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 .
Control of blood pressure and risk attenuation: a public health intervention in rural Bangladesh, Pakistan, and Sri Lanka feasibility trial results
Background : High blood pressure ( BP ) is the leading attributable risk for cardiovascular disease globally . There is little information on effective and sustainable public health system strategies for managing hypertension in South Asian countries . We conducted a feasibility study to gather preliminary data to optimize BP-lowering strategies for a public health intervention in rural communities in Bangladesh , Pakistan , and Sri Lanka . Methods : A mixed method feasibility study comprised a 3-month pre and postevaluation of a multicomponent intervention ( MCI ) , including BP screening and home health education by trained government community health worker ( CHW ) ; providers trained in hypertension management , and compensation of CHW for additional services . Checklists were used to document care . Stakeholder interviews were also conducted . Individuals aged 40 years and above with high BP ( systolic ≥140 mmHg or diastolic ≥90 mmHg based on two readings from 2 separate days , or receiving antihypertensive medications ) were enrolled from rural communities in Bangladesh , Pakistan , and Sri Lanka . BP was measured at baseline and 3 months postintervention . Results : A total of 412 ( 90 % ) of the 454 eligible individuals were recruited . Of those recruited , 90 % received home health education session by trained CHWs , 80 % were referred to trained providers , of whom 83 % completed the management checklist . A follow-up rate of 95.6 % was achieved . The mean SBP declined significantly by 4.5 mmHg 95 % confidence interval ( 2.3 , 6.7 ) mmHg ( P < 0.001 ) in the overall pooled analysis in three countries ; however , it varied among countries . BP decline was 10.5 mmHg ( 8.1 , 13.0 mmHg ) ( P < 0.001 ) in the pooled analysis of individuals with uncontrolled hypertension at baseline , and was also significant each of the three countries . All 98 stakeholders strongly supported upscaling the proposed MCI strategies . Conclusion : The proposed MCI is feasible for implementation and requires long-term , large-scale evaluation in the rural public health infrastructure in South Asian countries to determine sustainability of health system changes and BP control . If these long-term effects are confirmed , MCI may be a long-term strategy for tackling rising rates of cardiovascular disease in low-re source d countries . Clintrial.gov
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 .