Population Based Strategies for Effective Control of High Blood Pressure in Pakistan - Full Text View

Sponsors and Collaborators:	Aga Khan University Wellcome Trust Imperial College London
Information provided by:	Aga Khan University
ClinicalTrials.gov Identifier:	NCT00327574

Purpose

Studies have established that high blood pressure (BP) is the most common risk factor for cardiovascular disease (CVD). Despite a heavy burden of hypertension (33% of all persons aged 45 years and over), there are no reliable data on comparative strategies to manage hypertension in Pakistan. Our Wellcome Trust funded pilot study in Karachi, Pakistan on 320 adults aged 40 years and over showed that the prevalence of hypertension (95% CI) was 40.3% (34.9-45.7%), and CVD was 32.5% (27.6-37.8%).

We will now conduct a study with two components: 1) cross sectional study to determine the prevalence of CVD, and its determinants in Karachi, Pakistan; and 2) prospective, 2x2 factorial design, cluster allocation intervention study to evaluate the impact of a i) Population approach of household health education (HHE) by community health workers (CHW) on BP levels of population aged 5 years or over in low-middle income communities of Karachi; and ii) High-Risk approach of special BP management administered by intensively trained local general practitioners on BP levels of hypertensive subjects aged > = 40 years from the above population.

The cost effective BP control strategy would serve as a model for a much-needed national level hypertension control programme in Pakistan, and possibly other developing countries in South Asia.

We hypothesize that 1) HHE delivered by trained CHW is superior to no HHE in lowering BP levels of the population; and 2) management of hypertension by specially trained GPs is better than usual care provided in the communities of Karachi in lowering blood pressure of hypertensive subjects.

Condition	Intervention
Hypertension Cardiovascular Disease Obesity Diabetes Kidney Disease	Behavioral: Home heath education +/_ GP training

MedlinePlus related topics: Diabetes High Blood Pressure Obesity Obesity in Children

U.S. FDA Resources

Study Type:	Interventional
Study Design:	Prevention, Randomized, Single Blind, Active Control, Factorial Assignment, Efficacy Study

Further study details as provided by Aga Khan University:

Primary Outcome Measures:

Cross sectional: The prevalence (95% confidence intervals) of CVD, hypertension, diabetes, albuminuria, and mean values of lipid.
Intervention study: Changes in systolic and diastolic BP,
b) body mass index (BMI), e) waist hip ratio, and f) tobacco use from baseline to 2 year follow up visit
Cost Outcome Measures: These will be computed for hypertensive adults.
Primary outcomes: incremental cost per mm reduction in SBP, and DBP for each of the three intervention arms.
the three intervention arms

Secondary Outcome Measures:

Secondary Effect Outcomes: a) Proportion of subjects with mean follow-up BP less than 140/90 mm Hg,
and changes in b) BMI, c) waist hip ratio, and f) tobacco use.
Cost outcomes: the total cost per intervention and cost per subjects

Study Start Date:	June 2004
Estimated Study Completion Date:	September 2007

Detailed Description:

The proposed study will be conducted among the low and middle-income population in Karachi. This population is likely to be particularly prone to CVD, has the poorest access to quality care, and is often prescribed expensive drugs by GPs.

Screening visit: The Community Health Workers (CHW) will pay home visits to invite all subjects aged 5 years or over to participate in the survey. The screening would have three levels: 1) Household screening for subjects aged 5 years and over (n= 17,850 individuals, 3000 households). 2) Adult screening for individuals aged 40 years or over (n= 4200 individuals). 3) Hypertensive adults screening (n= 1860 individuals) for those identified to have hypertension on adult screening will be invited for re-measurement of BP to confirm hypertension.

Intervention Effectiveness Study: This is a 2x2 factorial design, cluster allocation intervention study comparing controls with intervention by primary care GP, with or without health education. The main comparisons relate to the reduction of BP in a) all household members (aged > 5 years), and b) hypertensive adults (aged > 40 years).

Interventions: The sample will be assigned to four intervention groups:

Group A: Routine care.
Group B: Routine care plus Health Education
Group C: Care provided by trained GP
Group D: Care provided by trained GP plus Health Education.

Eligibility

Ages Eligible for Study:	5 Years and older
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

All subjects aged 5 years or over residing in randomly selected communities

Exclusion Criteria:

Those who have severe co-morbid conditions
Pregnancy
Unable to give informed consent

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00327574

Locations

Pakistan, Sind
Aga Khan University
Karachi, Sind, Pakistan, 74800

Sponsors and Collaborators

Aga Khan University

Wellcome Trust

Imperial College London

Investigators

Principal Investigator:

Tazeen H Jafar, MD MPH

Aga Khan University, Karachi, Pakistan

More Information

Publications:

Jafar TH, Jafary FH, Jessani S, Chaturvedi N. Heart disease epidemic in Pakistan: women and men at equal risk. Am Heart J. 2005 Aug;150(2):221-6.

Jafar TH, Levey AS, Jafary FH, White F, Gul A, Rahbar MH, Khan AQ, Hattersley A, Schmid CH, Chaturvedi N. Ethnic subgroup differences in hypertension in Pakistan. J Hypertens. 2003 May;21(5):905-12.

Publications indexed to this study:

Jafar TH, Qadri Z, Chaturvedi N. Coronary artery disease epidemic in Pakistan: more electrocardiographic evidence of ischaemia in women than in men. Heart. 2008 Apr;94(4):408-13. Epub 2007 Jul 23.

Study ID Numbers:	GR 070854
Study First Received:	May 17, 2006
Last Updated:	May 25, 2006
ClinicalTrials.gov Identifier:	NCT00327574
Health Authority:	Pakistan: Pakistan Medical Research Council

Study placed in the following topic categories:

Body Weight
Signs and Symptoms
Obesity
Urologic Diseases
Vascular Diseases
Diabetes Mellitus

Nutrition Disorders
Overweight
Overnutrition
Kidney Diseases
Hypertension

Additional relevant MeSH terms:

Cardiovascular Diseases

ClinicalTrials.gov processed this record on January 14, 2009