Active Screening of Arterial Hypertension by Community Outreach Workers in the Cayenne Metropolitan Area to Reduce the Incidence of Cardiovascular Disease

Study Overview
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Brief Summary
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The main objective is to implement of a community-based primary care intervention against high blood pressure. We want to show that this intervention decreases the incidence of stroke in the community of agglomerations of the central coast of French Guiana, with a rapid effectiveness of about -30% at 2 years.

Detailed Description
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The hypothesis of the research is that, thanks to a strategy of early detection of hypertension based on outreach by community relays, it will be possible to increase the effectiveness of primary prevention among the precarious population (early treatment, access to healthcare, improvement of therapeutic follow-up, reduction of renunciations and interruptions of treatment). This strategy, adapted to the Guianese context, would make it possible to reduce the incidence and mortality of cardiovascular diseases among the most vulnerable people, particularly stroke. Such data would be a prerequisite for a more ambitious strategy, aiming to implement policies on a sufficient scale policies on a scale and intensity sufficient to have an impact on the problem of social inequalities in health other than those related to high blood pressure. The quasi-experimental before-and-after methodology makes it possible to compare, on a population basis, a quantitative endpoint - in this case the number of strokes - between before and after the implementation of a public health intervention. For reasons of acceptance by the partners, statistical power, and potential bias, a before-and-after design seems more interesting. It will be a pre-screening of hypertension, a possible referral for medical care or opening of health care rights and health education through hygienic and dietary advice and health prevention focused on hypertension.

Official Title
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Active Screening of Arterial Hypertension by Community Outreach Workers in the Cayenne Metropolitan Area to Reduce the Incidence of Cardiovascular Disease

Conditions
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High Blood Pressure

Intervention / Treatment
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* Drug: antihypertensive drug treatment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adults of at least 18 years old Residents of the agglomeration community of the central coast of French Guiana. Exclusion Criteria: Person who has objected to participating in the study Person under guardianship or curatorship, persons under protective supervision

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>diagnosis and treatment of high blood pressure | Drug: antihypertensive drug treatment<br>* Patients with hypertension will be treated for it by their physician<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To compare the incidence of stroke between before and after the start of the intervention according to PMSI data in resident persons in the agglomeration community of the central coast of French Guiana. | To compare the incidence of stroke between before and after the intervention | 5 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The incidence of acute coronary syndrome (ACS), transient ischemic attack, lower extremity arterial disease, aneurysm and end stage renal disease treated. |  | comparison between before (over 5 years) and 1, 2 and 3 years after the beginning of the intervention according to PMSI data in the neighborhoods | 
| Stroke incidence |  | comparison between before (over 5 years) and 1, 2 and 3 years after the beginning of the intervention according to PMSI data in the neighborhoods | 
| treatment adherence | lickert scale (5 levels) | Inclusion | 
| Number of systolic and diastolic blood pressure measurements performed, number of new diagnoses and number of rediscoveries among those lost to follow-up during the intervention (number of people who give up on diagnosis or medical care) |  | 2 years | 
| Quantification of the evolution of the prescription of antihypertensive drugs in Guiana via data from the Social Security |  | Before and 1, 2, and 3 years after the implementation of the intervention | 
| stroke in hospital case fatality |  | 1, 2, and 3 years after the start of the intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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High blood pressure, Precarity, community outreach workers, Cardiovascular disease, Health care