The overall quality of evidence based on GRADE criteria was moderate for systolic blood pressure , but low for diastolic blood pressure .
INTERPRETATION Task-sharing interventions are effective in reducing blood pressure .
BACKGROUND Task sharing for the management of hypertension could be useful for understaffed and re source -poor health systems .
We assessed the effectiveness of task-sharing interventions in improving blood pressure control among adults in low-income and middle-income countries .
Effect of a Community Health Worker–Led Multicomponent Intervention on Blood Pressure Control in Low-Income Patients in Argentina: A Randomized Clinical Trial
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 r and omized 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 r and omized 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 r and omized to usual care . Main Outcomes and Measures The co primary 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 < 140/90 mm Hg ) . Three BP measurements were obtained at each of 2 baseline and 2 termination visits using a st and ard protocol , the means of which were used for analyses . Results Of 1432 participants ( mean age , 55.8 years [ SD , 13.3 ] ; 772 women [ 53.0 % ] ) , 1357 ( 94.8 % ) completed the trial . Baseline mean systolic BP was 151.7 mm Hg for the intervention group and 149.8 mm Hg for the usual care group ; the mean diastolic BP was 92.2 mm Hg for the intervention group and 90.1 mm Hg for the usual care  group . Systolic BP reduction from baseline to month 18 was 19.3 mm Hg ( 95 % CI , 17.9 - 20.8 mm Hg ) for the intervention group and 12.7 mm Hg ( 95 % CI , 11.3 - 14.2 mm Hg ) for the usual care group ; the difference in the reduction was 6.6 mm Hg ( 95 % CI , 4.6 - 8.6 ; P < .001 ) . Diastolic BP decreased by 12.2 mm Hg ( 95 % CI , 11.2 - 13.2 mm Hg ) in the intervention group and 6.9 mm Hg ( 95 % CI , 5.9 - 7.8 mm Hg ) in the control group ; the difference in the reduction was 5.4 mm Hg ( 95 % CI , 4.0 - 6.8 mm Hg ; P < .001 ) . The proportion of patients with controlled hypertension increased from 17.0 % at baseline to 72.9 % at 18 months in the intervention group and from 17.6 % to 52.2 % in the usual care group ; the difference in the increase was 20.6 % ( 95 % CI , 15.4%-25.9 % ; P < .001 ) . No adverse events were reported . Conclusions and Relevance Low-income patients in Argentina with uncontrolled hypertension who participated in a community health worker – led multicomponent intervention experienced a greater decrease in systolic and diastolic BP than did patients who received usual care over 18 months . Further research is needed to assess generalizability and cost-effectiveness of this intervention and to underst and which components may have contributed most to the outcome . Trial Registration clinical trials.gov Identifier :
The overall quality of evidence based on GRADE criteria was moderate for systolic blood pressure , but low for diastolic blood pressure .
INTERPRETATION Task-sharing interventions are effective in reducing blood pressure .
BACKGROUND Task sharing for the management of hypertension could be useful for understaffed and re source -poor health systems .
We assessed the effectiveness of task-sharing interventions in improving blood pressure control among adults in low-income and middle-income countries .