Now, a new study published September 2, 2019, in The Lancet has suggested that community health workers can help patients get their blood pressure under control by delivering free medicine, counseling them on how to eat better and exercise more, and enlisting family and friends to encourage them to take their pills and make lifestyle changes. For the study, researchers followed 644 adults with hypertension in 14 communities in Colombia and Malaysia with established interventions that used health workers and close family and friends to help patients keep their blood pressure in check. Researchers also followed a control group of 727 patients in 16 communities who were screened for high blood pressure and told to see a doctor without getting extra support. At the start of the study, researchers assessed each patient’s risk of having a major cardiovascular event like a heart attack or stroke over the next decade using a tool known as the Framingham risk score. Where people received the community health intervention, patients’ average risk of a serious heart problem over the next decade started out at 32.6 percent and dropped by 11.2 percentage points by the end of the study. With the control groups, patients’ average risk started at 35.5 percent and dipped by 6.4 percentage points. The difference between communities can be explained by two things — support and accountability — says Andrew Moran, MD, MPH, an associate professor of medicine at Columbia University in New York City and director of global hypertension control at the nonprofit Resolve to Save Lives. “Making even simple changes in our habits is hard,” says Dr. Moran, who wasn’t involved in the study. “If you’ve ever tried to stick to a diet or exercise program, you know that the support from, and accountability to a friend, family member, or coach can be critical,” Moran adds. “In the study, nonphysician health workers, physicians, and friends or family supported patients’ adherence to treatment, and held the patients accountable when they lapsed.” Hypertension is the leading cause of cardiovascular disease worldwide, with the majority of the burden in low- and middle-income countries, the study team notes. Although there are clear benefits and recommendations for the use of anti-hypertensive medication and cholesterol-lowering statins in patients with hypertension, control of blood pressure and use of statins in these countries is very low. With the community health intervention, patients reduced their risk of cardiovascular disease 40 percent more than people achieved without the intervention, says lead study author Jon-David Schwalm, MD, of the Population Health Research Institute (PHRI) of McMaster University and Hamilton Health Sciences in Ontario, Canada. “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,” Dr. Schwalm says. Community health workers in the study used tablet computers to help manage patients and counsel them on the best ways to lower blood pressure. These health workers also provided free medicines, with their recommendations reviewed by physicians, and made regular house calls. While the study was a controlled experiment designed to test the effectiveness of a community-wide intervention to reduce heart disease risk in hypertension patients, the control group still had more support to lower their risk than typical people in Colombia and Malaysia. Even in the control group, everyone had been diagnosed with high blood pressure through screening, and other people in these countries might not be screened at all. And, because the intervention included so many different components, it’s impossible to say how much of its success might have been due to community health workers alone, or just giving out free drugs, or enlisting family and friends to keep patients on track with taking medicine, eating right, and exercising regularly. “The main message for patients is that consistently taking blood pressure medication will lower risk of heart attack and stroke, and that nonphysician health workers (not just doctors or specialists) can be key to a successful, more convenient treatment plan that will fit with patients’ real, day-to-day lives,” Moran says.
