Effectiveness of a scalable group-based education and monitoring program, delivered by health workers, to improve control of hypertension in rural India: A cluster randomised controlled trial

BackgroundNew methods are required to manage hypertension in resource-poor settings. We hypothesised that a community health worker (CHW)–led group-based education and monitoring intervention would improve control of blood pressure (BP).Methods and findingsWe conducted a baseline community-based survey followed by a cluster randomised controlled trial of people with hypertension in 3 rural regions of South India, each at differing stages of epidemiological transition. Participants with hypertension, defined as BP ≥ 140/90 mm Hg or taking antihypertensive medication, were advised to visit a doctor. In each region, villages were randomly assigned to intervention or usual care (UC) in a 1:2 ratio. In intervention clusters, trained CHWs delivered a group-based intervention to people with hypertension. The program, conducted fortnightly for 3 months, included monitoring of BP, education about hypertension, and support for healthy lifestyle change. Outcomes were assessed approximately 2 months after completion of the intervention. The primary outcome was control of BP (BP P = 0.001). In secondary outcome analyses, there was a greater decline in systolic BP in the intervention than UC group (−5.0 mm Hg, 95% CI −7.1 to −3.0; P 0.001) and a greater decline in diastolic BP (−2.1 mm Hg, 95% CI −3.6 to −0.6; P 0.006), but no detectable difference in the use of BP-lowering medications between groups (OR 1.2, 95% CI 0.8–1.9; P = 0.34). Similar results were found when using imputation analyses that included those lost to follow-up. Limitations include a relatively short follow-up period and use of outcome assessors who were not blinded to the group allocation.ConclusionsWhile the durability of the effect is uncertain, this trial provides evidence that a low-cost program using CHWs to deliver an education and monitoring intervention is effective in controlling BP and is potentially scalable in resource-poor settings globally.Trial registrationThe trial was registered with the Clinical Trials Registry-India (CTRI/2016/02/006678).