertensive medication intensification compared to the usual care among adults with hypertension.
Trial registration: clinicaltrials.gov Identifier: NCT02657746.
American Journal of Hypertension
de Silva, A.,
Khan, A. H.,
Clemens, J. D.,
Lim, C. W.,
Hughes, A. D.,
Jafar, T. H.
(2021). Effect of a multicomponent intervention on antihypertensive medication intensification in rural south Asia: Post-hoc analysis of a cluster RCT. American Journal of Hypertension.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_chs_chs/885