Effect of a community health worker–led multicomponent intervention on blood pressure control in low-income patients in Argentina: A randomized clinical trial

HE, JIANG; IRAZOLA, VILMA; MILLS, KATHERINE T.; POGGIO, ROSANA; BERATARRECHEA, ANDREA; DOLAN, JACQUELYN; CHEN, CHUNG-SHIUAN; GIBBONS, LUZ; KROUSEL-WOOD, MARIE; BAZZANO, LYDIA A.; NEJAMIS, ANALIA; GULAYIN, PABLO; SANTERO, MARILINA; AUGUSTOVSKI, FEDERICO; CHEN, JING; RUBINSTEIN, ADOLFO

JOURNAL AMERICAN MEDICAL ASSOCIATION

American Medical Association

Año: 2017 vol. 318 p. 1016 - 1025

0098-7484

IMPORTANCE: Despite extensive knowledge of hypertension treatment, the prevalence of uncontrolled hypertension is high and increasing in low- and middle-income countries. OBJECTIVE: To test whether a community health worker?led multicomponent intervention would improve blood pressure (BP) control among low-income patients with hypertension. DESIGN, SETTING, AND PARTICIPANTS: A cluster randomized trial was conducted in 18 centers for primary health care within a national public system providing free medications and health care to uninsured patients in Argentina. A total of 1432 low-income adult patients with uncontrolled hypertension were recruited between June 2013 and April 2015 and followed up to October 2016. INTERVENTIONS: Nine centers (743 patients) were randomized to the multicomponent intervention, which included a community health worker?led home intervention (health coaching, home BP monitoring, and BP audit and feedback), a physician intervention, and a text-messaging intervention over 18 months. Nine centers (689 patients) were randomized to usual care. MAIN OUTCOMES AND MEASURES: The coprimary outcomes were the differences in systolic and diastolic BP changes from baseline to the end of follow-up of patients with hypertension. Secondary outcomes included the proportion of patients with controlled hypertension (BP