Multifaceted Intensive Blood Pressure Control Model in Older and Younger Individuals With Hypertension
Authors: Xiaofan Guo, Nanxiang Ouyang, Guozhe Sun, Naijin Zhang, Zhao Li, Xingang Zhang, Guangxiao Li, Chang Wang, Lixia Qiao, Ying Zhou, Zihan Chen, Chuning Shi, Songyue Liu, Wei Miao, Danxi Geng, Pengyu Zhang, Yingxian Sun, Jiang He, Jianjun Mu, Dao Wen Wang, Liying Xing, Guocheng Ren, Chunxia Zhao, Ruihai Yang, Chung-Shiuan Chen, Jun Wang, Ning Ye, Zihao Fan, Nan Ye, Linlin Zhang, Shu Zhang, Qiyu Li, Qiying Qin, Canru Liu, Xiaoyu Zheng, Tao Wang, Li Jing, Boqiang Zhang, Qun Sun, Yu Yan, Yueyuan Liao, Qiong Ma, Chao Chu, Yue Sun, Dan Wang, Ling Zhou, Heng Ye, Haoran Wei, Hao Liu, Zhaoqing Sun, Liqiang Zheng, Yanli Chen, Ye Chang, Mohan Jiang, Hongmei Yang, Shasha Yu, Wenna Li, Ning Wang, Chunwei Wu, Lufan Sun, Zhi Du, Yan Li, Nan Gao, Xinchi Liu, Ying Wang, Mingang Huang, Yufang Zhou, Lingrui Meng, Jiawen Zhang, Zhen Huang, Huihui Chen, Yuxian Huang, Lingmin Sun, Xin Zhong, Hanmin Wang, Xinyan Hou, Huan Han, Baohui Jin
Journal: JAMA Cardiology (2024)

Importance The sustainable effectiveness and safety of a nonphysician community health care practitioner–led intensive blood pressure intervention on cardiovascular disease have not, to the authors’ knowledge, been studied, especially in the older adult population. Objective To evaluate such a multifaceted model with a more stringent blood pressure treatment goal (&amp;amp;lt;130/80 mm Hg) among patients aged 60 years and older with hypertension. Design, Setting, and Participants This was a 48-month follow-up study of the China Rural Hypertension Control Project (CRHCP), an open-cluster randomized clinical trial, conducted from 2018 to 2023. Participants 60 years and older and younger than 60 years with a diagnosis of hypertension from the CRHCP trial were included for analysis. Individuals were recruited from 326 villages in rural China. Interventions The well-trained, nonphysician, community health care practitioner implemented a multifaceted intervention program (eg, initiation or titration of antihypertensive medications) to achieve a blood pressure level of less than 130/80 mm Hg, supervised by primary care physicians. Main Outcomes and Measures Cardiovascular disease (a composite of myocardial infarction, stroke, heart failure requiring hospitalization, and cardiovascular disease death). Results A total of 22 386 individuals 60 years and older with hypertension and 11 609 individuals younger than 60 years with hypertension were included in the analysis. The mean (SD) age of the participants was 63.0 (9.0) years and included 20 825 females (61.3%). Among the older individuals with hypertension, a total of 11 289 patients were randomly assigned to the intervention group and 11 097 to the usual-care group. During a median (IQR) of 4.0 (4.0-4.1) years, there was a significantly lower rate of total cardiovascular disease (1133 [2.7%] vs 1433 [3.5%] per year; hazard ratio [HR], 0.75; 95% CI, 0.69-0.81; P &amp;amp;lt; .001) and all-cause mortality (1111 [2.5%] vs 1210 [2.8%] per year; HR, 0.90; 95% CI, 0.83-0.98; P = .01) in the intervention group than in the usual-care group. For patients younger than 60 years, the risk reductions were also significant for total cardiovascular disease (HR, 0.64; 95% CI, 0.56-0.75; P &amp;amp;lt; .001), stroke (HR, 0.64; 95% CI, 0.55-0.76; P &amp;amp;lt; .001), heart failure (HR, 0.39; 95% CI, 0.18-0.87; P = .02), and cardiovascular death (HR, 0.54; 95% CI, 0.37-0.77; P &amp;amp;lt; .001), with all interaction P values for age groups greater than .05. In both age categories, the incidences of injurious falls, symptomatic hypotension, syncope, and the results for kidney outcomes did not differ significantly between groups. Conclusions and Relevance In both the aging and younger general population with hypertension, the nonphysician health care practitioner–led, multifaceted, intensive blood pressure intervention model could effectively and safely reduce the risk of cardiovascular disease and all-cause death. Trial Registration ClinicalTrials.gov Identifier: NCT03527719