The Lancet published an RCT of a low-cost program led by non-physician community healthcare providers to reduce hypertension in rural China. Quick take: Blockbuster results - a 1/3 reduction in cardiovascular events incl death over 3 yrs, with major global health implications.

Background:

• Hypertension is the leading preventable cause of premature death worldwide. In low and middle-income countries, approximately 30% of adults have hypertension and, of those, only 8% have it controlled.

Program & Study Design:

• The study randomly assigned 326 villages in rural China, containing 34,000 adults with hypertension, to treatment vs control. In T villages, trained nonphysician community healthcare providers initiated antihypertensive medications per a simple protocol, supervised by physicians.

• They also delivered discounted or free antihypertensive medications and health coaching for patients, with the goal of reducing blood pressure to under 130/80. The program is low cost: about $222/person total over the 3-year program.

Findings:

• A statistically significant 1/3 reduction in the primary outcome - a composite of heart attack, stroke, heart failure, & cardiovascular disease death over 3 yrs (1.62%/yr in T vs 2.40%/yr in C). Also a significant reduction in all-cause death (1.4%/yr vs 1.6%/yr).

Comment:

• Based on careful review, this was a high-quality RCT (e.g., low attrition, baseline balance, prespecified analyses) that produced definitive results. Replication RCTs in other low/middle-income countries to hopefully establish generalizability of the results would be desirable.

• If the findings generalize, this low-cost public health program could prevent millions of premature deaths worldwide each year.