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Research

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

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c2641 (Published 07 June 2010) Cite this as: BMJ 2010;340:c2641
  1. Tazeen H Jafar, professor of community health sciences and medicine (nephrology) 1,
  2. Muhammad Islam, senior instructor in community health sciences (statistician)1,
  3. Juanita Hatcher, professor of community health sciences (statistician) 1,
  4. Shiraz Hashmi, project coordinator 1,
  5. Rasool Bux, data manager1,
  6. Ayesha Khan, nutritionist 1,
  7. Neil Poulter, professor of preventive cardiovascular medicine 2,
  8. Salma Badruddin, professor of community health sciences (nutritionist) 1,
  9. Nish Chaturvedi, professor of clinical epidemiology2,
  10. for the Hypertension Research Group
  1. 1Departments of Medicine and Community Health Sciences, Aga Khan University, Karachi, Pakistan
  2. 2National Heart and Lung Institute, Imperial College London, London
  1. Correspondence to: T H Jafar tazeen.jafar{at}aku.edu
  • Accepted 14 March 2010

Abstract

Objective To assess the effectiveness of a community based lifestyle intervention on blood pressure in children and young adults in a developing country setting.

Design Cluster randomised controlled trial.

Setting 12 randomly selected geographical census based clusters in Karachi, Pakistan.

Participants 4023 people aged 5-39 years.

Intervention Three monthly family based home health education delivered by lay health workers.

Main outcome measure Change in blood pressure from randomisation to end of follow-up at 2 years.

Results Analysed using the intention to treat principle, the change in systolic blood pressure (adjusted for age, sex, and baseline blood pressure) was significant; it increased by 1.5 (95% confidence interval 1.1 to 1.9) mm Hg in the control group and by 0.1 (−0.3 to 0.5) mm Hg in the home health education group (P for difference between groups=0.02). Findings for diastolic blood pressure were similar; the change was 1.5 mm Hg greater in the control group than in the intervention group (P=0.002).

Conclusions Simple, family based home health education delivered by trained lay health workers significantly ameliorated the usual increase in blood pressure with age in children and young adults in the general population of Pakistan, a low income developing country. This strategy is potentially feasible for up-scaling within the existing healthcare systems of Indo-Asia.

Trial registration Clinical trials NCT00327574.

Footnotes

  • We thank the members of Hypertension Research Group, more than 40 field workers, and support staff (including Rahim Rehmani), as their hard work was critical to the success of the study. Members of the Hypertension Research Group include Fahim Jafary, Aamir Hameed, Ata Khan, Anwar Gilani, Shehla Zaidi, Nadir Syed, Saleem Jessani, Zeeshan Qadri, and Peter Cosgrove. We also thank members of the Data Safety and Monitoring Committee (Umer Daar, Bhojo Khealani, and Yasmin Parpio). We express our appreciation to all participants for their cooperation during the study.

  • Contributors: THJ, JH, NP, and NC were responsible for the study concept and design. THJ, JH, SB, AK, SH, and RB were responsible for the implementation of the study and acquisition of data. MI analysed the data with advice from JH and THJ. All authors drafted and critically revised the manuscript for important intellectual content. THJ, JH, NP, and NC obtained funding and are the guarantors.

  • Funding: The study was financially supported by a research award (070854/Z/03/Z) from the Wellcome Trust, UK. The design and conduct of the study and the analysis, interpretation, and presentation of the data were the responsibility of the authors, with no involvement from the funder.

  • Competing interests: None declared.

  • Ethical approval: The Aga Khan University Ethics Review Committee approved the study.

  • Data sharing: The protocol, training manuals, and statistical code are available from the corresponding author at tazeen.jafar{at}aku.edu.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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