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HOPE 4 trial: Community-based intervention successful in reducing CV risk in hypertensive patients

ESC 2019
A reduction of more than 75% in cardiovascular risk has been achieved with a community-based intervention aimed at patients with new or poorly controlled hypertension in Colombia and Malaysia. Key to the success of this care model was addressing multiple barriers to implementation by integrating efforts by the patient, family, or friends and their primary care physician, being led by non-physician health workers.

Most of the burden of hypertension can be found in low- and middle-income countries, which prompted researchers of the HOPE 4 trial to find an effective method to safely and substantially reduce individual cardiovascular risk in patients [1]. The health outcomes prevention and evaluation 4 (Hope 4) is a community-based cluster randomised controlled trial including 1,371 patients  50 years with new or poorly controlled hypertension from 30 communities in Colombia and Malaysia. Of those, 16 communities (n=727) were randomised to usual care (control group) and 14 communities (n=644) were randomised to a multifaceted intervention for 1 year. The intervention strategy consisted of community screening to detect patients with new or poorly controlled hypertension, initiation and monitoring of treatments, controlling multiple risk factors by non-physician health workers (with tablet-based management algorithms and counselling), free antihypertensive and statin medications recommended by non-physician health workers supervised by physicians, and a treatment supporter (who could be a friend or family member) to enhance adherence to medications and lifestyle advice. Of the participants, 73.5% had a history of hypertension. Although they were using antihypertensive drugs, their blood pressure was not controlled.

At 12 months, the results of applying this interventional strategy showed that the Framingham Risk Score estimate in the intervention group was reduced by an absolute 11.2% (which is a relative risk reduction of 34.2%, P<0.001). With regard to systolic blood pressure, an absolute 11.5 mmHg greater reduction was observed in the patients in the intervention group as well as a 0.4 mmol/L larger reduction in their serum LDL cholesterol. Finally, 69% of patients in the intervention group had controlled hypertension vs 31% in the control group.

1. Schwalm JD. HOPE 4 - Impact on cardiovascular risk of a community-based multi-faceted intervention in individuals with hypertension in 2 middle income countries: The Heart Outcomes Prevention and Evaluation 4 study. FP Number 3184. ESC Congress 2019, 31 Aug-4 Sept, Paris, France.

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