Effectiveness of a lifestyle intervention led by female community health volunteers versus usual care in blood pressure reduction (COBIN)

an open-label, cluster-randomised trial

Dinesh Neupane, Craig S. McLachlan, Shiva Raj Mishra, Michael Hecht Olsen, Henry Baker Perry, Arjun Karki, Per Kallestrup

Research output: Contribution to journalArticle

Abstract

Introduction Elevated blood pressure greatly contributes to cardiovascular deaths in low-income and middle-income countries. We aimed to investigate the effectiveness of a population-level intervention led by existing community health workers in reducing the burden of hypertension in a low-income population. Methods We did a community-based, open-label, two-group, cluster-randomised controlled trial in Nepal. Using computer-generated codes, we randomly assigned (1:1) 14 clusters to a lifestyle intervention led by female community health volunteers (FCHVs) or usual care (control group). In the intervention group, 43 FCHVs provided home visits every 4 months for lifestyle counselling and blood pressure monitoring. Eligible participants had been involved in a previous population-based survey, were aged 25–65 years, did not have plans to migrate outside the study area, and were not severely ill or pregnant. The primary outcome was mean systolic blood pressure at 1 year. We included all participants who remained in the trial at 1 year in the primary analysis. This trial is registered with ClinicalTrials.gov, number NCT02428075. Findings Between April 1, 2015, and Dec 31, 2015, we recruited 1638 participants (939 assigned to intervention; 699 assigned to control). At 1 year, 855 participants remained in the intervention group (425 were normotensive, 175 were prehypertensive, and 255 had hypertension) and 613 remained in the control group (305 were normotensive, 128 were prehypertensive, and 180 had hypertension). The mean systolic blood pressure at 1 year was significantly lower in the intervention group than in the control group for all cohorts: the difference was −2·28 mm Hg (95% CI −3·77 to −0·79, p=0·003) for participants who were normotensive, −3·08 mm Hg (–5·58 to −0·59, p=0·015) for participants who were prehypertensive, and −4·90 mm Hg (–7·78 to −2·00, p=0·001) for participants who were hypertensive. Interpretation A simple, FCHV-led lifestyle intervention coupled with monitoring of blood pressure is effective for reduction of blood pressure in individuals with hypertension and ameliorates age-related increases in blood pressure in adults without hypertension in the general population of Nepal. Funding Aarhus University, Jayanti Memorial Trust.

Original languageEnglish (US)
Pages (from-to)e66-e73
JournalThe Lancet Global Health
Volume6
Issue number1
DOIs
StatePublished - Jan 1 2018

Fingerprint

Life Style
Volunteers
Blood Pressure
Health
Hypertension
Nepal
Control Groups
Population
House Calls
Poverty
Counseling
Randomized Controlled Trials

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Effectiveness of a lifestyle intervention led by female community health volunteers versus usual care in blood pressure reduction (COBIN) : an open-label, cluster-randomised trial. / Neupane, Dinesh; McLachlan, Craig S.; Mishra, Shiva Raj; Olsen, Michael Hecht; Perry, Henry Baker; Karki, Arjun; Kallestrup, Per.

In: The Lancet Global Health, Vol. 6, No. 1, 01.01.2018, p. e66-e73.

Research output: Contribution to journalArticle

@article{ab80fe47bf8a431e8976a219d4f8f8ef,
title = "Effectiveness of a lifestyle intervention led by female community health volunteers versus usual care in blood pressure reduction (COBIN): an open-label, cluster-randomised trial",
abstract = "Introduction Elevated blood pressure greatly contributes to cardiovascular deaths in low-income and middle-income countries. We aimed to investigate the effectiveness of a population-level intervention led by existing community health workers in reducing the burden of hypertension in a low-income population. Methods We did a community-based, open-label, two-group, cluster-randomised controlled trial in Nepal. Using computer-generated codes, we randomly assigned (1:1) 14 clusters to a lifestyle intervention led by female community health volunteers (FCHVs) or usual care (control group). In the intervention group, 43 FCHVs provided home visits every 4 months for lifestyle counselling and blood pressure monitoring. Eligible participants had been involved in a previous population-based survey, were aged 25–65 years, did not have plans to migrate outside the study area, and were not severely ill or pregnant. The primary outcome was mean systolic blood pressure at 1 year. We included all participants who remained in the trial at 1 year in the primary analysis. This trial is registered with ClinicalTrials.gov, number NCT02428075. Findings Between April 1, 2015, and Dec 31, 2015, we recruited 1638 participants (939 assigned to intervention; 699 assigned to control). At 1 year, 855 participants remained in the intervention group (425 were normotensive, 175 were prehypertensive, and 255 had hypertension) and 613 remained in the control group (305 were normotensive, 128 were prehypertensive, and 180 had hypertension). The mean systolic blood pressure at 1 year was significantly lower in the intervention group than in the control group for all cohorts: the difference was −2·28 mm Hg (95{\%} CI −3·77 to −0·79, p=0·003) for participants who were normotensive, −3·08 mm Hg (–5·58 to −0·59, p=0·015) for participants who were prehypertensive, and −4·90 mm Hg (–7·78 to −2·00, p=0·001) for participants who were hypertensive. Interpretation A simple, FCHV-led lifestyle intervention coupled with monitoring of blood pressure is effective for reduction of blood pressure in individuals with hypertension and ameliorates age-related increases in blood pressure in adults without hypertension in the general population of Nepal. Funding Aarhus University, Jayanti Memorial Trust.",
author = "Dinesh Neupane and McLachlan, {Craig S.} and Mishra, {Shiva Raj} and Olsen, {Michael Hecht} and Perry, {Henry Baker} and Arjun Karki and Per Kallestrup",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/S2214-109X(17)30411-4",
language = "English (US)",
volume = "6",
pages = "e66--e73",
journal = "The Lancet Global Health",
issn = "2214-109X",
publisher = "Elsevier BV",
number = "1",

}

TY - JOUR

T1 - Effectiveness of a lifestyle intervention led by female community health volunteers versus usual care in blood pressure reduction (COBIN)

T2 - an open-label, cluster-randomised trial

AU - Neupane, Dinesh

AU - McLachlan, Craig S.

AU - Mishra, Shiva Raj

AU - Olsen, Michael Hecht

AU - Perry, Henry Baker

AU - Karki, Arjun

AU - Kallestrup, Per

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Introduction Elevated blood pressure greatly contributes to cardiovascular deaths in low-income and middle-income countries. We aimed to investigate the effectiveness of a population-level intervention led by existing community health workers in reducing the burden of hypertension in a low-income population. Methods We did a community-based, open-label, two-group, cluster-randomised controlled trial in Nepal. Using computer-generated codes, we randomly assigned (1:1) 14 clusters to a lifestyle intervention led by female community health volunteers (FCHVs) or usual care (control group). In the intervention group, 43 FCHVs provided home visits every 4 months for lifestyle counselling and blood pressure monitoring. Eligible participants had been involved in a previous population-based survey, were aged 25–65 years, did not have plans to migrate outside the study area, and were not severely ill or pregnant. The primary outcome was mean systolic blood pressure at 1 year. We included all participants who remained in the trial at 1 year in the primary analysis. This trial is registered with ClinicalTrials.gov, number NCT02428075. Findings Between April 1, 2015, and Dec 31, 2015, we recruited 1638 participants (939 assigned to intervention; 699 assigned to control). At 1 year, 855 participants remained in the intervention group (425 were normotensive, 175 were prehypertensive, and 255 had hypertension) and 613 remained in the control group (305 were normotensive, 128 were prehypertensive, and 180 had hypertension). The mean systolic blood pressure at 1 year was significantly lower in the intervention group than in the control group for all cohorts: the difference was −2·28 mm Hg (95% CI −3·77 to −0·79, p=0·003) for participants who were normotensive, −3·08 mm Hg (–5·58 to −0·59, p=0·015) for participants who were prehypertensive, and −4·90 mm Hg (–7·78 to −2·00, p=0·001) for participants who were hypertensive. Interpretation A simple, FCHV-led lifestyle intervention coupled with monitoring of blood pressure is effective for reduction of blood pressure in individuals with hypertension and ameliorates age-related increases in blood pressure in adults without hypertension in the general population of Nepal. Funding Aarhus University, Jayanti Memorial Trust.

AB - Introduction Elevated blood pressure greatly contributes to cardiovascular deaths in low-income and middle-income countries. We aimed to investigate the effectiveness of a population-level intervention led by existing community health workers in reducing the burden of hypertension in a low-income population. Methods We did a community-based, open-label, two-group, cluster-randomised controlled trial in Nepal. Using computer-generated codes, we randomly assigned (1:1) 14 clusters to a lifestyle intervention led by female community health volunteers (FCHVs) or usual care (control group). In the intervention group, 43 FCHVs provided home visits every 4 months for lifestyle counselling and blood pressure monitoring. Eligible participants had been involved in a previous population-based survey, were aged 25–65 years, did not have plans to migrate outside the study area, and were not severely ill or pregnant. The primary outcome was mean systolic blood pressure at 1 year. We included all participants who remained in the trial at 1 year in the primary analysis. This trial is registered with ClinicalTrials.gov, number NCT02428075. Findings Between April 1, 2015, and Dec 31, 2015, we recruited 1638 participants (939 assigned to intervention; 699 assigned to control). At 1 year, 855 participants remained in the intervention group (425 were normotensive, 175 were prehypertensive, and 255 had hypertension) and 613 remained in the control group (305 were normotensive, 128 were prehypertensive, and 180 had hypertension). The mean systolic blood pressure at 1 year was significantly lower in the intervention group than in the control group for all cohorts: the difference was −2·28 mm Hg (95% CI −3·77 to −0·79, p=0·003) for participants who were normotensive, −3·08 mm Hg (–5·58 to −0·59, p=0·015) for participants who were prehypertensive, and −4·90 mm Hg (–7·78 to −2·00, p=0·001) for participants who were hypertensive. Interpretation A simple, FCHV-led lifestyle intervention coupled with monitoring of blood pressure is effective for reduction of blood pressure in individuals with hypertension and ameliorates age-related increases in blood pressure in adults without hypertension in the general population of Nepal. Funding Aarhus University, Jayanti Memorial Trust.

UR - http://www.scopus.com/inward/record.url?scp=85037635749&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85037635749&partnerID=8YFLogxK

U2 - 10.1016/S2214-109X(17)30411-4

DO - 10.1016/S2214-109X(17)30411-4

M3 - Article

VL - 6

SP - e66-e73

JO - The Lancet Global Health

JF - The Lancet Global Health

SN - 2214-109X

IS - 1

ER -