Displaying publications 1 - 20 of 44 in total

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  1. Ong HT
    Med J Malaysia, 2002 Dec;57(4):510-4.
    PMID: 12733181
    Matched MeSH terms: Hypertension/therapy*
  2. O'Holohan DR
    Med J Malaya, 1969 Jun;23(4):260-4.
    PMID: 4242172
    Matched MeSH terms: Hypertension/therapy*
  3. Ching SM, Mokshashri NR, Kannan MM, Lee KW, Sallahuddin NA, Ng JX, et al.
    BMC Complement Med Ther, 2021 Jan 06;21(1):8.
    PMID: 33407414 DOI: 10.1186/s12906-020-03172-3
    BACKGROUND: The benefits of qigong for systolic and diastolic blood pressure (BP) reduction have been noted in previously published systematic reviews; however, the data on its effectiveness has been at best scarce. We aimed to update the evidence of qigong on blood pressure reduction after taking into consideration the risks of random error and reliability of data in the cumulative meta-analysis using trial sequential analysis (TSA).

    METHODS: Included trials were assessed using Cochrane risk of bias instrument. We performed meta-analysis with random-effects model and random errors were evaluated with TSA. We performed the search for the eligible randomized controlled trial (RCT) through Medline, Cinahl, Cochrane Central Register of Controlled Trials and also PubMed.

    RESULTS: A total of 370 subjects sourced from seven eligible RCTs were entered into the analysis. The pooled results demonstrated the significant reduction with the use of qigong of the systolic blood pressure [weighted mean difference (WMD), - 10.66 mmHg (95% confidence interval (CI) = - 17.69,-3.62, p 

    Matched MeSH terms: Hypertension/therapy*
  4. Supramaniam V
    Med J Malaysia, 1982 Sep;37(3):249-52.
    PMID: 7177007
    A random sample of 102 hypertensives out of a total of 347 in the Malaysian Armed Forces were studied with regard to patient education, knowledge of hypertension and therapy compliance. It was found that for 53 percent, patient education was unsatisfactory and as a result 67 percent had inadequate knowledge of hypertension. Adherance to therapy - drug intake, weight reduction and cessation of smoking - was poor (more than 59 percent, 96 percent and 70 percent failure respectively). There was no significant difference between asymptomatically and symptomatically detected hypertensives.
    Matched MeSH terms: Hypertension/therapy*
  5. Kow FP, Adlina B, Sivasangari S, Punithavathi N, Ng KK, Ang AH, et al.
    Med J Malaysia, 2018 08;73(4):233-238.
    PMID: 30121686 MyJurnal
    INTRODUCTION: As pharmacological treatment of hypertension has become a burden worldwide, the study looked into nonpharmacological ways of reducing blood pressure. The objective was to determine if music guided, slow and deep breathing will reduce the blood pressure among patients with hypertension in eight weeks.

    METHODS: A participant blinded, multi-centre, randomised controlled trial was conducted in which the participants in the intervention group (IG) practiced deep breathing exercise guided by sound cues and those in the control group (CG) listened to the music. The primary end point was reduction in blood pressure at eight weeks.

    RESULTS: 87 patients, 46 males and 41 females with mean age of 61.1 years were recruited and 93.1% of them successfully completed the study. There was significant reduction in systolic and diastolic Blood Pressure from baseline by 8 weeks in both groups. The reduction in Mean systolic blood pressure (SBP) in the control arm was 10.5mmHg compared to 8.3mmHg (p<0.001) in intervention group. Diastolic blood pressure (DBP) reduction in control and intervention groups were 5.2 mmHg (p<0.001) and 5.6 mmHg (p<0.001) respectively. The absolute difference in SBP reduction from baseline in IG & CG was -2.2 (95%CI: -7.8 to 3.5) and DBP was -0.4 (95%CI: -2.9 to 3.6). However, blood pressure reduction between the two groups was not significant.

    CONCLUSIONS: Both listening to music and deep breathing exercise were associated with a clinically significant reduction in SBP and DBP. However, deep breathing exercise did not augment the benefit of music in reducing BP.

    Matched MeSH terms: Hypertension/therapy*
  6. Ab Majid NL, Omar MA, Khoo YY, Mahadir Naidu B, Ling Miaw Yn J, Rodzlan Hasani WS, et al.
    J Hum Hypertens, 2018 09;32(8-9):617-624.
    PMID: 29899376 DOI: 10.1038/s41371-018-0082-x
    Hypertension is strongly associated with chronic diseases such as myocardial infarction, stroke, heart failure, and renal failure. The objective of this study is to determine the trend of prevalence, awareness, treatment, and control of hypertension among Malaysian population since 2006 to 2015. The study used the data from National Health and Morbidity Survey (NHMS) 2006, 2011, and 2015. It was a cross-sectional with two-stage stratified random sampling throughout Malaysia for eligible respondents 18 years old and above. Respondents were interviewed face to face and blood pressure was recorded as the average reading from two electronic pressure monitoring measurements. Data was analyzed using the Complex sample module in SPSS Version 20. The prevalence of hypertension in Malaysia was 34.6% (95% CI: 33.9, 35.3) in 2006, 33.6% (95% CI: 32.6, 34.6) in 2011 and 35.3% (95% CI: 34.5, 36.3) in 2015. Awareness of hypertension in 2006, 2011, and 2015 was 35.6% (95% CI: 34.6, 36.6), 40.7% (95% CI: 39.3, 42.1), and 37.5% (95% CI: 36.1, 38.9) respectively. The trend of receiving treatment from 2006 to 2015 was 78.9% (95% CI: 77.5, 80.2) to 83.2% (95% CI: 81.3, 84.8). The control of hypertension increased significantly from 27.5% (95% CI: 25.9, 29.2) in 2006 to 37.4% (95% CI: 35.3, 39.5) in 2015. Despite higher proportions receiving treatment over time, the control of hypertension remained below 40% since NHMS 2006 until 2015. The strategies to further reduce the prevalence and increase awareness of hypertension should be enhanced particularly among the targeted age group to ensure early detection, treatment, and control thus preventing from long-term complications.
    Study name: National Health and Morbidity Survey (NHMS-2006, NHMS-2011, NHMS-2015)
    Matched MeSH terms: Hypertension/therapy
  7. Wong AP, Kassab YW, Mohamed AL, Abdul Qader AM
    Pak J Pharm Sci, 2018 Jan;31(1):237-244.
    PMID: 29348109
    Hypertension is one of the major causes of morbidity and mortality. Worldwide, Hypertension is estimated to cause 7.5 million deaths, about 12.8% of the total of all deaths. This accounts for 57 million disability adjusted life years (DALYS) or 3.7% of total DALYS. This led WHO to set a target of 25% reduction in prevalence by 2025. To reach that, WHO has adopted non-conventional methods for the management of hypertension? Despite worldwide popularity of such non-conventional therapies, only small volume of evidence exists that supports its effectiveness. This review attempted to make a critical appraisal of the evidence, with the aim to (1) describe the therapeutic modalities frequently used, and (2) review the current level of evidence attributable to each modality. Databases from Cochrane Library, MEDLINE, PUBMED, and EMBASE were searched from 2005-2015. A total of 23 publications have been identified and selected. Out of these, 15 systematic reviews and/or meta-analysis of RCTs, 5 RCTs, 1 non-RCT, and 2 observational studies without control. Among those 23 publications, therapeutic modalities identified are: fish oil, qigong, yoga, coenzyme Q10, melatonin, meditation, vitamin D, vitamin C, monounsaturated fatty acids, dietary amino-acids, chiropractic, osteopathy, folate, inorganic nitrate, beetroot juice, beetroot bread, magnesium, and L-arginine. The followings were found to have weak or no evidence: fish oil, yoga, vitamin D, monounsaturated fatty acid, dietary amino-acids, and osteopathy. Those found to have significant reduction in blood pressure are: magnesium, qigong, melatonin, meditation, vitamin C, chiropractic, folate, inorganic nitrate, beetroot juice and L-arginine. Coenzyme Q10on the other hand, showed contradicting results were some studies found weak or no effect on blood pressure while others showed significant blood pressure reduction effect. By virtue of the research designs and methodologies, the evidence contributed from these studies is at level 1. Results from this review suggest that certain non-conventional therapies may be effective in treating hypertension and improving cardiac function and therefore considered as part of an evidence-based approach.
    Matched MeSH terms: Hypertension/therapy*
  8. Al-Jabi SW, Zyoud SH, Sweileh WM, Wildali AH, Saleem HM, Aysa HA, et al.
    Health Expect, 2015 Dec;18(6):3336-48.
    PMID: 25484002 DOI: 10.1111/hex.12324
    BACKGROUND: Evaluation of the association between treatment satisfaction and health-related quality of life (HRQoL) may enable health-care providers to understand the issues that influence quality of life and to recognize the aspects of hypertension treatment that need improvement to enhance the long-term treatment outcomes.

    OBJECTIVE: The aim of this study was to determine the relationship between HRQoL and treatment satisfaction in a sample of Palestinian hypertensive patients.

    METHODS: A cross-sectional study was conducted, adopting the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4) for the assessment of treatment satisfaction and using the European Quality of Life scale (EQ-5D-5L) for the assessment of HRQoL. Descriptive and comparative statistics were used to describe socio-demographic and disease-related characteristics of the patients. All analyses were performed using SPSS v 15.0.

    RESULTS: Four hundred and ten hypertensive patients were enrolled in the study. This study findings indicate a positive correlation between all satisfaction domains and HRQoL. Significant differences were observed between this study variables (P < 0.001). After adjustment for covariates using multiple linear regression, an increase of one point in the global satisfaction scale was associated with a 0.16 increase in EQ-5D index scores (r = 0.16; P < 0.001).

    CONCLUSIONS: Patients with reportedly higher satisfaction scores have reported relatively higher EQ-5D-5L index values. These study findings could be helpful in clinical practice, mainly in the early treatment of hypertensive patients, at a point where improving treatment satisfaction and HRQoL is still possible.

    Matched MeSH terms: Hypertension/therapy*
  9. Ariff F, Suthahar A, Ramli M
    Singapore Med J, 2011 Jan;52(1):29-34.
    PMID: 21298238
    INTRODUCTION: The objective of this study was to investigate the relationship between hypertensive patients and their coping style and associated lifestyle factors.
    METHODS: A total of 502 participants attending nine outpatient clinics completed the validated Bahasa Malaysia version of the Coping Inventory for Stressful Situations and sociodemographic questionnaires. The height, weight, pulse rate and blood pressure of all the participants were measured using standardised methods.
    RESULTS: A total of 264 (52.6 percent) participants were hypertensive, while 238 (47.4 percent) were not. Participants with a high task-oriented score showed a significantly lower risk of hypertension compared to those with a low score (odds ratio [OR] 0.546; 95 percent confidence interval [CI] 0.371-0.804). Those with a high emotion-oriented coping score were associated with an increased risk of hypertension (OR 1.691; 95 percent CI 1.107-2.582). Hypertension was also significantly associated with a higher mean body mass index, positive family history of hypertension, history of diabetes mellitus and hypercholesterolaemia. In multiple logistic regression analysis with hypertension status as the dependent variable, a high emotion-oriented coping score, a low task-oriented coping score, age, body mass index, positive family history of hypertension and history of diabetes mellitus remain significant factors in the final model.
    CONCLUSION: These results indicated a significant relationship between hypertension and coping styles and lifestyle factors. They underscored the importance of further study as well as the development and implementation of intervention measures to improve coping skills among hypertensive patients, which may be incorporated into the management of hypertension.
    Matched MeSH terms: Hypertension/therapy
  10. Lye HS, Kuan CY, Ewe JA, Fung WY, Liong MT
    Int J Mol Sci, 2009 Sep;10(9):3755-75.
    PMID: 19865517 DOI: 10.3390/ijms10093755
    Probiotics are live organisms that are primarily used to improve gastrointestinal disorders such as diarrhea, irritable bowel syndrome, constipation, lactose intolerance, and to inhibit the excessive proliferation of pathogenic intestinal bacteria. However, recent studies have suggested that probiotics could have beneficial effects beyond gastrointestinal health, as they were found to improve certain metabolic disorders such as hypertension. Hypertension is caused by various factors and the predominant causes include an increase in cholesterol levels, incidence of diabetes, inconsistent modulation of renin and imbalanced sexual hormones. This review discusses the antihypertensive roles of probiotics via the improvement and/or treatment of lipid profiles, modulation of insulin resistance and sensitivity, the modulation of renin levels and also the conversion of bioactive phytoestrogens as an alternative replacement of sexual hormones such as estrogen and progesterone.
    Matched MeSH terms: Hypertension/therapy*
  11. Lee PY, Liew SM, Abdullah A, Abdullah N, Ng CJ, Hanafi NS, et al.
    PLoS One, 2015;10(5):e0126191.
    PMID: 25942686 DOI: 10.1371/journal.pone.0126191
    INTRODUCTION: Most studies have reported barriers to guideline usage mainly from doctors' perspective; few have reported the perspective of other stakeholders. This study aimed to determine the views and barriers to adherence of a national clinical practice guideline (CPG) on management of hypertension from the perspectives of policymakers, doctors and allied healthcare professionals.

    METHODS: This study used a qualitative approach with purposive sampling. Seven in depth interviews and six focus group discussions were conducted with 35 healthcare professionals (policy makers, doctors, pharmacists and nurses) at a teaching hospital in Kuala Lumpur, Malaysia, between February and June 2013. All interviews were audio-recorded, transcribed verbatim and checked. Thematic approach was used to analyse the data.

    RESULTS: Two main themes and three sub-themes emerged from this study. The main themes were (1) variation in the use of CPG and (2) barriers to adherence to CPG. The three sub-themes for barriers were issues inherent to the CPG, systems and policy that is not supportive of CPG use, and attitudes and behaviour of stakeholders. The main users of the CPG were the primary care doctors. Pharmacists only partially use the guidelines, while nurses and policy makers were not using the CPG at all. Participants had suggested few strategies to improve usage and adherence to CPG. First, update the CPG regularly and keep its content simple with specific sections for allied health workers. Second, use technology to facilitate CPG accessibility and provide protected time for implementation of CPG recommendations. Third, incorporate local CPG in professional training, link CPG adherence to key performance indicators and provide incentives for its use.

    CONCLUSIONS: Barriers to the use of CPG hypertension management span across all stakeholders. The development and implementation of CPG focused mainly on doctors with lack of involvement of other healthcare stakeholders. Guidelines should be made simple, current, reliable, accessible, inclusive of all stakeholders and with good policy support.

    Matched MeSH terms: Hypertension/therapy*
  12. Aris IB, Wagie AA, Mariun NB, Jammal AB
    J Telemed Telecare, 2001;7(1):51-3.
    PMID: 11265939
    We developed a personal blood pressure monitoring system for patients with hypertension or hypotension. The system can be used to measure a patient's blood pressure at home and to transmit the data automatically to a hospital database via the Internet. The accuracy of blood pressure readings using the system was assessed by comparison with readings from a standard digital sphygmomanometer in four subjects. The measurement error for the systolic readings was 1.7-2.7% and for the diastolic readings 2.7-3.2%. The system therefore appears to be a promising means of assessing blood pressure remotely.
    Matched MeSH terms: Hypertension/therapy*
  13. Sivalingam N, Looi KW
    Med J Malaysia, 1999 Dec;54(4):496-503.
    PMID: 11072469
    Near-miss cases in life-threatening obstetric patients occurring over a one year period are analysed retrospectively with regards to morbidity measured in terms of hospital stay, utilisation of high dependency ward and intensive care beds and adequacy of clinical management. One-hundred and twenty two cases occurred among 9932 deliveries. Massive obstetric haemorrhage (54.2%) and hypertensive disorders of pregnancy (36.9%) were the two main diagnostic groups. Seventy one (58.2%) cases were referred from peripheral centres for obstetric management and 77 (63.1%) were not booked at this hospital for antenatal care. A majority were not ill-looking (92 cases) at the time of admission but turned for the worse in the course of labour. Interventional measures taken in clinical management were considered appropriate in all cases. Delay in instituting treatment was present in 6 cases. Remediable measures were recognised in 15 (12.3%). This study, apart from supplementing mortality audits, demonstrates that high risk obstetric patients can be triaged at the time of admission to labour wards by trained midwives and junior doctors in busy obstetric units without compromising standards of care.

    Study site: Obstetric and Gynaecologic Unit in Ipoh Hospital.
    Matched MeSH terms: Hypertension/therapy*
  14. Lim TO
    Singapore Med J, 1991 Dec;32(6):431-3.
    PMID: 1788603
    An audit to assess the adequacy of hypertension care was performed by examining the records and interviewing 55 selected hypertensive patients on treatment and follow-up at the outpatient department of a hospital. The patients selected had no previous record of drop out of treatment and had excellent compliance with drug therapy, so that ineffective blood pressure control cannot be attributable to these two reasons. Adequacy of care was measured by the number of patients whose management as indicated in their records complied with pre-defined criteria of adequate care. Only 18% of patients had achieved adequate blood pressure control. Assessment of patients was inadequate. None of the patients had been screened for secondary causes though 16% of patients had some basic investigations (urinalysis, blood urea and serum potassium), 5% had an assessment of target-organ damage, and 2% had been screened for other cardiovascular risk factors. Only 5% had a surveillance of side-effects from drug-therapy, 45% of the patients demonstrate adequate knowledge concerning complications of hypertension. The use of non-drug treatment was non-existent. The results of this study suggest that there were considerable deficiencies in the management of hypertension. Measures needed to overcome this are discussed.
    Matched MeSH terms: Hypertension/therapy*
  15. Ariffin F, Ramli AS, Daud MH, Haniff J, Abdul-Razak S, Selvarajah S, et al.
    Med J Malaysia, 2017 04;72(2):106-112.
    PMID: 28473673 MyJurnal
    INTRODUCTION: Non-communicable diseases (NCD) is a global health threat. the Chronic Care Model (CCM) was proven effective in improving NCD management and outcomes in developed countries. Evidence from developing countries including Malaysia is limited and feasibility of CCM implementation has not been assessed. this study intends to assess the feasibility of public primary health care clinics (PHC) in providing care according to the CCM.

    METHODOLOGY: A cross-sectional survey was conducted to assess the public PHC ability to implement the components of CCM. All public PHC with Family Medicine Specialist in Selangor and Kuala Lumpur were invited to participate. A site feasibility questionnaire was distributed to collect site investigator and clinic information as well as delivery of care for diabetes and hypertension.

    RESULTS: there were a total of 34 public PHC invited to participate with a response rate of 100%. there were 20 urban and 14 suburban clinics. the average number of patients seen per day ranged between 250-1000 patients. the clinic has a good mix of multidisciplinary team members. All clinics had a diabetic registry and 73.5% had a hypertensive registry. 23.5% had a dedicated diabetes and 26.5% had a dedicated hypertension clinic with most clinic implementing integrated care of acute and NCD cases.

    DISCUSSION: the implementation of the essential components of CCM is feasible in public PHCs, despite various constraints. Although variations in delivery of care exists, majority of the clinics have adequate staff that were willing to be trained and are committed to improving patient care.
    Matched MeSH terms: Hypertension/therapy
  16. Burns-Cox CJ, Awang Z, Sushama PC
    Med J Malaya, 1971 Dec;26(2):94-7.
    PMID: 4260867
    Matched MeSH terms: Hypertension/therapy
  17. Mahmood S, Shah KU, Khan TM, Nawaz S, Rashid H, Baqar SWA, et al.
    Ir J Med Sci, 2019 May;188(2):437-452.
    PMID: 30136222 DOI: 10.1007/s11845-018-1889-8
    Hypertension is a major risk factor for a number of cardiovascular diseases. Proper management of hypertension may require both pharmacological and non-pharmacological interventions. Non-pharmacological interventions help reduce the daily dose of antihypertensive medication and delay the progression from prehypertension to hypertension stage. Non-pharmacological interventions include lifestyle modifications like dietary modifications, exercise, avoiding stress, and minimizing alcohol consumption. Nutritional requirements of hypertensive individuals can be addressed through adopting either the DASH diet or through traditional Mediterranean diet. These dietary guidelines promote the consumption of fruits, vegetables, grains, dairy products, and food rich in K+, Mg+2, Ca+2, and phosphorus. Restriction of Na+ intake has the greatest role in lowering the blood pressure. The DASH diet alone has the effect equal to that of a single drug therapy. After dietary modifications, exercise and weight loss are the second major intervention for hypertension management. Avoiding stressful lifestyle, depression, and anxiety also help to reduce elevated blood pressure. Minimizing alcohol intake also favors the blood pressure reduction. However, lifestyle modification is a dynamic process and requires continuous adherence. It is a multi-factorial approach targeting more than one intervention. However, 6-12-month lifestyle modifications can be attempted in stage-1 hypertensive patients without any cardiovascular complication, in the hope that they may be sufficiently effective to make it unnecessary to use medicines.
    Matched MeSH terms: Hypertension/therapy*
  18. Palafox B, Seguin ML, McKee M, Dans AL, Yusoff K, Candari CJ, et al.
    BMJ Open, 2018 07 30;8(7):e024000.
    PMID: 30061449 DOI: 10.1136/bmjopen-2018-024000
    INTRODUCTION: Hypertension is a leading contributor to the global burden of disease. While safe and effective treatment exists, blood pressure control is poor in many countries, often reflecting barriers at the levels of health systems and services as well as at the broader level of patients' sociocultural contexts. This study examines how these interact to facilitate or hinder hypertension control, taking into account characteristics of service provision components and social contexts.

    METHODS AND ANALYSIS: The study, set in Malaysia and the Philippines, builds on two systematic reviews of barriers to effective hypertension management. People with hypertension (pre-existing and newly diagnosed) will be identified in poor households in 24-30 communities per country. Quantitative and qualitative methods will be used to examine their experiences of and pathways into seeking and obtaining care. These include two waves of household surveys of 20-25 participants per community 12-18 months apart, microcosting exercises to assess the cost of illness (including costs due to health seeking activities and inability to work (5 per community)), preliminary and follow-up in-depth interviews and digital diaries with hypertensive adults over the course of a year (40 per country, employing an innovative mobile phone technology), focus group discussions with study participants and structured assessments of health facilities (including formal and informal providers).

    ETHICS AND DISSEMINATION: Ethical approval has been granted by the Observational Research Ethics Committee at the London School of Hygiene and Tropical Medicine and the Research Ethics Boards at the Universiti Putra Malaysia and the University of the Philippines Manila. The project team will disseminate findings and engage with a wide range of stakeholders to promote uptake and impact. Alongside publications in high-impact journals, dissemination activities include a comprehensive stakeholder analysis, engagement with traditional and social media and 'digital stories' coproduced with research participants.

    Matched MeSH terms: Hypertension/therapy*
  19. M Yatim H, Wong YY, Neoh CF, Lim SH, Hassali MA, Hong YH
    Public Health, 2019 Aug;173:5-8.
    PMID: 31207425 DOI: 10.1016/j.puhe.2019.04.020
    OBJECTIVE: The objective of this study was to explore factors influencing patients with hypertension to participating in a hypertension self-management education (HSME) programme and challenges of sustaining the learnt self-care practices.

    STUDY DESIGN: This was a qualitative study with focus group discussions.

    METHODS: Focus group discussions using a semistructured moderator guide were conducted among participants who had attended the HSME programme. Data were audio recorded, transcribed verbatim and analysed using a thematic analysis approach.

    RESULTS: Three focus groups involving 19 participants were conducted. Four major themes emerged from the data collected. Most participants enjoyed the group-based HSME sessions because sharing experiences with those having similar health problems can reduce their sense of isolation. However, the participants highlighted the difficulty in sustaining self-care practices in the presence of friends and family influences.

    CONCLUSION: A number of patient-, family- and community-level motivators and barriers to patients' hypertension self-management have been identified. Efforts to tailor behavioural interventions to sustain daily self-care activities during social and cultural events are imperative.
    Matched MeSH terms: Hypertension/therapy*
  20. Schwalm JD, McCready T, Lopez-Jaramillo P, Yusoff K, Attaran A, Lamelas P, et al.
    Lancet, 2019 10 05;394(10205):1231-1242.
    PMID: 31488369 DOI: 10.1016/S0140-6736(19)31949-X
    BACKGROUND: Hypertension is the leading cause of cardiovascular disease globally. Despite proven benefits, hypertension control is poor. We hypothesised that a comprehensive approach to lowering blood pressure and other risk factors, informed by detailed analysis of local barriers, would be superior to usual care in individuals with poorly controlled or newly diagnosed hypertension. We tested whether a model of care involving non-physician health workers (NPHWs), primary care physicians, family, and the provision of effective medications, could substantially reduce cardiovascular disease risk.

    METHODS: HOPE 4 was an open, community-based, cluster-randomised controlled trial involving 1371 individuals with new or poorly controlled hypertension from 30 communities (defined as townships) in Colombia and Malaysia. 16 communities were randomly assigned to control (usual care, n=727), and 14 (n=644) to the intervention. After community screening, the intervention included treatment of cardiovascular disease risk factors by NPHWs using tablet computer-based simplified management algorithms and counselling programmes; free antihypertensive and statin medications recommended by NPHWs but supervised by physicians; and support from a family member or friend (treatment supporter) to improve adherence to medications and healthy behaviours. The primary outcome was the change in Framingham Risk Score 10-year cardiovascular disease risk estimate at 12 months between intervention and control participants. The HOPE 4 trial is registered at ClinicalTrials.gov, NCT01826019.

    FINDINGS: All communities completed 12-month follow-up (data on 97% of living participants, n=1299). The reduction in Framingham Risk Score for 10-year cardiovascular disease risk was -6·40% (95% CI 8·00 to -4·80) in the control group and -11·17% (-12·88 to -9·47) in the intervention group, with a difference of change of -4·78% (95% CI -7·11 to -2·44, p<0·0001). There was an absolute 11·45 mm Hg (95% CI -14·94 to -7·97) greater reduction in systolic blood pressure, and a 0·41 mmol/L (95% CI -0·60 to -0·23) reduction in LDL with the intervention group (both p<0·0001). Change in blood pressure control status (<140 mm Hg) was 69% in the intervention group versus 30% in the control group (p<0·0001). There were no safety concerns with the intervention.

    INTERPRETATION: A comprehensive model of care led by NPHWs, involving primary care physicians and family that was informed by local context, substantially improved blood pressure control and cardiovascular disease risk. This strategy is effective, pragmatic, and has the potential to substantially reduce cardiovascular disease compared with current strategies that are typically physician based.

    FUNDING: Canadian Institutes of Health Research; Grand Challenges Canada; Ontario SPOR Support Unit and the Ontario Ministry of Health and Long-Term Care; Boehringer Ingelheim; Department of Management of Non-Communicable Diseases, WHO; and Population Health Research Institute. VIDEO ABSTRACT.

    Matched MeSH terms: Hypertension/therapy
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