BACKGROUND The burden of hypertension is escalating, and control rates are poor in low- and middle-income countries. Cardiovascular mortality is high in rural areas. METHODS We conducted a cluster-randomized, controlled trial in rural districts in Bangladesh, Pakistan, and Sri Lanka. A total of 30 communities were randomly assigned to either a multicomponent intervention (intervention group) or usual care (control group). The intervention involved home visits by trained government community health workers for blood-pressure monitoring and counseling, training of physicians, and care coordination in the public sector. A total of 2645 adults with hypertension were enrolled. The primary outcome was reduction in systolic blood pressure at 24 months. Follow-up at 24 months was completed for more than 90% of the participants. RESULTS At baseline, the mean systolic blood pressure was 146.7 mm Hg in the intervention group and 144.7 mm Hg in the control group. At 24 months, the mean systolic blood pressure fell by 9.0 mm Hg in the intervention group and by 3.9 mm Hg in the control group; the mean reduction was 5.2 mm Hg greater with the intervention (95% confidence interval [CI], 3.2 to 7.1; P<0.001). The mean reduction in diastolic blood pressure was 2.8 mm Hg greater in the intervention group than in the control group (95% CI, 1.7 to 3.9). Blood-pressure control (<140/90 mm Hg) was achieved in 53.2% of the participants in the intervention group, as compared with 43.7% of those in the control group (relative risk, 1.22; 95% CI, 1.10 to 1.35). All-cause mortality was 2.9% in the intervention group and 4.3% in the control group. CONCLUSIONS In rural communities in Bangladesh, Pakistan, and Sri Lanka, a multicomponent intervention that was centered on proactive home visits by trained government community health workers who were linked with existing public health care infrastructure led to a greater reduction in blood pressure than usual care among adults with hypertension. (Funded by the Joint Global Health Trials scheme; COBRA-BPS ClinicalTrials.gov number, NCT02657746.).

中文翻译：

---

管理南亚农村高血压的社区干预措施。

背景 在低收入和中等收入国家，高血压的负担不断增加，控制率很差。农村地区的心血管死亡率很高。方法 我们在孟加拉国、巴基斯坦和斯里兰卡的农村地区进行了一项整群随机对照试验。总共 30 个社区被随机分配到多组分干预（干预组）或常规护理（对照组）。干预包括由训练有素的政府社区卫生工作者进行血压监测和咨询、医生培训和公共部门护理协调的家访。共招募了 2645 名成年高血压患者。主要结果是 24 个月时收缩压的降低。超过 90% 的参与者完成了 24 个月的随访。结果 在基线时，干预组的平均收缩压为 146.7 毫米汞柱，对照组为 144.7 毫米汞柱。24 个月时，干预组的平均收缩压下降了 9.0 毫米汞柱，对照组下降了 3.9 毫米汞柱；干预后的平均降低幅度为 5.2 毫米汞柱（95% 置信区间 [CI]，3.2 至 7.1；P<0.001）。干预组舒张压的平均降低幅度比对照组高 2.8 mmHg（95% CI，1.7 至 3.9）。干预组有 53.2% 的参与者达到血压控制（<140/90 mmHg），而对照组为 43.7%（相对风险，1.22；95% CI，1.10 至 1.35） . 干预组的全因死亡率为 2.9%，对照组为 4.3%。结论 在孟加拉国、巴基斯坦的农村社区，斯里兰卡是一项多组分干预措施，其核心是由受过培训的政府社区卫生工作者主动进行家访，这些工作人员与现有的公共卫生保健基础设施相关联，导致高血压成人的血压降幅比常规护理更大。（由全球联合健康试验计划资助；COBRA-BPS ClinicalTrials.gov 编号，NCT02657746。）。