Identifying Who Benefits the Most from a Community Health Worker‐Led Multicomponent Intervention for Hypertension

Autores
Pan, Meng; Beratarrechea, Andrea; Poggio, Rosana; He, Hua; Chen, Chung Shiuan; Chen, Jing; Irazola, Vilma; Rubinstein, Adolfo Luis; He, Jiang; Mills, Katherine T.
Año de publicación
2024
Idioma
inglés
Tipo de recurso
artículo
Estado
versión publicada
Descripción
Background: Uncontrolled hypertension is a major public health challenge in low- and middle-income countries. The Hypertension Control Program in Argentina (HCPIA) showed that a community health worker-led multicomponent intervention was effective for blood pressure (BP) reduction in resource-limited settings, but whether the intervention was equally effective across participant subgroups is unknown.Objective: To identify participants who benefit the most from the HCPIA BP control intervention.Methods: This secondary analysis used data from HCPIA, a successful 18-month cluster-randomized trial in 18 health centers with 1,432 low-income hypertensive patients in Argentina. Fifteen baseline characteristics were used to define subgroups. The proportion of controlled BP (<140/90 mmHg) was estimated using generalized linear mixed models with arm-by-subgroup interaction terms. The distribution of trial BP response among intervention patient subgroups was assessed.Results: Participants were 53.0% female, a mean age of 56 years, and 17.4% controlled BP at baseline. After the intervention, 72.9% of intervention and 52.2% of control participants had controlled BP. The intervention was more effective in physically inactive patients (OR = 2.76, 95% CI: 1.82 and 4.21; p for interaction = 0.04), moderately active patients (OR = 3.08, 95% CI: 1.90 and 4.99; p for interaction = 0.03), and those with uncontrolled BP at baseline (OR = 2.77, 95% CI: 2.15 and 3.57; p for interaction = 0.05). Among intervention participants, 20.2% had no BP response (BP change < -4 mmHg), 41.3% had a moderate BP response (BP change: -4 mmHg to -24 mmHg), and 38.5% had a high BP response (BP change > -24 mmHg). Women (p=0.01), those who were physically inactive (p=0.03), and those not taking antihypertensive medications at baseline (p=0.001) had the greatest BP response.Conclusion: The effect of the intervention was consistent across many subgroups with some key groups showing a particularly strong intervention effect. These findings could be useful for planning future hypertension control programs in low- and middle-income countries.
Fil: Pan, Meng. University of Tulane; Estados Unidos
Fil: Beratarrechea, Andrea. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Poggio, Rosana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
Fil: He, Hua. University of Tulane; Estados Unidos
Fil: Chen, Chung Shiuan. University of Tulane; Estados Unidos
Fil: Chen, Jing. University of Tulane; Estados Unidos
Fil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
Fil: Rubinstein, Adolfo Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
Fil: He, Jiang. University of Tulane; Estados Unidos
Fil: Mills, Katherine T.. University of Tulane; Estados Unidos
Materia
HYPERTENSION CONTROL PROGRAM
COMMUNITY HEALTH WORKER
LOW- AND MIDDLE-INCOME COUNTRIES
PRIMARY HEALTH CARE
BLOOD PRESSURE REDUCTION
ARGENTINA
Nivel de accesibilidad
acceso abierto
Condiciones de uso
https://creativecommons.org/licenses/by/2.5/ar/
Repositorio
CONICET Digital (CONICET)
Institución
Consejo Nacional de Investigaciones Científicas y Técnicas
OAI Identificador
oai:ri.conicet.gov.ar:11336/291090
Acceder
id CONICETDig_fa82c8ec0bfecd3fb541d4dd1b509d4a
oai_identifier_str oai:ri.conicet.gov.ar:11336/291090
network_acronym_str CONICETDig
repository_id_str 3498
network_name_str CONICET Digital (CONICET)
spelling Identifying Who Benefits the Most from a Community Health Worker‐Led Multicomponent Intervention for HypertensionPan, MengBeratarrechea, AndreaPoggio, RosanaHe, HuaChen, Chung ShiuanChen, JingIrazola, VilmaRubinstein, Adolfo LuisHe, JiangMills, Katherine T.HYPERTENSION CONTROL PROGRAMCOMMUNITY HEALTH WORKERLOW- AND MIDDLE-INCOME COUNTRIESPRIMARY HEALTH CAREBLOOD PRESSURE REDUCTIONARGENTINAhttps://purl.org/becyt/ford/3.3https://purl.org/becyt/ford/3Background: Uncontrolled hypertension is a major public health challenge in low- and middle-income countries. The Hypertension Control Program in Argentina (HCPIA) showed that a community health worker-led multicomponent intervention was effective for blood pressure (BP) reduction in resource-limited settings, but whether the intervention was equally effective across participant subgroups is unknown.Objective: To identify participants who benefit the most from the HCPIA BP control intervention.Methods: This secondary analysis used data from HCPIA, a successful 18-month cluster-randomized trial in 18 health centers with 1,432 low-income hypertensive patients in Argentina. Fifteen baseline characteristics were used to define subgroups. The proportion of controlled BP (<140/90 mmHg) was estimated using generalized linear mixed models with arm-by-subgroup interaction terms. The distribution of trial BP response among intervention patient subgroups was assessed.Results: Participants were 53.0% female, a mean age of 56 years, and 17.4% controlled BP at baseline. After the intervention, 72.9% of intervention and 52.2% of control participants had controlled BP. The intervention was more effective in physically inactive patients (OR = 2.76, 95% CI: 1.82 and 4.21; p for interaction = 0.04), moderately active patients (OR = 3.08, 95% CI: 1.90 and 4.99; p for interaction = 0.03), and those with uncontrolled BP at baseline (OR = 2.77, 95% CI: 2.15 and 3.57; p for interaction = 0.05). Among intervention participants, 20.2% had no BP response (BP change < -4 mmHg), 41.3% had a moderate BP response (BP change: -4 mmHg to -24 mmHg), and 38.5% had a high BP response (BP change > -24 mmHg). Women (p=0.01), those who were physically inactive (p=0.03), and those not taking antihypertensive medications at baseline (p=0.001) had the greatest BP response.Conclusion: The effect of the intervention was consistent across many subgroups with some key groups showing a particularly strong intervention effect. These findings could be useful for planning future hypertension control programs in low- and middle-income countries.Fil: Pan, Meng. University of Tulane; Estados UnidosFil: Beratarrechea, Andrea. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Poggio, Rosana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: He, Hua. University of Tulane; Estados UnidosFil: Chen, Chung Shiuan. University of Tulane; Estados UnidosFil: Chen, Jing. University of Tulane; Estados UnidosFil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Rubinstein, Adolfo Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: He, Jiang. University of Tulane; Estados UnidosFil: Mills, Katherine T.. University of Tulane; Estados UnidosWiley2024-09info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdfapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/291090Pan, Meng; Beratarrechea, Andrea; Poggio, Rosana; He, Hua; Chen, Chung Shiuan; et al.; Identifying Who Benefits the Most from a Community Health Worker‐Led Multicomponent Intervention for Hypertension; Wiley; International Journal of Hypertension; 2024; 1; 9-2024; 1-112090-0392CONICET DigitalCONICETenginfo:eu-repo/semantics/altIdentifier/url/https://onlinelibrary.wiley.com/doi/10.1155/2024/6311938info:eu-repo/semantics/altIdentifier/doi/10.1155/2024/6311938info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2026-08-25T15:01:31Zoai:ri.conicet.gov.ar:11336/291090instacron:CONICETInstitucionalhttp://ri.conicet.gov.ar/Organismo científico-tecnológicoNo correspondehttp://ri.conicet.gov.ar/oai/requestdasensio@conicet.gov.ar; lcarlino@conicet.gov.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:34982026-08-25 15:01:32.232CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse
dc.title.none.fl_str_mv Identifying Who Benefits the Most from a Community Health Worker‐Led Multicomponent Intervention for Hypertension
title Identifying Who Benefits the Most from a Community Health Worker‐Led Multicomponent Intervention for Hypertension
spellingShingle Identifying Who Benefits the Most from a Community Health Worker‐Led Multicomponent Intervention for Hypertension
Pan, Meng
HYPERTENSION CONTROL PROGRAM
COMMUNITY HEALTH WORKER
LOW- AND MIDDLE-INCOME COUNTRIES
PRIMARY HEALTH CARE
BLOOD PRESSURE REDUCTION
ARGENTINA
title_short Identifying Who Benefits the Most from a Community Health Worker‐Led Multicomponent Intervention for Hypertension
title_full Identifying Who Benefits the Most from a Community Health Worker‐Led Multicomponent Intervention for Hypertension
title_fullStr Identifying Who Benefits the Most from a Community Health Worker‐Led Multicomponent Intervention for Hypertension
title_full_unstemmed Identifying Who Benefits the Most from a Community Health Worker‐Led Multicomponent Intervention for Hypertension
title_sort Identifying Who Benefits the Most from a Community Health Worker‐Led Multicomponent Intervention for Hypertension
dc.creator.none.fl_str_mv Pan, Meng
Beratarrechea, Andrea
Poggio, Rosana
He, Hua
Chen, Chung Shiuan
Chen, Jing
Irazola, Vilma
Rubinstein, Adolfo Luis
He, Jiang
Mills, Katherine T.
author Pan, Meng
author_facet Pan, Meng
Beratarrechea, Andrea
Poggio, Rosana
He, Hua
Chen, Chung Shiuan
Chen, Jing
Irazola, Vilma
Rubinstein, Adolfo Luis
He, Jiang
Mills, Katherine T.
author_role author
author2 Beratarrechea, Andrea
Poggio, Rosana
He, Hua
Chen, Chung Shiuan
Chen, Jing
Irazola, Vilma
Rubinstein, Adolfo Luis
He, Jiang
Mills, Katherine T.
author2_role author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv HYPERTENSION CONTROL PROGRAM
COMMUNITY HEALTH WORKER
LOW- AND MIDDLE-INCOME COUNTRIES
PRIMARY HEALTH CARE
BLOOD PRESSURE REDUCTION
ARGENTINA
topic HYPERTENSION CONTROL PROGRAM
COMMUNITY HEALTH WORKER
LOW- AND MIDDLE-INCOME COUNTRIES
PRIMARY HEALTH CARE
BLOOD PRESSURE REDUCTION
ARGENTINA
purl_subject.fl_str_mv https://purl.org/becyt/ford/3.3
https://purl.org/becyt/ford/3
dc.description.none.fl_txt_mv Background: Uncontrolled hypertension is a major public health challenge in low- and middle-income countries. The Hypertension Control Program in Argentina (HCPIA) showed that a community health worker-led multicomponent intervention was effective for blood pressure (BP) reduction in resource-limited settings, but whether the intervention was equally effective across participant subgroups is unknown.Objective: To identify participants who benefit the most from the HCPIA BP control intervention.Methods: This secondary analysis used data from HCPIA, a successful 18-month cluster-randomized trial in 18 health centers with 1,432 low-income hypertensive patients in Argentina. Fifteen baseline characteristics were used to define subgroups. The proportion of controlled BP (<140/90 mmHg) was estimated using generalized linear mixed models with arm-by-subgroup interaction terms. The distribution of trial BP response among intervention patient subgroups was assessed.Results: Participants were 53.0% female, a mean age of 56 years, and 17.4% controlled BP at baseline. After the intervention, 72.9% of intervention and 52.2% of control participants had controlled BP. The intervention was more effective in physically inactive patients (OR = 2.76, 95% CI: 1.82 and 4.21; p for interaction = 0.04), moderately active patients (OR = 3.08, 95% CI: 1.90 and 4.99; p for interaction = 0.03), and those with uncontrolled BP at baseline (OR = 2.77, 95% CI: 2.15 and 3.57; p for interaction = 0.05). Among intervention participants, 20.2% had no BP response (BP change < -4 mmHg), 41.3% had a moderate BP response (BP change: -4 mmHg to -24 mmHg), and 38.5% had a high BP response (BP change > -24 mmHg). Women (p=0.01), those who were physically inactive (p=0.03), and those not taking antihypertensive medications at baseline (p=0.001) had the greatest BP response.Conclusion: The effect of the intervention was consistent across many subgroups with some key groups showing a particularly strong intervention effect. These findings could be useful for planning future hypertension control programs in low- and middle-income countries.
Fil: Pan, Meng. University of Tulane; Estados Unidos
Fil: Beratarrechea, Andrea. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Poggio, Rosana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
Fil: He, Hua. University of Tulane; Estados Unidos
Fil: Chen, Chung Shiuan. University of Tulane; Estados Unidos
Fil: Chen, Jing. University of Tulane; Estados Unidos
Fil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
Fil: Rubinstein, Adolfo Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
Fil: He, Jiang. University of Tulane; Estados Unidos
Fil: Mills, Katherine T.. University of Tulane; Estados Unidos
description Background: Uncontrolled hypertension is a major public health challenge in low- and middle-income countries. The Hypertension Control Program in Argentina (HCPIA) showed that a community health worker-led multicomponent intervention was effective for blood pressure (BP) reduction in resource-limited settings, but whether the intervention was equally effective across participant subgroups is unknown.Objective: To identify participants who benefit the most from the HCPIA BP control intervention.Methods: This secondary analysis used data from HCPIA, a successful 18-month cluster-randomized trial in 18 health centers with 1,432 low-income hypertensive patients in Argentina. Fifteen baseline characteristics were used to define subgroups. The proportion of controlled BP (<140/90 mmHg) was estimated using generalized linear mixed models with arm-by-subgroup interaction terms. The distribution of trial BP response among intervention patient subgroups was assessed.Results: Participants were 53.0% female, a mean age of 56 years, and 17.4% controlled BP at baseline. After the intervention, 72.9% of intervention and 52.2% of control participants had controlled BP. The intervention was more effective in physically inactive patients (OR = 2.76, 95% CI: 1.82 and 4.21; p for interaction = 0.04), moderately active patients (OR = 3.08, 95% CI: 1.90 and 4.99; p for interaction = 0.03), and those with uncontrolled BP at baseline (OR = 2.77, 95% CI: 2.15 and 3.57; p for interaction = 0.05). Among intervention participants, 20.2% had no BP response (BP change < -4 mmHg), 41.3% had a moderate BP response (BP change: -4 mmHg to -24 mmHg), and 38.5% had a high BP response (BP change > -24 mmHg). Women (p=0.01), those who were physically inactive (p=0.03), and those not taking antihypertensive medications at baseline (p=0.001) had the greatest BP response.Conclusion: The effect of the intervention was consistent across many subgroups with some key groups showing a particularly strong intervention effect. These findings could be useful for planning future hypertension control programs in low- and middle-income countries.
publishDate 2024
dc.date.none.fl_str_mv 2024-09
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
http://purl.org/coar/resource_type/c_6501
info:ar-repo/semantics/articulo
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/11336/291090
Pan, Meng; Beratarrechea, Andrea; Poggio, Rosana; He, Hua; Chen, Chung Shiuan; et al.; Identifying Who Benefits the Most from a Community Health Worker‐Led Multicomponent Intervention for Hypertension; Wiley; International Journal of Hypertension; 2024; 1; 9-2024; 1-11
2090-0392
CONICET Digital
CONICET
url http://hdl.handle.net/11336/291090
identifier_str_mv Pan, Meng; Beratarrechea, Andrea; Poggio, Rosana; He, Hua; Chen, Chung Shiuan; et al.; Identifying Who Benefits the Most from a Community Health Worker‐Led Multicomponent Intervention for Hypertension; Wiley; International Journal of Hypertension; 2024; 1; 9-2024; 1-11
2090-0392
CONICET Digital
CONICET
dc.language.none.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv info:eu-repo/semantics/altIdentifier/url/https://onlinelibrary.wiley.com/doi/10.1155/2024/6311938
info:eu-repo/semantics/altIdentifier/doi/10.1155/2024/6311938
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
https://creativecommons.org/licenses/by/2.5/ar/
eu_rights_str_mv openAccess
rights_invalid_str_mv https://creativecommons.org/licenses/by/2.5/ar/
dc.format.none.fl_str_mv application/pdf
application/pdf
application/pdf
dc.publisher.none.fl_str_mv Wiley
publisher.none.fl_str_mv Wiley
dc.source.none.fl_str_mv reponame:CONICET Digital (CONICET)
instname:Consejo Nacional de Investigaciones Científicas y Técnicas
reponame_str CONICET Digital (CONICET)
collection CONICET Digital (CONICET)
instname_str Consejo Nacional de Investigaciones Científicas y Técnicas
repository.name.fl_str_mv CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicas
repository.mail.fl_str_mv dasensio@conicet.gov.ar; lcarlino@conicet.gov.ar
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