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The largest study on hypertension
ever to be conducted in Pakistan was launched on April 19, 2004 by Aga Khan
University (AKU), following a US $500,000 grant from UK-based Wellcome Trust,
widely known for its high profile in the best academic and research circles
throughout the world. AKU's activities based on research are strengthened through
collaborative linkages with prestigious national and international institutions
with established expertise in particular areas of focus as defined by the University.
The study entitled "Population-Based
Strategies for Effective Control of High Blood Pressure in Pakistan" is designed
by Dr. Tazeen Jafar, Associate Professor, and faculty from the Departments of
Community Health Sciences and Medicine at AKU, in collaboration with Imperial
College, UK.
The 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. The results also 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 University appreciates
that the endemic problems of a region beset with financial difficulties and
low development indicators can be addressed only through relevant research focusing
on producing low cost, accessible and innovative solutions.
The full scale study will
be conducted on about 20,000 subjects from randomly selected low and middle-income
communities in Karachi. This study includes a population survey to estimate
the burden of cardiovascular disease, and, 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 programme. AKU provides an enabling environment to conduct
research for needs that are widespread.
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