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Multifaceted Intensive Blood Pressure Control Model in Older and Younger Individuals With Hypertension: A Randomized
Xiaofan Guo1, Nanxiang Ouyang1, Guozhe Sun1
1Department of Cardiology, First Hospital of China Medical University, Shenyang, China.
Insights
A community health care practitioner-led intensive blood pressure intervention significantly reduced cardiovascular disease and death in adults with hypertension. This effective and safe model benefits both older and younger populations.
Area of Science:
- Cardiovascular Health
- Hypertension Management
- Public Health Interventions
Background:
- The effectiveness and safety of nonphysician-led intensive blood pressure interventions for cardiovascular disease (CVD) are not well-established, particularly in older adults.
- Previous studies have not evaluated such models with stringent blood pressure goals (<130/80 mm Hg).
Purpose of the Study:
- To evaluate a multifaceted, nonphysician-led intensive blood pressure intervention model.
- To assess the model's effectiveness and safety in patients aged 60 years and older with hypertension, aiming for a blood pressure goal of <130/80 mm Hg.
Main Methods:
- A 48-month, open-cluster randomized clinical trial (China Rural Hypertension Control Project) involving 33,995 participants (≥60 years and <60 years) with hypertension.
- Nonphysician community health care practitioners implemented interventions, including medication management, supervised by primary care physicians.
- Primary outcome was composite cardiovascular disease (myocardial infarction, stroke, heart failure hospitalization, CVD death).
Main Results:
- The intervention group showed significantly lower rates of total cardiovascular disease (HR, 0.75) and all-cause mortality (HR, 0.90) compared to the usual-care group in older adults.
- Significant risk reductions for total CVD, stroke, heart failure, and CVD death were also observed in the younger population (<60 years).
- No significant differences in injurious falls, symptomatic hypotension, syncope, or kidney outcomes were found between groups in either age category.
Conclusions:
- The nonphysician-led intensive blood pressure intervention model is effective and safe for reducing cardiovascular disease and all-cause mortality in both older and younger adults with hypertension.
- This model offers a viable strategy for improving hypertension management and cardiovascular outcomes in community settings.
Importance:
The sustainable effectiveness and safety of a nonphysician community health care practitioner-led intensive blood pressure intervention on cardiovascular disease have not, to the authors' knowledge, been studied, especially in the older adult population.
Objective:
To evaluate such a multifaceted model with a more stringent blood pressure treatment goal (<130/80 mm Hg) among patients aged 60 years and older with hypertension.
Design, Setting, And Participants:
This was a 48-month follow-up study of the China Rural Hypertension Control Project (CRHCP), an open-cluster randomized clinical trial, conducted from 2018 to 2023. Participants 60 years and older and younger than 60 years with a diagnosis of hypertension from the CRHCP trial were included for analysis. Individuals were recruited from 326 villages in rural China.
Interventions:
The well-trained, nonphysician, community health care practitioner implemented a multifaceted intervention program (eg, initiation or titration of antihypertensive medications) to achieve a blood pressure level of less than 130/80 mm Hg, supervised by primary care physicians.
Main Outcomes And Measures:
Cardiovascular disease (a composite of myocardial infarction, stroke, heart failure requiring hospitalization, and cardiovascular disease death).
Results:
A total of 22 386 individuals 60 years and older with hypertension and 11 609 individuals younger than 60 years with hypertension were included in the analysis. The mean (SD) age of the participants was 63.0 (9.0) years and included 20 825 females (61.3%). Among the older individuals with hypertension, a total of 11 289 patients were randomly assigned to the intervention group and 11 097 to the usual-care group. During a median (IQR) of 4.0 (4.0-4.1) years, there was a significantly lower rate of total cardiovascular disease (1133 [2.7%] vs 1433 [3.5%] per year; hazard ratio [HR], 0.75; 95% CI, 0.69-0.81; P < .001) and all-cause mortality (1111 [2.5%] vs 1210 [2.8%] per year; HR, 0.90; 95% CI, 0.83-0.98; P = .01) in the intervention group than in the usual-care group. For patients younger than 60 years, the risk reductions were also significant for total cardiovascular disease (HR, 0.64; 95% CI, 0.56-0.75; P < .001), stroke (HR, 0.64; 95% CI, 0.55-0.76; P < .001), heart failure (HR, 0.39; 95% CI, 0.18-0.87; P = .02), and cardiovascular death (HR, 0.54; 95% CI, 0.37-0.77; P < .001), with all interaction P values for age groups greater than .05. In both age categories, the incidences of injurious falls, symptomatic hypotension, syncope, and the results for kidney outcomes did not differ significantly between groups.
Conclusions And Relevance:
In both the aging and younger general population with hypertension, the nonphysician health care practitioner-led, multifaceted, intensive blood pressure intervention model could effectively and safely reduce the risk of cardiovascular disease and all-cause death.
Trial Registration:
ClinicalTrials.gov Identifier: NCT03527719.
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