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

Mahesh Kumar Khanal, Pratiksha Bhandari, Raja Ram Dhungana, Pratik Bhandari, Lal B Rawal, Yadav Gurung, K N Paudel, Amit Singh, Surya Devkota, Barbora de Courten, Mahesh Kumar Khanal, Pratiksha Bhandari, Raja Ram Dhungana, Pratik Bhandari, Lal B Rawal, Yadav Gurung, K N Paudel, Amit Singh, Surya Devkota, Barbora de Courten

Abstract

Background: Hypertension is a major global public health problem. Elevated blood pressure can cause cardiovascular and kidney diseases. We assessed the effectiveness of health education sessions and home support programs in reducing blood pressure among patients with uncontrolled hypertension in a suburban community of Nepal.

Methods: We conducted a community-based, open-level, parallel-group, cluster randomized controlled trial in Birendranagar municipality of Surkhet, Nepal. We randomly assigned four clusters (wards) into intervention and control arms. We provided four health education sessions, frequent home and usual care for intervention groups over six months. The participants of the control arm received only usual care from health facilities. The primary outcome of this study was the proportion of controlled systolic blood pressure (SBP). The analysis included all participants who completed follow-up at six months.

Results: 125 participants were assigned to either the intervention (n = 63) or the control (n = 62) group. Of them, 60 participants in each group completed six months follow-up. The proportion of controlled SBP was significantly higher among the intervention participants compared to the control (58.3% vs. 40%). Odds ratio of this was 2.1 with 95% CI: 1.01-4.35 (p = 0.046) and that of controlled diastolic blood pressure (DBP) was 1.31 (0.63-2.72) (p = 0.600). The mean change (follow-up minus baseline) in SBP was significantly higher in the intervention than in the usual care (-18.7 mmHg vs. -11.2 mmHg, p = 0.041). Such mean change of DBP was also higher in the intervention (-10.95 mmHg vs. -5.53 mmHg, p = 0.065). The knowledge score on hypertension improved by 2.38 (SD 2.4) in the intervention arm, which was significantly different from that of the control group, 0.13 (1.8) (p<0.001).

Conclusions: Multiple health education sessions complemented by frequent household visits by health volunteers can effectively improve knowledge on hypertension and reduce blood pressure among uncontrolled hypertensive patients at the community level in Nepal.

Trial registration: ClinicalTrial.gov: NCT02981251.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. CONSORT 2010 flow diagram of…
Fig 1. CONSORT 2010 flow diagram of study participants.
Fig 2. Box-plot of mean SBP and…
Fig 2. Box-plot of mean SBP and DBP of intervention and control group.

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