Community Based Intensive BP Control Effective and Safe

An open-cluster randomized clinical trial in China showed that a nonphysician community health care practitioner–led, multifaceted, intensive blood pressure (BP) intervention was effective and safe in younger and older individuals with high BP. From 2018 to 2023, 22 386 and 11 609 individuals (mean age 63.0 years, females 61.3%) 60 years and older or younger than 60 years with high BP, respectively, were recruited from 326 villages. Nonphysician health care practitioners implemented a multifaceted, intensive BP intervention program supervised by primary care physicians with a target BP of less than 130/80 mm Hg. Among the older patients, a total of 11 289 and 11 097 patients were randomly assigned to the intervention and the usual-care groups, respectively. During a median of 4.0 years, there was a significantly lower rate of total cardiovascular disease (CVD, 2.7% vs 3.5% per year; hazard ratio [HR], 0.75) and all-cause mortality (2.5% vs 2.8% per year; HR, 0.90) in the intervention group than in the usual-care group. The risk reductions were also significant for total CVD (HR, 0.64), stroke (HR, 0.64), heart failure (HR, 0.39), and CVD death (HR, 0.54) in patients younger than 60 years. For both older and younger patients, the incidences of injurious falls, symptomatic hypotension, syncope, and kidney outcomes did not differ significantly between groups. The findings indicate that the nonphysician health care practitioner–led, multifaceted, BP intervention model with a BP target lower than 130/80 mm Hg could effectively and safely reduce risk of CVD and all-cause deaths in older and younger patients regardless of their baseline BP level, CVD risk category, or diabetes status, and this strategy should be integrated into high BP control programs. Source: https://jamanetwork.com/