Long-term effectiveness of a village doctor-led multifaceted strategy on blood pressure control: a cluster randomized trial

Objective: We tested the effectiveness of a village doctor-led multifaceted strategy on blood pressure (BP) control over 36 months among patients with hypertension in rural China. Village doctors are community health workers who provide basic primary health care in rural China. Design and method: 326 villages were randomly assigned to the village doctor-led intervention or usual care. Individuals aged 40 years or older with an untreated mean BP 140/90 mm Hg or greater (130/80 mm Hg or greater in individuals with clinical cardiovascular disease) or treated BP 130/80 mm Hg or greater were recruited. The trained village doctors initiated and titrated antihypertensive medications according to a simple stepped-care protocol with supervision from primary care physicians. They also delivered discounted and free medications to patients and conducted health coaching on lifestyle change, medication adherence, and home BP monitoring. Intention to treat analysis was conducted. Results: At baseline, mean age (62.8 vs. 63.2 years), percentage of women (60.9% vs. 61.6%), mean systolic BP (157.0 vs. 155.5 mm Hg), and diastolic BP (88.1 vs. 87.3 mm Hg) were comparable between intervention and control groups. At 36 months, 72.5% of participants in the intervention and 11.7% in the control group had a BP less than 130/80 mmHg, with a net group difference of 60.8% (P<0.0001). Mean systolic BP decreased by -30.8 mmHg from baseline to 36 months in the intervention group and by -7.6 mm Hg in the control group, with a net group difference of -23.1 mm Hg (P<0.0001). Intervention effects on other outcomes are shown in the Table. No treatment-related serious adverse events were reported in either group. Conclusions: Conclusions: In rural China, the village doctor-led multifaceted strategy significantly reduced BP over 36 months in patients with hypertension. This proven-effective and sustainable implementation strategy could be scaled up throughout rural China and in other low- and middle-income countries for hypertension control.