Nav: Home

It takes a community to lower cardiovascular risk

September 02, 2019

HAMILTON, ON (Sept. 2, 2019) - Concerted effort by friends, family and non-physician health workers can make a dramatic difference in reducing the risk factors for heart problems in patients with hypertension, an international study by Hamilton researchers has found.

People with new or poorly controlled hypertension given an integrated and comprehensive intervention by non-physician health workers along with personal supporters over a year had a reduction in cardiovascular risk of more than 40 per cent compared to usual care.

"There was a doubling in blood pressure control, with reductions in low-density lipoprotein (LDL) cholesterol, and improvements in medication adherence, physical activity, and diet," said lead author Jon-David Schwalm of the Population Health Research Institute (PHRI) of McMaster University and Hamilton Health Sciences.

The study results are part of a presentation today in Paris, France at the European Society of Cardiology Congress with the World Congress of Cardiology and are also being published in The Lancet. The clinical trial, called Heart Outcomes Prevention and Evaluation 4 or HOPE 4, is led by PHRI.

Hypertension is the leading cause of cardiovascular disease worldwide, with the majority of the burden in low- and middle-income countries. Although there are clear benefits and recommendations for the use of antihypertensive medications and statins in patients with hypertension, control of blood pressure and use of statins in these countries is very low.

The study involved 1,371 people 50 or older from 30 communities in Colombia and Malaysia.

People in sixteen communities received usual care and those in 14 communities had an intervention that included the initiation and monitoring of treatments and controlling risk factors by non-physician health workers using computer tablet-based management algorithms and counselling; the provision of free antihypertensive and statin medicines recommended by non-physician health workers under supervision of physicians, and the involvement of a friend or family member to support adherence to medications and lifestyle advice.

"Previous studies with non-physician health workers led to modest effects on cardiovascular risk factors. We tested whether an intervention involving health workers, general practitioners and family, with provision of evidence-based medications, can safely and substantially reduce individual cardiovascular risk and found it successful," said Schwalm, an associate professor of medicine at McMaster, a scientist at the PHRI and an interventional cardiologist at Hamilton Health Sciences.

Regarding how the intervention was done, computer tablets were used to collect study data, help the health workers make decisions when with the patients using simplified management algorithms to initiate and monitor antihypertensives and statins, and support counselling participants on health behaviours.

The friend or family supporter was encouraged to attend sessions with the health worker or physician, and they were present at three-quarters of the visits. In addition, the supporter's role was to give ongoing help to improve adherence to medications and healthy behaviours between scheduled health worker visits.

The primary outcome was change in Framingham Risk Score, which is an estimate of the ten-year risk of cardiovascular disease. In those who received the intervention, their risk score dropped by 11.2 per cent as compared to 6.4 per cent in the control. This is approximately two fold.

There was an 11.45 mmHg greater reduction in systolic blood pressure, and a 0.41 mmol/L larger reduction in serum LDL cholesterol in the intervention, compared to the control group. Both of these findings are statistically significant and predict large reductions in future cardiovascular disease events. The proportion of patients with controlled hypertension was more than twice as great, 69 per cent in the intervention group compared to 31 per cent in the control group.

In particular, there were important improvements in physical activity and diet.

"All components of the intervention were essential to the benefits observed," Schwalm said. "Our intervention is innovative in how, by taking a systems approach, it is more than the sum of its parts. It was developed after a detailed health system assessment and barrier analysis in each country, using a combination of quantitative and qualitative research, to identify local challenges and tailor the intervention to overcome these."

Salim Yusuf, principal investigator of the study and PHRI executive director, added that the research results will have global impact.

"This strategy is pragmatic, effective, and scalable, and has the potential to substantially reduce cardiovascular disease globally, compared to current methods that are solely physician based," he said.

"Adopting or adapting the HOPE 4 strategy in different countries to better control hypertension and reduce other risk factors could help achieve the United Nations' target for a one-third reduction in premature cardiovascular mortality by 2030."
The trial is sponsored by the Canadian Institutes of Health Research, Grand Challenges Canada, Ontario SPOR Support Unit and the Ontario Ministry of Health, Boehringer Ingelheim, the World Health Organization, PHRI and the Hamilton Health Sciences Research Institute.

Editors: A picture of lead author Jon-David Schwalm is included with this email.

Post-embargo link to paper:

For more information or to arrange an interview, please contact:

Susan Emigh
Public Relations, Faculty of Health Sciences
McMaster University
905-525-9140, ext. 22555

McMaster University

Related Blood Pressure Articles:

Arm cuff blood pressure measurements may fall short for predicting heart disease risk in some people with resistant high blood pressure
A measurement of central blood pressure in people with difficult-to-treat high blood pressure could help reduce risk of heart disease better than traditional arm cuff readings for some patients, according to preliminary research presented at the American Heart Association's Hypertension 2019 Scientific Sessions.
Heating pads may lower blood pressure in people with high blood pressure when lying down
In people with supine hypertension due to autonomic failure, a condition that increases blood pressure when lying down, overnight heat therapy significantly decreased systolic blood pressure compared to a placebo.
The Lancet Neurology: High blood pressure and rising blood pressure between ages 36-53 are associated with smaller brain volume and white matter lesions in later years
A study of the world's oldest, continuously-studied birth cohort tracked blood pressure from early adulthood through to late life and explored its influence on brain pathologies detected using brain scanning in their early 70s.
Blood pressure control is beneficial, is it not?
Until recently, physicians had generally assumed that older adults benefit from keeping their blood pressure below 140/90 mmHg.
The 'blue' in blueberries can help lower blood pressure
A new study published in the Journal of Gerontology Series A has found that eating 200g of blueberries every day for a month can lead to an improvement in blood vessel function and a decrease in systolic blood pressure in healthy people.
How to classify high blood pressure in pregnancy?
The American Heart Association (AHA) and the American College of Cardiology (ACC) changed their guidance to lower the threshold criteria for hypertension in adults.
Discovery could advance blood pressure treatments
A team of Vanderbilt University Medical Center researchers, working with the US Department of Veteran's Affairs (VA), has discovered genetic associations with blood pressure that could guide future treatments for patients with hypertension.
Blue light can reduce blood pressure
Exposure to blue light decreases blood pressure, reducing the risk of developing cardiovascular disease, a new study from the University of Surrey and Heinrich Heine University Dusseldorf in collaboration with Philips reports.
Poor oral health linked to higher blood pressure, worse blood pressure control
Poor oral health may interfere with blood pressure control in people diagnosed with hypertension.
Largest ever genetic study of blood pressure
The largest ever genetic analysis of over one million people has identified 535 new genes associated with high blood pressure.
More Blood Pressure News and Blood Pressure Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Rethinking Anger
Anger is universal and complex: it can be quiet, festering, justified, vengeful, and destructive. This hour, TED speakers explore the many sides of anger, why we need it, and who's allowed to feel it. Guests include psychologists Ryan Martin and Russell Kolts, writer Soraya Chemaly, former talk radio host Lisa Fritsch, and business professor Dan Moshavi.
Now Playing: Science for the People

#538 Nobels and Astrophysics
This week we start with this year's physics Nobel Prize awarded to Jim Peebles, Michel Mayor, and Didier Queloz and finish with a discussion of the Nobel Prizes as a way to award and highlight important science. Are they still relevant? When science breakthroughs are built on the backs of hundreds -- and sometimes thousands -- of people's hard work, how do you pick just three to highlight? Join host Rachelle Saunders and astrophysicist, author, and science communicator Ethan Siegel for their chat about astrophysics and Nobel Prizes.