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Nonphysician Community Health-Care Provider-Led Intensive Blood Pressure Intervention 

In Chinese villages, intensive blood care intervention by nonphysicians effectively reduced cardiovascular disease and death, compared with usual care, researchers report.

The open-label, blinded-endpoint, cluster-randomized trial included participants aged 40 years or older with an untreated systolic blood pressure of at least 140 mm Hg or a diastolic blood pressure of at least 90 mm Hg (≥130 mm Hg and ≥80 mm Hg for those at high risk for cardiovascular disease or if currently taking antihypertensive medication). A total of 326 villages were cluster randomized to a nonphysician community health-care provider-led intervention (a simple stepped-care protocol to achieve a systolic blood pressure goal of less than 130 mm Hg and diastolic blood pressure goal of less than 80 mm Hg) with supervision from primary care physicians. Based on a primary effectiveness outcome of a composite outcome of myocardial infarction, stroke, heart failure requiring hospitalization, and cardiovascular disease death during the 36-month follow-up, the investigators found: “Between May 8 and Nov 28, 2018, we enrolled 163 villages per group with 33,995 participants. Over 36 months, the net group difference in systolic blood pressure reduction was –23.1 mm Hg (95% CI –24.4 to –21.9; P <0.0001) and in diastolic blood pressure reduction, it was –9.9 mm Hg (–10.6 to –9.3; P <0.0001). Fewer patients in the intervention group than the usual care group had a primary outcome (1.62% vs 2.40% per year; hazard ratio [HR] 0.67, 95% CI 0.61–0.73; P<0.0001). Secondary outcomes were also reduced in the intervention group: myocardial infarction (HR 0.77, 95% CI 0.60–0.98; P = 0.037), stroke (0.66, 0.60–0.73; p<0.0001), heart failure (0.58, 0.42–0.81; P = 0.0016), cardiovascular disease death (0.70, 0.58–0.83; P <0.0001), and all-cause death (0.85, 0.76–0.95; P = 0.0037). The risk reduction of the primary outcome was consistent across subgroups of age, sex, education, antihypertensive medication use, and baseline cardiovascular disease risk. Hypotension was higher in the intervention than in the usual care group (1.75% vs 0.89%; P <0.0001).”

Source: Lancet