Effectiveness of community-based health education and home support program to reduce blood pressure among patients with uncontrolled hypertension in Nepal: A cluster-randomized trial

Primary Prevention of Cardiovascular Disease in Asia: Opportunities and Solutions: A Narrative Review

IMPORTANCE

Asia faces a rapidly rising burden of cardiovascular disease (CVD). Preventive cardiology efforts may help address the CVD epidemic.

OBSERVATIONS

Solutions to address the CVD burden include a cardiovascular risk assessment framework, improving health screening efforts, better cardiovascular risk factor management, novel innovation strategies encompassing targeted lifestyle measures, and strengthening governmental efforts. With the region's wide socioeconomic and other disparities, contextualizing and practical adaptation of various strategies into local practices, especially in low-middle-income countries, will determine the success of CVD prevention efforts.

CONCLUSIONS

A differential approach addressing cardiovascular risk factor screening, prevention, and management that considers the context-specific socioeconomic, governmental, and cultural aspects in diverse Asian populations may help reduce the rapidly rising CVD trajectory in Asia.

Colostomy care education to increase the knowledge and skills of parents caring for children with a stoma

BACKGROUND

Colostomy surgery in developing countries can save children's lives, but improper care can lead to complications. Successful treatment emphasises the role of parents. Education on caring for a colostomy in children increases parents' knowledge and skills in providing effective care.

AIM

To explore the influence of education on knowledge and skills of parents caring for children with a stoma.

METHODS

A literature review was conducted by searching for articles in online databases including PubMed Central, NCBI, Wiley, ProQuest and Elsevier. Quasi-experimental studies published between 2014 and 2023 on paediatric colostomy care education were screened for eligibility.

RESULTS

A total of 9 articles were considered eligible for inclusion, and the thematic analysis described the effects of using different media to deliver educational interventions to parents of children with a stoma. Participants were parents, and the outcomes measured included knowledge and skills in caring for children with a stoma.

CONCLUSION

Education improved the knowledge and skills of parents, but literature was limited, and the educational interventions were not applied continuously.

Advancements in Managing Choledocholithiasis and Acute Cholangitis in the Elderly: A Comprehensive Review

The increasing elderly population has led to a rising prevalence of choledocholithiasis and acute cholangitis, presenting unique diagnostic and therapeutic challenges owing to age-related physiological changes and multiple comorbidities. This comprehensive review synthesizes current evidence and recent advances in managing these conditions in elderly patients, with a particular focus on diagnostic innovations, therapeutic strategies, and perioperative optimization. Recent advances in diagnostic modalities, including enhanced imaging techniques and AI-assisted systems, have improved early detection accuracy, whereas minimally invasive interventions, particularly endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic common bile duct exploration (LCBDE), have demonstrated superior outcomes when combined with comprehensive perioperative care. The implementation of multidisciplinary approaches and personalized treatment strategies has significantly improved patient outcomes, with evidence supporting the critical role of early antibiotic intervention, careful surgical selection, and enhanced recovery protocols in reducing morbidity and mortality. The optimal management of elderly patients with choledocholithiasis and acute cholangitis requires a systematic, individualized approach incorporating advanced diagnostic techniques, minimally invasive interventions, and comprehensive perioperative care, while future research should focus on developing age-specific treatment algorithms and validating novel therapeutic approaches.

Primary Care-Based Digital Health-Enabled Stroke Management Intervention: Long-Term Follow-Up of a Cluster Randomized Clinical Trial

Importance

Despite evidence of the short-term benefits of multicomponent primary care-based interventions, their long-term effects are unproven.

Objective

To evaluate the long-term outcomes of a system-integrated technology-enabled model of care (SINEMA intervention) for stroke management for systolic blood pressure (BP) and other outcomes among patients with stroke in China.

Design, Setting, and Participants

This long-term follow-up included community-dwelling clinically stable surviving participants with stroke in an open-label cluster randomized clinical trial. Of 218 villages from Nanhe County in Hebei, China, an area with suboptimal health care resources and stroke prevalence doubling the national average, 50 villages (clusters) were recruited between June 23 and July 29, 2017, and randomized in a 1:1 ratio to an intervention or a control arm (usual care). The intervention lasted 1 year (to July 31, 2018), with a posttrial observational follow-up conducted from October 1, 2022, to August 27, 2023.

Interventions

Village doctors were provided with training, performance-based incentives, technical support, and customized mobile health tools to deliver monthly follow-up to patients. Patients also received daily voice messages emphasizing medication adherence and physical activity. No intervention was requested or supported during the posttrial period.

Main Outcomes and Measures

Between-arm differences in intention-to-treat analyses of individual-level changes from baseline to long-term posttrial in systolic BP (primary outcome) and stroke recurrence, diastolic BP, BP control, antihypertensive medication use and regimen adherence, and disability (secondary outcomes).

Results

Among a total of 1042 stroke survivors, 44 (4.2%) were lost to follow-up and 998 (mean [SD] age at baseline: 65.0 [8.2] years; 544 [54.4%] men) completed posttrial assessment at a mean (SD) period of 66.6 (3.7) months (5.5 years) after baseline. The multicomponent intervention was associated with an estimated between-arm net reduction in systolic BP of -2.8 (95% CI, -5.3 to -0.3) mm Hg (P = .03). Most secondary outcomes showed a tendency toward lasting effects, with a notable absolute net reduction of 6.0 (95% CI, -11.3 to -0.7) percentage points and risk ratio of 0.77 (95% CI, 0.61-0.99) for stroke recurrence. In subgroup analyses, significant between-arm differences were observed among women and people with lower educational attainment, lower income, and higher use of and adherence to medications.

Conclusions and Relevance

In this long-term follow-up of a cluster randomized clinical trial, the 1-year intervention was associated with significantly reduced systolic BP and stroke recurrence at 5.5 years, providing evidence of long-term health and inequity-reducing benefits and holding promise for scaling up of the intervention in resource-limited settings.

Trial Registration

ClinicalTrials.gov Identifier: NCT05792618.

Effect of health extension workers-led home-based multicomponent intervention on blood pressure reduction among hypertensive patients in rural districts of northwest Ethiopia: a cluster-randomised controlled trial

OBJECTIVES

To evaluate effects of health extension workers-led home-based multicomponent intervention on blood pressure change in hypertensive patients in rural districts of northwest Ethiopia.

DESIGN

Two-arm cluster randomised controlled trial was conducted.

PARTICIPANTS

Hypertensive patients' age ≥25 years were included. 20 clusters or kebeles with 456 participants were randomly assigned to the intervention group (10 clusters with 228 participants) and the control group (10 clusters with 228 participants).

INTERVENTIONS

Participants in the intervention kebeles received health extension workers-led home-based multicomponent interventions every other month for 40-60 min for 9 months.

MAIN OUTCOME MEASURES

The primary outcomes were the differences in mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) changes from baseline between patients in the intervention and control groups. Intention-to-treat analysis was used for the primary analyses. Linear mixed effect model was used to evaluate the intervention's effect on change in mean SBP and DBP. Effect sizes of mean difference and relative benefit increase were used.

RESULTS

At 9 months, the mean SBP decreased by 15.8 mm Hg (95% CI: 13.5, 18.1) in the intervention and 10.8 mm Hg (95% CI: 8.7, 12.9) in the control groups; with a 5.0 mm Hg (95% CI: 1.9, 8.1) greater reduction in the intervention group. The mean DBP decreased by 12.1 mm Hg (95% CI: 10.6, 13.5) in the intervention and 8.4 mm Hg (95% CI: 7.0, 9.8) in the control group. The proportion of optimal blood pressure control was higher in the intervention group (45.8%) than the control group (28.2%) with percentage difference of 17.6% (95% CI: 8.5, 26.7).

CONCLUSIONS

Health extension workers-led home-based multicomponent intervention has resulted significant reduction of blood pressure and achieved a higher proportion of optimal blood pressure control. This strategy is effective, but further research is needed to determine its cost effectiveness for scaling up and integrating in primary care settings.

TRIAL REGISTRATION

The trial is registered with Pan African clinical trial registry (PACTR202102729454417).

Evaluation of the effects of health education interventions for hypertensive patients based on the health belief model

BACKGROUND

Hypertension is a major risk factor for cardiovascular disease and stroke, and its prevalence is increasing worldwide. Health education interventions based on the health belief model (HBM) can improve the knowledge, attitudes, and behaviors of patients with hypertension and help them control their blood pressure.

AIM

To evaluate the effects of health education interventions based on the HBM in patients with hypertension in China.

METHODS

Between 2021 and 2023, 140 patients with hypertension were randomly assigned to either the intervention or control group. The intervention group received health education based on the HBM, including lectures, brochures, videos, and counseling sessions, whereas the control group received routine care. Outcomes were measured at baseline, three months, and six months after the intervention and included blood pressure, medication adherence, self-efficacy, and perceived benefits, barriers, susceptibility, and severity.

RESULTS

The intervention group had significantly lower systolic blood pressure [mean difference (MD): -8.2 mmHg, P < 0.001] and diastolic blood pressure (MD: -5.1 mmHg, P = 0.002) compared to the control group at six months. The intervention group also had higher medication adherence (MD: 1.8, P < 0.001), self-efficacy (MD: 12.4, P < 0.001), perceived benefits (MD: 3.2, P < 0.001), lower perceived barriers (MD: -2.6, P = 0.001), higher perceived susceptibility (MD: 2.8, P = 0.002), and higher perceived severity (MD: 3.1, P < 0.001) than the control group at six months.

CONCLUSION

Health education interventions based on the HBM effectively improve blood pressure control and health beliefs in patients with hypertension and should be implemented in clinical practice and community settings.

Effectiveness of a Health Education Program in Hypertensive Patients with Dyslipidemia and/or Microalbuminuria: A Quasi-Experimental Study in Vinh Long Province, Vietnam

INTRODUCTION

Hypertension, a major health concern, is associated with significant mortality and disease burden worldwide, including Vietnam. Comprehensive interventions targeting medication, lifestyle modifications, dyslipidemia (DLP), and microalbuminuria (MAU) are vital for effective hypertension management and reducing the risk of cardiovascular disease complications (CDV). While medication interventions have proven efficacy, the evidence regarding the effectiveness of community-based health education interventions in managing DLP and MAU is limited. Therefore, this study aims to evaluate the effectiveness of community health education interventions in reducing hypertension risk factors and achieving hypertension management objectives, as well as managing DLP and MAU among hypertension patients.

METHODS

A quasi-experimental study was conducted on 330 hypertensive patients with dyslipidemia (DLP) and/or microalbuminuria (MAU) who were divided into a control group (n = 164) and an intervention group (n = 166). The control group received standard national hypertension management, while the intervention group received additional intensive health education provided by trained volunteers. The effectiveness of the intervention was assessed by comparing outcomes such as lifestyle factors, BMI control, treatment adherence, hypertension control, and DLP and MAU status between the two groups before and after a two-year intervention period.

RESULTS

The health education intervention resulted in significant reductions in dietary risk factors, specifically in fruit and vegetable consumption (p < 0.001). There was a lower prevalence of high salt intake in the intervention group compared to the control group (p = 0.002), while no significant differences were observed in other dietary factors. Smoking habits and low physical activity significantly decreased in the intervention group, with a notable disparity in physical activity proportions (p < 0.001). Both groups showed significant improvements in achieving hypertension management targets, with the intervention group demonstrating superior outcomes. The intervention was effective in reducing the prevalence of risk factors, particularly treatment non-adherence, blood pressure control, and low physical activity. Additionally, the intervention group had a higher likelihood of achieving DLP and MAU control compared to the control group.

CONCLUSIONS

This study underscored the additional positive impact of incorporating health education by non-professional educators in achieving favorable outcomes, including better control of BMI, blood pressure, medication adherence, and management of dyslipidemia (DLP) and microalbuminuria (MAU). Further research is warranted to fully explore the potential of health education in primary healthcare settings and maximize its effectiveness.

Evaluation of community-based care delivered by primary healthcare providers in management of hypertension in a rural area of West Bengal

Background

Lifestyle modifications and medication compliance are key strategies.

Objectives

To evaluate the effect of community-based care delivered by trained primary healthcare providers in management of hypertension.

Materials and Methods

A longitudinal study was conducted between two groups of newly diagnosed hypertensive patients to evaluate the impact of an educational intervention. Six blocks in a district were chosen with pairwise matching. All primary healthcare providers of one block in each pair were randomized to receive the intervention and the other was controlled. Next screening for risk factors, detection of hypertension, counseling, and follow-up care were provided. The patients within the control group received usual care as per clinician's discretion. A total of 227 patients in the "study" group and 230 patients in the "control" group were recruited from 12 subcenters selected randomly. Data analysis was done by χ2 test, t test, and GLM analysis using SPSS 16.

Results

Patients in the intervention blocks demonstrated a statistically significant mean reduction in SBP of 16.14 ± 0.82 and DBP by 11.65 ± 0.53 compared to 9.83 ± 1.02 and 7.68 ± 0.66, respectively, in the control blocks after adjusting for age, sex, and baseline blood pressure at one-year follow-up. Regarding lifestyle-related cardiovascular risk factors, statistically significant differences were found in favor of the intervention group.

Conclusion

The study supports and reinforces the utilization of trained primary healthcare providers under the NPCDCS program in screening and promoting blood pressure control by preventive services to hypertensive patients in the community.

Influence of Internet-Based Health Management on Control of Clinical Parameters in Patients With Hypertension: Four-Year Longitudinal Study

BACKGROUND

In recent years, more and more studies have shown that internet-based health management can help patients with hypertension control their blood pressure. However, there is a lack of similar research in China.

OBJECTIVE

We designed this study to clarify the impact of long-term internet-based health management on the control of clinical parameters in patients with hypertension. These results are also expected to identify the relevant factors affecting the control of clinical parameters in hypertension more accurately toward developing more targeted health management strategies.

METHODS

This was a longitudinal study of internet-based health management in the five provinces of northwest China. The inclusion criteria were aged ≥18 years and no serious cognitive disease or mental disorder. After collecting the physical examination data of 8567 people in the five northwest provinces in 2013, we conducted online health management (including diet, exercise, and behavior) and follow-up. In the physical examination in 2013, 1008 new patients with hypertension were identified, who were divided into a good blood pressure control group and poor blood pressure control group. Physical examination and a questionnaire survey were conducted every 2 years to understand the changes of health management on the subjects' health-related behaviors. We then analyzed the changes of clinical indicators related to hypertension and the influencing factors related to blood pressure control in patients with hypertension. All statistical analyses were performed using R software (version 4.1.2) and a P value <.05 was considered statistically significant.

RESULTS

A total of 8567 people met the inclusion criteria and underwent health management. Self-comparison showed that after 4 years of health management, the smoking cessation rate and amount of exercise significantly increased (both P<.001). The low-density lipoprotein-cholesterol levels also increased (P=.005), whereas the high-density lipoprotein-cholesterol levels decreased (P=.007). The newly discovered patients with hypertension in 2013 were further screened. After 4 years of health management, their smoking cessation rate increased significantly (P=.03) and the amount of exercise increased but not significantly (P=.08). In terms of clinical indicators, the diastolic blood pressure considerably decreased (P<.001) and the systolic blood pressure slightly decreased (P=.13). The correlation analysis of blood pressure control in patients with new-onset hypertension showed that gender (female) and changing relevant factors according to health management behaviors (BMI; cereals and potatoes intake; fish, livestock meat, and eggs intake; fruit intake; and physical activity) were the protective factors of blood pressure control.

CONCLUSIONS

Internet-based health management has a significant and long-term effect on blood pressure control in patients with hypertension.

Effects of lifestyle interventions on cardiovascular risk factors in South Asians: a systematic review and meta-analysis

BACKGROUND

The cardiovascular disease (CVD) burden among South Asians is high. Lifestyle interventions have been effective in the primary prevention of CVD, but this has not been replicated, through a synthesis of randomised trials, in South Asians.

METHODS

Four electronic databases (MEDLINE, Embase, CENTRAL and CINAHL), two clinical trial registries and references of included articles were searched through June 2022 (featuring ≥90% South Asian participants). Random-effects pairwise meta-analyses were performed, and heterogeneity was quantified with the I2 statistic. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework was used to report on the quality of evidence (International Prospective Register of Systematic Reviews registration (PROSPERO).

RESULTS

Thirty-five studies were included. Twelve tested diet and physical activity interventions; 18 tested diet alone; and 5 tested physical activity alone. All reported effects of the intervention(s) on at least one established risk factor for CVD, including blood pressure (systolic blood pressure (SBP), diastolic blood pressure (DBP) and blood lipids (high-density lipoprotein cholesterol (HDLc), low-density lipoprotein cholesterol (LDLc) or triglycerides). No trials reported clinical CVD. There is moderate-quality evidence that diet and physical activity interventions improve SBP (mean difference (MD) -2.72 mm Hg, 95% CI -4.11 to -1.33) and DBP (MD -1.53 mm Hg, 95% CI -2.57 to -0.48); high-quality to moderate-quality evidence that diet-only interventions improve DBP (MD -2.05 mm Hg, 95% CI -2.93 to -1.16) and blood lipids (triglycerides (MD -0.10 mmol/L, 95% CI -0.14 to -0.06) and LDLc (MD -0.19 mmol/L, 95% CI -0.32 to -0.06)); and moderate-quality evidence that physical activity-only interventions improve SBP (MD -9.7 mm Hg, 95% CI -11.05 to -8.35), DBP (MD -7.29 mm Hg, 95% CI -8.42 to -6.16) and HDLc (MD 0.08 mmol/L, 95% CI 0.04 to 0.11) compared with usual care.

CONCLUSIONS

Lifestyle interventions improve blood pressure and blood lipid profiles in adult South Asians at risk of CVD. Tailored interventions should be used to modify cardiovascular risk factors in this at-risk group.

PROSPERO REGISTRATION NUMBER

CRD42018090419.

Need for HTA supported risk factor screening for hypertension and diabetes in Nepal: A systematic scoping review

Objective

Health Technology Assessment (HTA) is a comprehensive and important tool for assessment and decision-making in public health and healthcare practice. It is recommended by the WHO and has been applied in practice in many countries, mostly the developed ones. HTA might be an important tool to achieve universal health coverage (UHC), especially beneficial to low-and-middle-income countries (LMIC). Even though the Package for Essential Non-communicable Diseases (PEN) has already been initiated, there is a clear policy gap in the HTA of any health device, service, or procedure, including the assessment of cardiovascular risk factors (CVRFs) in Nepal. Hence, we carried out the review to document the HTA supported evidence of hypertension and diabetes screening, as CVRFs in Nepal.

Materials and methods

We searched in PubMed, Cochrane, and Google Scholar, along with some gray literature published in the last 6 years (2016-2021) in a systematic way with a controlled vocabulary using a well-designed and pilot tested search strategy, screened them, and a total of 53 articles and reports that matched the screening criteria were included for the review. We then, extracted the data in a pre-designed MS-Excel format, first in one, and then, from it, in two, with more specific data.

Results

Of 53 included studies, we reported the prevalence and/or proportion of hypertension and diabetes with various denominators. Furthermore, HTA-related findings such as cost, validity, alternative tool or technology, awareness, and intervention effectiveness have been documented and discussed further, however, not summarized due to their sparingness.

Conclusion

Overall, the prevalence of DM (4.4-18.8%) and HTN (17.2-70.0%) was reported in most studies, with a few, covering other aspects of HTA of DM/HTN. A national policy for establishing an HTA agency and some immediately implementable actions are highly recommended.