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Title: Control of blood pressure and risk attenuation: Post trial follow-up of randomized groups
Authors: Jafar T.H. 
Jehan I.
Liang F. 
Barbier S.
Islam M.
Bux R.
Khan A.H.
Nadkarni N. 
Poulter N.
Chaturvedi N.
Ebrahim S.
Keywords: antihypertensive agent
low density lipoprotein cholesterol
blood pressure measurement
blood pressure regulation
cardiovascular risk
cluster analysis
cohort analysis
controlled study
diabetes mellitus
diastolic blood pressure
follow up
health education
home health education
major clinical study
randomized controlled trial
risk reduction
systolic blood pressure
urban area
general practitioner
health education
medical education
middle aged
randomized controlled trial
risk reduction
treatment outcome
Education, Medical, Continuing
Follow-Up Studies
General Practitioners
Health Education
Middle Aged
Risk Reduction Behavior
Treatment Outcome
Issue Date: 2015
Publisher: Public Library of Science
Citation: Jafar T.H., Jehan I., Liang F., Barbier S., Islam M., Bux R., Khan A.H., Nadkarni N., Poulter N., Chaturvedi N., Ebrahim S. (2015). Control of blood pressure and risk attenuation: Post trial follow-up of randomized groups. PLoS ONE 10 (11) : e0140550. ScholarBank@NUS Repository.
Abstract: Background Evidence on long term effectiveness of public health strategies for lowering blood pressure (BP) is scarce. In the Control of Blood Pressure and Risk Attenuation (COBRA) Trial, a 2 x 2 factorial, cluster randomized controlled trial, the combined home health education (HHE) and trained general practitioner (GP) intervention delivered over 2 years was more effective than no intervention (usual care) in lowering systolic BP among adults with hypertension in urban Pakistan. However, it was not clear whether the effect would be sustained after the cessation of intervention. We conducted 7 years follow-up inclusive of 5 years of post intervention period of COBRA trial participants to assess the effectiveness of the interventions on BP during extended follow-up. Methods A total of 1341 individuals 40 years or older with hypertension (systolic BP 140 mm Hg or greater, diastolic BP 90 mm Hg or greater, or already receiving treatment) were followed by trained research staff masked to randomization status. BP was measured thrice with a calibrated automated device (Omron HEM-737 IntelliSense) in the sitting position after 5 minutes of rest. BP measurements were repeated after two weeks. Generalized estimating equations (GEE) were used to analyze the primary outcome of change in systolic BP from baseline to 7- year follow-up. The multivariable model was adjusted for clustering, age at baseline, sex, baseline systolic and diastolic BP, and presence of diabetes.Findings After 7 years of follow-up, systolic BP levels among those randomised to combined HHE plus trained GP intervention were significantly lower (2.1 [4.1â€"0.1] mm Hg) compared to those randomised to usual care, (P = 0.04). Participants receiving the combined intervention compared to usual care had a greater reduction in LDL-cholesterol (2.7 [4.8 to 0.6] mg/dl. Conclusions The benefit in systolic BP reduction observed in the original cohort assigned to the combined intervention was attenuated but still evident at 7- year follow-up. These findings highlight the potential for scaling-up simple strategies for cardiovascular risk reduction in lowand middle- income countries. © 2015 Jafar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Source Title: PLoS ONE
ISSN: 19326203
DOI: 10.1371/journal.pone.0140550
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