Population Based Strategies for Effective Control of High Blood Pressure in Pakistan
Today Aga Khan University formally launched the largest study on hypertension conducted in Pakistan. This project was funded by UK-based Wellcome Trust, widely known for its high profile in the best academic and research circles throughout the world. The study entitled "Population-Based Strategies for Effective Control of High Blood Pressure in Pakistan " was designed by faculty from Departments of Community Health Sciences and Medicine in collaboration with Imperial College, UK.
This study follows the successful completion of a pilot study which used rigorous scientific criteria for determining the burden of hypertension, diabetes, and heart disease in a representative adult population of Karachi. The study revealed that one in three middle aged adults have evidence of hypertension and one in four of diabetes and heart disease. Further, the results showed that women have at least equivalent risks of heart disease to men. This is the highest prevalence of chronic illnesses reported from this region of the world, and deserves emergent attention.
The full scale study being launched now would be conducted on about 20,000 subjects from randomly selected low and middle-income communities in Karachi. This study includes 1) a population survey to estimate the burden of cardiovascular disease, and, 2) a randomized intervention trial to assess the impacts of a Population Approach and a High Risk Approach on control of high blood pressure.
The Population Approach consists of home health education (HHE) delivered by trained community health workers (CHW) to children, women and men versus no HHE. Health messages will include information on the deleterious effects of hypertension, and non-pharmacological interventions for preventing and controlling hypertension and CVD, along with advice on weight loss strategies, exercise, smoking cessation, low salt and saturated fat intake, and high fruit and vegetable intake. Special advice will be designed for children to ensure adequate caloric and nutrient intake for optimum growth. The CHWs will make appointments for the first two sessions, each lasting one and one-half hours within one month of each other, at times that are convenient to most occupants in the house. The messages will be reinforced during subsequent 3-monthly visits of one hour each. This proposed frequency of visit by CHW is consistent with other government sponsored home-based preventive services in Pakistan, thus, ensuring sustainability.
The High Risk Approach comprises of targeted training of general practitioners (GP). These GPs will be intensively trained in standard treatment algorithms for management of hypertension using non-pharmacologic (diet, weight loss, exercise) and low cost generic drug intervention. Hypertensive adults identified in the population survey would be randomized to care by specially trained GP or usual care in the community.
Outcomes including blood pressure levels of the study population would be assessed during a follow-up period of two years and cost effectiveness of the strategies would be assessed by in-depth economic analysis.
This is the first large scale study on hypertension to be conducted in Pakistan with the long-term objective of leading the development of a sustainable and implementable nationwide blood pressure control program.