Implementation, integration, and institutionalization of a community-based strategy for hypertension control in...

Hypertension is the leading modifiable risk factor for cardiovascular disease, particularly in low- and middle-income countries (LMICs). Despite the effectiveness of pharmacological and non-pharmacological interventions, control rates remain low. Therefore, novel community-based strategies are needed for enhancing the detection, treatment, and control of hypertension. Our aim will be to implement and evaluate the results of a community-based strategy to reduce blood pressure (BP) levels in a LMIC.

We describe the "Implementation, Integration, and Institutionalization of a Community-Based Care Program to Reduce Cardiovascular Risk in Santander" (RE-HOPE) study protocol. Adults aged ≥18 years, with de novo or uncontrolled hypertension, or with hypertension not participating in cardiovascular risk management programs, will be included. Individuals will be identified through active community screening. The intervention will consist of early identification of hypertension, enrolling participants in primary care institutions, and conducting follow-up home visits. These visits will include counseling on medication adherence and lifestyle modifications, as well as training for healthcare providers and community health workers (CHWs). Referrals to primary care providers and follow-up appointments will be coordinated by CHWs. The primary outcome will be change in BP levels from baseline to 12 months of follow-up.

We expect to generate evidence about implementation outcomes, such as feasibility and acceptability of community-based screening, the adoption of this approach by primary care centers and fidelity of activities developed by CHWs. In addition, the implementation of this model is anticipated to reduce the prevalence of uncontrolled hypertension and minimize barriers to healthcare access. It is also expected that this strategy facilitates the timely detection and monitoring, address institutionalization gaps, and ultimately reduce the long-term burden of hypertension.

The RE-HOPE study will provide evidence on the effectiveness and implementation of a community-based hypertension control strategy integrated into primary care services. This strategy may serve as a replicable approach for improving hypertension control in low- and middle-income countries (LMICs).