Community based lifestyle intervention for blood pressure reduction in children and young adults in developing country: cluster randomised controlled trial

Jafar, Tazeen H.; Islam, Muhammad Shariful; Hatcher, Juanita; Hashmi, Shiraz; Bux, Rasool; Khan, Ayesha; Poulter, Neil; Badruddin, S H; Chaturvedi, Nish

doi:10.1136/bmj.c2641

Cited by 62 publications

(89 citation statements)

References 39 publications

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“…These models provided estimates of the IRDs for CHD, stroke, or HF associated with a 1 mm Hg decrement in SBP at study baseline potentially achievable after lifestyle interventions were fully implemented16, 17, 33, 34, 35; estimates for a 2‐mm Hg reduction were obtained by multiplying the SBP regression coefficient by 2.…”

Section: Methodsmentioning

confidence: 99%

Reducing the Blood Pressure–Related Burden of Cardiovascular Disease: Impact of Achievable Improvements in Blood Pressure Prevention and Control

Hardy

Loehr

Butler

et al. 2015

JAHA

156

130

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Background US blood pressure reduction policies are largely restricted to hypertensive populations and associated benefits are often estimated based on unrealistic interventions.Methods and ResultsWe used multivariable linear regression to estimate incidence rate differences contrasting the impact of 2 pragmatic hypothetical interventions to reduce coronary heart disease, stroke, and heart failure (HF) incidence: (1) a population‐wide intervention that reduced systolic blood pressure by 1 mm Hg and (2) targeted interventions that reduced the prevalence of unaware, untreated, or uncontrolled blood pressure above goal (per Eighth Joint National Committee treatment thresholds) by 10%. In the Atherosclerosis Risk in Communities Study (n=15 744; 45 to 64 years at baseline, 1987–1989), incident coronary heart disease and stroke were adjudicated by physician panels. Incident HF was defined as the first hospitalization with discharge diagnosis code of “428.” A 10% proportional reduction in unaware, untreated, or uncontrolled blood pressure above goal resulted in ≈4.61, 3.55, and 11.01 fewer HF events per 100 000 person‐years in African Americans, and 3.77, 1.63, and 4.44 fewer HF events per 100 000 person‐years, respectively, in whites. In contrast, a 1 mm Hg population‐wide systolic blood pressure reduction was associated with 20.3 and 13.3 fewer HF events per 100 000 person‐years in African Americans and whites, respectively. Estimated event reductions for coronary heart disease and stroke were smaller than for HF, but followed a similar pattern for both population‐wide and targeted interventions.ConclusionsModest population‐wide shifts in systolic blood pressure could have a substantial impact on cardiovascular disease incidence and should be developed in parallel with interventions targeting populations with blood pressure above goal.

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Section: Methodsmentioning

confidence: 99%

Reducing the Blood Pressure–Related Burden of Cardiovascular Disease: Impact of Achievable Improvements in Blood Pressure Prevention and Control

Hardy

Loehr

Butler

et al. 2015

JAHA

156

130

View full text Add to dashboard Cite

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“…The use of non-invasive methods to screen for many CVRDs is generally feasible for community health workers. 78 The most recent data demonstrate that well-trained community health workers can deliver lifestyle modification advice, 79 identify high-risk individuals with similar effectiveness to primary care physicians, 80 be cost-effective in helping patients to adhere to hypertension regimens, 81 and be trained to use mHealth tools effectively. 78,82,83 However, exactly what and how many roles (screening, follow-up, medication prescription) these community health workers should play is unclear.…”

Section: Pathways To Addressing Cvrds In Lmicsmentioning

confidence: 99%

Cardiovascular, respiratory, and related disorders: key messages from Disease Control Priorities, 3rd edition

et al. 2018

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Cardiovascular, respiratory, and related disorders (CVRDs) are the leading causes of adult death worldwide, and substantial inequalities in care of patients with CVRDs exist between countries of high income and countries of low and middle income. Based on current trends, the UN Sustainable Development Goal to reduce premature mortality due to CVRDs by a third by 2030 will be challenging for many countries of low and middle income. We did systematic literature reviews of effectiveness and cost-effectiveness to identify priority interventions. We summarise the key findings and present a costed essential package of interventions to reduce risk of and manage CVRDs. On a population level, we recommend tobacco taxation, bans on trans fats, and compulsory reduction of salt in manufactured food products. We suggest primary health services be strengthened through the establishment of locally endorsed guidelines and ensured availability of essential medications. The policy interventions and health service delivery package we suggest could serve as the cornerstone for the management of CVRDs, and afford substantial financial risk protection for vulnerable households. We estimate that full implementation of the essential package would cost an additional US$21 per person in the average low-income country and $24 in the average lower-middle-income country. The essential package we describe could be a starting place for low-income and middle-income countries developing universal health coverage packages. Interventions could be rolled out as disease burden demands and budgets allow. Our outlined interventions provide a pathway for countries attempting to convert the UN Sustainable Development Goal commitments into tangible action.

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“…The sampling technique and participants particulars of the COBRA trial have been described in greater detail elsewhere [25]. Briefly, the sampling involved randomly selecting 12 out of 4200 lower middle income (average household income less than $70/month) household groups.…”

Section: Study Design and Participantsmentioning

confidence: 99%

Do dietary patterns explain high prevalence of cardiovascular risk factors among Pakistani urban adults? A cross-sectional study

et al. 2016

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Background: The prevalence of cardiovascular disease (CVD) in South Asia is higher than in any other developing countries. The diversity of diets in populations among developing countries may be one explanation for the differences in CVD. This study was carried out to explore the association between dietary patterns and the presence of cardiovascular risk factors among Pakistani low income urban adults. Methods: Socio demographic, physical activity and dietary information was collected from 1546 Pakistani subjects aged ≥40 years from the Control of Hypertension and Risk Attenuation (COBRA) study. Anthropometric, clinical and biomarker measures were assessed. Cluster analysis was used to identify dietary patterns from a food frequency questionnaire (FFQ) and multinomial regression was employed to investigate the association between dietary clusters and cardiovascular risk factors, using one of the dietary clusters as a reference category. Results: The most prevalent CVD risk factors among participants were elevated low density lipoprotein-cholesterol (LDL-C) (69.8 %) and systolic blood pressure (SBP) (68.2 %), followed by central obesity (57.1 %), low levels of high density lipoprotein-Cholesterol (HDL-C) (56.3 %), overall obesity (46.0 %), high total cholesterol (32.3 %), and elevated fasting blood sugar (FBS) (34.9 %). The cluster analysis generated 3 non-overlapping diet patterns. Cluster 1(Traditional Pakistani Diet), was dominated by fruits, vegetables, milk products and chicken, included participants with high mean body mass index (BMI), waist circumference (WC), HDL-C and low mean SBP. Cluster 2 (Moderate Diet) reflected a moderate intake of most food items and included participants with significantly higher mean SBP. Cluster 3 (Fatty Diet) was characterized by high intake of beef, whole milk, paratha and lentils and those following this cluster had a low mean HDL-C and high SBP. In analyses controlling for age, gender, tobacco use and physical activity, participants in the Traditional diet cluster were more likely to be overweight (OR 1.39, 95 % CI 1.08 to 1.78) and high central adiposity (1.33, 95 % CI 1.04 to 1.71) than participants in the Moderate diet cluster, though less likely to have elevated SBP (OR 0.67, 95 % CI 0.51 to 0.86). LDL-C levels were higher in both the traditional Pakistani diet and Fatty diet cluster compared to the Moderate diet cluster. Low HDL-C was also more prevalent among the Traditional Pakistani diet cluster. Conclusion: Among Pakistani population discernable diet patterns can be derived using clusters analysis. CVD risk factors prevalence differed by cluster membership, though relations for specific CVD risk are not consistent across clusters.

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Community based lifestyle intervention for blood pressure reduction in children and young adults in developing country: cluster randomised controlled trial

Cited by 62 publications

References 39 publications

Reducing the Blood Pressure–Related Burden of Cardiovascular Disease: Impact of Achievable Improvements in Blood Pressure Prevention and Control

Reducing the Blood Pressure–Related Burden of Cardiovascular Disease: Impact of Achievable Improvements in Blood Pressure Prevention and Control

Cardiovascular, respiratory, and related disorders: key messages from Disease Control Priorities, 3rd edition

Do dietary patterns explain high prevalence of cardiovascular risk factors among Pakistani urban adults? A cross-sectional study

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