Nonphysician-Led Intensive BP Intervention Model Shows Promise Across Age Groups in Hypertension Treatment: JAMA

A community-based intensive blood pressure (BP) intervention is effective and safe for older and younger adults with hypertension, according to a randomized trial conducted in rural China. The findings from the randomized clinical trial, including 22 386 individuals 60 years and older and 11 609 individuals younger than 60 years, were published online in JAMA Cardiology on June 18, 2024.

"Such an intervention model safely and sustainably reduced incident cardiovascular disease (CVD) by 25% and total mortality by 10% in older individuals with hypertension," the researchers reported. "The risk reductions were also profound in younger patients with hypertension."

The sustainable safety and effectiveness of a nonphysician community health care practitioner-led intensive blood pressure intervention on cardiovascular disease have not been studied to the authors’ knowledge, especially in the older adult population. Considering this, Xiaofan Guo, First Hospital of China Medical University, Shenyang, China, and colleagues aimed to evaluate such a multifaceted model with a more stringent BP treatment goal (<130/80 mm Hg) among patients aged 60 years and older with hypertension.

For this purpose, the researchers conducted a 48-month follow-up study of the China Rural Hypertension Control Project (CRHCP), an open-cluster randomized clinical trial, from 2018 to 2023. The analysis included participants 60 years and older and younger than 60 years with a hypertension diagnosis from the CRHCP trial. Individuals were recruited from 326 villages in rural China.

The nonphysician, well-trained, community health care practitioner implemented a multifaceted intervention program (eg, initiation or titration of antihypertensive medications) to achieve a BP level of less than 130/80 mm Hg, supervised by primary care physicians.

The primary outcome was cardiovascular disease, a composite of stroke, myocardial infarction, cardiovascular disease death, and heart failure requiring hospitalization.

The analysis included 22 386 individuals 60 years and older with hypertension and 11 609 individuals younger than 60 years with hypertension. The mean age of the participants was 63.0 years and included 61.3% females.

The study led to the following findings:

• Among the older individuals with hypertension, 11 289 patients were randomly assigned to the intervention group and 11 097 to the usual-care group. During a median of 4.0 years, there was a significantly lower rate of total cardiovascular disease (2.7% versus 3.5% per year; hazard ratio [HR], 0.75) and all-cause mortality (2.5% versus 2.8% per year; HR, 0.90) in the intervention group than in the usual-care group.
• For patients younger than 60 years, the risk reductions were also significant for total cardiovascular disease (HR, 0.64), heart failure (HR, 0.39), stroke (HR, 0.64), and cardiovascular death (HR, 0.54).
• In both age categories, the incidences of injurious falls, symptomatic hypotension, and syncope, and the results for kidney outcomes did not differ significantly between groups.

In conclusion, the findings revealed that the nonphysician health care practitioner-led, multifaceted, BP intervention model with a treatment BP target of lower than 130/80 mm Hg could safely and effectively reduce CVD and all-cause death risk in both the older and younger general population with hypertension. Specifically, these results have substantial implications for the future of hypertension management among older adults.

"This effective, feasible, and sustainable strategy should be integrated into hypertension control programs in low-resource settings in China and worldwide," the researchers wrote.

Reference:

Guo X, Ouyang N, Sun G, et al. Multifaceted Intensive Blood Pressure Control Model in Older and Younger Individuals With Hypertension: A Randomized Clinical Trial. JAMA Cardiol. Published online June 18, 2024. doi:10.1001/jamacardio.2024.1449