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Area of Science:

  • Public Health
  • Cardiovascular Medicine
  • Health Services Research

Background:

  • Uncontrolled hypertension poses a significant public health challenge in low- and middle-income countries.
  • The Hypertension Control Program in Argentina (HCPIA) demonstrated a community health worker-led intervention's effectiveness in reducing blood pressure (BP) in resource-limited settings.
  • However, the intervention's differential effectiveness across participant subgroups was previously unknown.

Purpose of the Study:

  • To identify specific participant subgroups that benefit most from the HCPIA BP control intervention.
  • To analyze the impact of the intervention on various demographic and clinical characteristics.

Main Methods:

  • A secondary analysis of the 18-month HCPIA cluster-randomized trial data involving 1,432 low-income hypertensive patients.
  • Subgroup analyses were conducted using 15 baseline characteristics.
  • Generalized linear mixed models with arm-by-subgroup interaction terms were employed to estimate BP control proportions.

Main Results:

  • The intervention significantly increased BP control rates from 17.4% at baseline to 72.9% in the intervention group versus 52.2% in the control group.
  • The intervention demonstrated greater effectiveness in physically inactive (OR=2.76) and moderately active patients (OR=3.08), and those with uncontrolled baseline BP (OR=2.77).
  • Women, physically inactive individuals, and those not on antihypertensive medication at baseline showed the greatest BP response.

Conclusions:

  • The HCPIA intervention's effectiveness was largely consistent across subgroups, with notable enhanced effects in specific groups.
  • Findings suggest targeted approaches for future hypertension control programs in resource-limited settings.
  • The study highlights the potential for community health worker-led interventions to address hypertension disparities.