A community-based comprehensive intervention to reduce cardiovascular risk in hypertension (HOPE 4)
Digital
- Autores:
-
Schwalm, Jon-David
McCready, Tara
Lopez-Jaramillo, Patricio
Yusoff, Khalid
Attaran, Amir
Lamelas, Pablo
Camacho López, Paul Anthony
Majid, Fadhlina
Bangdiwala, Shrikant I.
Thabane, Lehana
Islam, Shofiqul
McKee, Martin
Yusuf, Salim
- Tipo de recurso:
- Article of journal
- Fecha de publicación:
- 2019
- Institución:
- Universidad de Santander
- Repositorio:
- Repositorio Universidad de Santander
- Idioma:
- eng
- OAI Identifier:
- oai:repositorio.udes.edu.co:001/5708
- Acceso en línea:
- https://doi.org/10.1016/S0140-6736(19)31949-X
https://repositorio.udes.edu.co/handle/001/5708
- Palabra clave:
- Rights
- closedAccess
- License
- Copyright © 2019 Elsevier Ltd. All rights reserved.
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A community-based comprehensive intervention to reduce cardiovascular risk in hypertension (HOPE 4) |
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A cluster-randomised controlled trial |
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A community-based comprehensive intervention to reduce cardiovascular risk in hypertension (HOPE 4) |
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A community-based comprehensive intervention to reduce cardiovascular risk in hypertension (HOPE 4) |
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A community-based comprehensive intervention to reduce cardiovascular risk in hypertension (HOPE 4) |
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A community-based comprehensive intervention to reduce cardiovascular risk in hypertension (HOPE 4) |
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A community-based comprehensive intervention to reduce cardiovascular risk in hypertension (HOPE 4) |
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A community-based comprehensive intervention to reduce cardiovascular risk in hypertension (HOPE 4) |
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Schwalm, Jon-David McCready, Tara Lopez-Jaramillo, Patricio Yusoff, Khalid Attaran, Amir Lamelas, Pablo Camacho López, Paul Anthony Majid, Fadhlina Bangdiwala, Shrikant I. Thabane, Lehana Islam, Shofiqul McKee, Martin Yusuf, Salim |
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Schwalm, Jon-David McCready, Tara Lopez-Jaramillo, Patricio Yusoff, Khalid Attaran, Amir Lamelas, Pablo Camacho López, Paul Anthony Majid, Fadhlina Bangdiwala, Shrikant I. Thabane, Lehana Islam, Shofiqul McKee, Martin Yusuf, Salim |
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2019-10-05 |
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2021-11-17T13:16:33Z |
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2021-11-17T13:16:33Z |
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eng |
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Jon-David Schwalm, Tara McCready, Patricio Lopez-Jaramillo, Khalid Yusoff, Amir Attaran, Pablo Lamelas, Paul A Camacho, Fadhlina Majid, Shrikant I Bangdiwala, Lehana Thabane, Shofiqul Islam, Martin McKee, Salim Yusuf, A community-based comprehensive intervention to reduce cardiovascular risk in hypertension (HOPE 4): a cluster-randomised controlled trial, The Lancet, Volume 394, Issue 10205, 2019, Pages 1231-1242, ISSN 0140-6736, https://doi.org/10.1016/S0140-6736(19)31949-X. (https://www.sciencedirect.com/science/article/pii/S014067361931949X) |
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Scopus |
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The Lancet |
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Copyright © 2019 Elsevier Ltd. All rights reserved. |
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Atribución-NoComercial 4.0 Internacional (CC BY-NC 4.0) |
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12 p |
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Schwalm, Jon-David6b83b076-aaaa-4d09-81b5-d524c025088f-1McCready, Tara2e01aadd-bde9-4281-96ec-00e0c64a8a5d-1Lopez-Jaramillo, Patricio9a71267b-dcb0-4d31-b37d-2d30be58d4d2-1Yusoff, Khalid933db13d-f5bb-4ea6-91a5-68eea1ca9ffc-1Attaran, Amir59c97851-4790-4118-9a7b-0c16a1e87a03-1Lamelas, Pabloc34042d8-0e01-44e0-98aa-83108a6c9b9d-1Camacho López, Paul Anthony594e3832-d941-4df3-b3cc-a2c088dca74c-1Majid, Fadhlina30bf85f0-eeee-42e1-8072-75d98b505521-1Bangdiwala, Shrikant I.ad2a4ed9-cbe3-4dad-a2d9-c457ce2309f2-1Thabane, Lehana42609cea-4e33-41d3-9586-fe88631d8473-1Islam, Shofiqule02df6ce-a317-49c4-8ebd-72d82c266011-1McKee, Martin5258b372-6b7d-4e6f-aaa6-0e81538245af-1Yusuf, Salim06a836b5-f5e3-41d9-a516-9cc46e5d7948-1Everest2021-11-17T13:16:33Z2021-11-17T13:16:33Z2019-10-05DigitalBackground Hypertension is the leading cause of cardiovascular disease globally. Despite proven benefits, hypertension control is poor. We hypothesised that a comprehensive approach to lowering blood pressure and other risk factors, informed by detailed analysis of local barriers, would be superior to usual care in individuals with poorly controlled or newly diagnosed hypertension. We tested whether a model of care involving non-physician health workers (NPHWs), primary care physicians, family, and the provision of effective medications, could substantially reduce cardiovascular disease risk. Methods HOPE 4 was an open, community-based, cluster-randomised controlled trial involving 1371 individuals with new or poorly controlled hypertension from 30 communities (defined as townships) in Colombia and Malaysia. 16 communities were randomly assigned to control (usual care, n=727), and 14 (n=644) to the intervention. After community screening, the intervention included treatment of cardiovascular disease risk factors by NPHWs using tablet computer-based simplified management algorithms and counselling programmes; free antihypertensive and statin medications recommended by NPHWs but supervised by physicians; and support from a family member or friend (treatment supporter) to improve adherence to medications and healthy behaviours. The primary outcome was the change in Framingham Risk Score 10-year cardiovascular disease risk estimate at 12 months between intervention and control participants. The HOPE 4 trial is registered at ClinicalTrials.gov, NCT01826019. Findings All communities completed 12-month follow-up (data on 97% of living participants, n=1299). The reduction in Framingham Risk Score for 10-year cardiovascular disease risk was −6·40% (95% CI 8·00 to −4·80) in the control group and −11·17% (−12·88 to −9·47) in the intervention group, with a difference of change of −4·78% (95% CI −7·11 to −2·44, p<0·0001). There was an absolute 11·45 mm Hg (95% CI −14·94 to −7·97) greater reduction in systolic blood pressure, and a 0·41 mmol/L (95% CI −0·60 to −0·23) reduction in LDL with the intervention group (both p<0·0001). Change in blood pressure control status (<140 mm Hg) was 69% in the intervention group versus 30% in the control group (p<0·0001). There were no safety concerns with the intervention. Interpretation A comprehensive model of care led by NPHWs, involving primary care physicians and family that was informed by local context, substantially improved blood pressure control and cardiovascular disease risk. This strategy is effective, pragmatic, and has the potential to substantially reduce cardiovascular disease compared with current strategies that are typically physician based. Funding Canadian Institutes of Health Research; Grand Challenges Canada; Ontario SPOR Support Unit and the Ontario Ministry of Health and Long-Term Care; Boehringer Ingelheim; Department of Management of Non-Communicable Diseases, WHO; and Population Health Research Institute.Ciencias Médicas y de la Salud12 papplication/pdfhttps://doi.org/10.1016/S0140-6736(19)31949-Xhttps://repositorio.udes.edu.co/handle/001/5708engLondon, England1242102051231324Jon-David Schwalm, Tara McCready, Patricio Lopez-Jaramillo, Khalid Yusoff, Amir Attaran, Pablo Lamelas, Paul A Camacho, Fadhlina Majid, Shrikant I Bangdiwala, Lehana Thabane, Shofiqul Islam, Martin McKee, Salim Yusuf, A community-based comprehensive intervention to reduce cardiovascular risk in hypertension (HOPE 4): a cluster-randomised controlled trial, The Lancet, Volume 394, Issue 10205, 2019, Pages 1231-1242, ISSN 0140-6736, https://doi.org/10.1016/S0140-6736(19)31949-X. (https://www.sciencedirect.com/science/article/pii/S014067361931949X)ScopusThe LancetCopyright © 2019 Elsevier Ltd. All rights reserved.info:eu-repo/semantics/closedAccessAtribución-NoComercial 4.0 Internacional (CC BY-NC 4.0)https://creativecommons.org/licenses/by-nc/4.0/http://purl.org/coar/access_right/c_14cbhttps://www.sciencedirect.com/science/article/abs/pii/S014067361931949X?via%3DihubA community-based comprehensive intervention to reduce cardiovascular risk in hypertension (HOPE 4)A cluster-randomised controlled trialArtículo de revistahttp://purl.org/coar/resource_type/c_6501http://purl.org/coar/resource_type/c_2df8fbb1Textinfo:eu-repo/semantics/articlehttp://purl.org/redcol/resource_type/ARTinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/version/c_970fb48d4fbd8a85Todas las AudienciasPublicationORIGINALA community-based comprehensive intervention to reduce cardiovascular risk in hypertension (HOPE 4). 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