Community Health Worker-Led Intervention to Control Blood Pressure

Evidence Rating: Suggestive Tier

Highlights

Program: Hypertension Control Program in Argentina (HCPIA), a multicomponent program to improve blood pressure control among low-income patients with hypertension. The program includes a community health worker-led, home-based component; a physician training component; and a text messaging component.
Evaluation Methods: A well-conducted randomized controlled trial (RCT) in which 18 community health care centers in Argentina were randomly assigned to a treatment versus control group.
Key Findings: 18 months after random assignment, 73% of HCPIA patients had controlled hypertension (i.e., a blood pressure reading under 140/90 mm Hg) versus 52% of control group patients. This difference was statistically significant.
Other: The program was evaluated in a middle-income country (Argentina), with a sample of low-income, uninsured patients who receive free medications and health care as part of a national public system. Whether the results would generalize to the United States or other settings is yet unknown; replication trials in such settings are needed to find out.

The Hypertension Control Program in Argentina (HCPIA) is an 18-month multicomponent program to improve blood pressure control among low-income, uninsured patients with hypertension. The program includes (i) a community health worker-led, home-based component, in which health workers coach patients on lifestyle modifications to reduce blood pressure, home blood pressure monitoring, and medication adherence during monthly or bi-monthly home visits; (ii) physician training and certification in blood pressure management; and (iii) weekly, personalized text messages sent to patients to encourage medication adherence and health behavioral change. The average cost of the program is approximately $115 per patient.

References

He, J., V. Irazola, K.T. Mills, R. Poggio, A. Beratarrechea, J. Dolan, C. Chen, L. Gibbons, M. Krousel-Wood, L.A. Bazzano, A. Nejamis, P. Gulayin, M. Santero, F. Augustovski, J. Chen, & A. Rubinstein (2017). Effects of a Community Health Worker-Led Multicomponent Intervention on Blood Pressure Control in Low-Income Patients in Argentina: A randomized clinical trial. The Journal of the American Medical Association 318(11): 1016-1025.

Murray, David M., Sherri P. Varnell, and Jonathan L. Blitstein (2004). Design and Analysis of Group-Randomized Trials: A Review of Recent Methodological Developments. American Journal of Public Health. 94(3): 423-432.

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Top Tier

Programs shown in well-conducted RCTs, carried out in typical community settings, to produce sizable, sustained effects on important outcomes. Top Tier evidence includes a requirement for replication – specifically, the demonstration of such effects in two or more RCTs conducted in different implementation sites, or, alternatively, in one large multi-site RCT. Such evidence provides confidence that the program would produce important effects if implemented faithfully in settings and populations similar to those in the original studies.
Near Top Tier

Programs shown to meet almost all elements of the Top Tier standard, and which only need one additional step to qualify. This category primarily includes programs that meet all elements of the Top Tier standard in a single study site, but need a replication RCT to confirm the initial findings and establish that they generalize to other sites. This is best viewed as tentative evidence that the program would produce important effects if implemented faithfully in settings and populations similar to those in the original study.
Suggestive Tier

Programs that have been evaluated in one or more well-conducted RCTs (or studies that closely approximate random assignment) and found to produce sizable positive effects, but whose evidence is limited by only short-term follow-up, effects that fall short of statistical significance, or other factors. Such evidence suggests the program may be an especially strong candidate for further research, but does not yet provide confidence that the program would produce important effects if implemented in new settings.

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