Evaluation of the World Health Organization-HEARTS hypertension control package in Bangladesh: a quasi-experimental trial

Heart. 2024 Aug 14;110(17):1090-1098. doi: 10.1136/heartjnl-2024-324253.

Abstract

Background: The World Health Organization (WHO) promotes the HEARTS technical package for improving hypertension control worldwide, but its effectiveness has not been rigorously evaluated.

Objective: To compare hypertension outcomes in clinics implementing HEARTS versus clinics continuing usual hypertension care in rural Bangladesh.

Methods: A matched-pair cluster quasi-experimental trial in Upazila Health Complexes (UHCs; primary healthcare facilities) was conducted in rural Bangladesh. A total of 3935 patients (mean age 52.3 years, 70.5% female) with uncontrolled hypertension (blood pressure (BP) ≥140/90 mm Hg regardless of treatment history) were enrolled: 1950 patients from 7 HEARTS UHCs and 1985 patients from 7 matched usual care UHCs. The primary outcome was systolic BP at 6 months measured at the patient's home; secondary outcomes were diastolic BP, hypertension control rate (<140/90 mm Hg) and loss to follow-up. Multivariable mixed-effects linear and Poisson models were conducted.

Results: Baseline mean systolic BP was 158.4 mm Hg in the intervention group and 158.8 mm Hg in the usual care group. At 6 months, 95.5% of participants completed follow-up. Compared with usual care, the intervention significantly lowered systolic BP (-23.7 mm Hg vs -20.0 mm Hg; net difference -3.7 mm Hg (95% CI -5.1 to -2.2)) and diastolic BP (-10.2 mm Hg vs -8.3 mm Hg; net difference -1.9 mm Hg (95% CI -2.7 to -1.1)) and improved hypertension control (62.0% vs 49.7%, net difference 12.3% (95% CI 9.0 to 16.8)). Rate of missed clinic visits was lower in the intervention group (8.8% vs 39.3%, p<0.001).

Conclusions: After WHO-HEARTS package implementation in rural Bangladesh, BP was lowered and hypertension control improved significantly compared with usual care.

Trial registration number: NCT04992039.

Keywords: global health; hypertension.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Antihypertensive Agents / therapeutic use
  • Bangladesh / epidemiology
  • Blood Pressure / physiology
  • Female
  • Humans
  • Hypertension* / epidemiology
  • Hypertension* / physiopathology
  • Hypertension* / therapy
  • Male
  • Middle Aged
  • Treatment Outcome
  • World Health Organization*

Substances

  • Antihypertensive Agents

Associated data

  • ClinicalTrials.gov/NCT04992039