RESUMO
Purpose: The National Essential Public Health Services Package (NEPHSP), a set of community-based hypertension management programs, was launched by the Chinese government in 2009. However, the data are limited for the comprehensive evaluation of NEPHSP on hypertension management. This study was to estimate the effect of NEPHSP on hypertension control nationwide in China. Methods: Data were from China Hypertension Survey (CHS). The participants (n = 119,412) aged ≥35 years with hypertension were included in the analysis. Further, a subset of 64,188 diagnosed hypertensive patients were analyzed to evaluate the effect of NEPHSP by comparing the ones covered and not covered by NEPHSP. Blood pressure (BP) was measured by trained staff using a validated digital portable monitor in local communities or clinics. Results: Among adults aged ≥35 years with hypertension, the coverage of NEPHSP was 25.6% and increased with age. The coverage was significantly higher in women than in men (P < 0.001). Among the 64, 188 diagnosed hypertensive patients, compared to the control group (not covered by NEPHSP), the mean systolic and diastolic BPs were 2 mmHg and 1.6 mmHg lower in NEPHSP group, respectively. The rate of treatment for hypertension was significantly higher in NEPHSP group than the control group (93.0% vs. 81.4%, P < 0.001), and the rate of BP control was also significantly higher in NEPHSP group than the control group (35.9% vs. 29.6%, P < 0.001). Furthermore, similar trends were found in rural and urban, as well as in men and women. Conclusions: Our results showed that NEPHSP is effective in improving hypertension treatment and control in hypertensive patients in China. However, the coverage of NEPHSP was still low.
Assuntos
Hipertensão , Adulto , Pressão Sanguínea , China , Atenção à Saúde , Feminino , Humanos , Hipertensão/terapia , Masculino , População RuralRESUMO
Importance: The prevalence of hypertension is high and still increasing across the world, while the control rate remains low in many countries. Emerging technology, such as telemedicine, may offer additional support to change the unsatisfactory situation. Objective: To establish a multicomponent intervention delivered on a web-based telemedicine platform and oriented with the Chinese hypertension management guidelines and to evaluate the effect of the intervention on blood pressure (BP) control for patients with hypertension. Design, Setting, and Participants: This cluster randomized clinical trial of a hypertension management program was conducted at 66 community health centers in China from October 1, 2018, to May 31, 2020, with a 12-month follow-up. Patients with hypertension were blinded to randomization and were randomized to either the intervention group or control group. Hypertension was diagnosed at mean systolic BP (SBP) and diastolic BP (DBP) readings higher than 140 and 90 mm Hg or with use of antihypertensive medication. Evaluation of the intervention effect was based on the principle of modified intention to treat. Interventions: Multicomponent intervention was delivered on a web-based platform and consisted of a primary prevention program for cardiovascular disease and standardized management for hypertension. Main Outcomes and Measures: The primary outcome was the change in BP control rate (SBP and DBP levels <140 and 90 mm Hg, or <130 and 80 mm Hg for patients with diabetes) from baseline to the 12-month follow-up among patients with hypertension in the intervention and control groups. Results: A total of 4118 patients (mean [SD] age, 61.6 [9.4] years; 2265 women [55.0%]) were included in the analysis, with 2985 in the intervention group and 1133 in the control group. The BP control rate at baseline was 22.8% in the intervention group and 22.5% in the control group. After 12 months of the intervention, the BP control rate for the intervention group compared with the control group was significantly higher (47.4% vs 30.2%; odds ratio, 1.18; 95% CI, 1.13-1.24; P < .001). The intervention effect on SBP level was -10.1 mm Hg (95% CI, -11.7 to -8.5 mm Hg; P < .001) and on DBP level was -1.8 mm Hg (95% CI, -2.8 to -0.8 mm Hg; P < .001). Conclusions and Relevance: Results of this trial showed that a multicomponent intervention delivered on a web-based platform improved BP control rate and lowered BP level more than usual care alone. Such a telemedicine program may provide a new, effective way to treat patients with hypertension in the community and may generate public health benefits across diverse populations. Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR1800017791.