Primary Care Strategies to Reduce High Blood Pressure: A Cluster Randomized Trial in Rural Bangladesh, Pakistan and Sri Lanka

Project Brief: This study examined primary care strategies to reduce high blood pressure among rural hypertensive patients. It explored the determinants of uncontrolled hypertension among rural South Asia. Among hypertensive individuals, 58.0% had uncontrolled BP, off them highest found in Pakistan, and then Sri Lanka and Bangladesh. It suggested improving access and adherence to antihypertensive medications in disadvantaged populations in rural South Asia. The study also explored prevalence of Chronic Kidney Disease (CKD) and cardiometabolic multimorbidity were found very high among the rural South Asian hypertensive individuals.

The study also revealed three major care pathways of hypertension treatment, management and control in rural Bangladesh.  Seek specialized hospitals for acute care, private hospitals/local pharmacy for nonacute symptoms, and incidental hypertension identification while being treated for another condition. It also revealed patients experiences on accessing healthcare services for management of hypertension in rural Bangladesh, Pakistan and Sri Lanka.  Patients reported low knowledge on how to prevent or treat hypertension and also reported some barriers to accessing health services, such as- inadequate services, poor quality of existing facilities, shortage of medicine supplies, busyness of doctors due to high patient load, long travel distance to facilities, and long waiting times, and costs.

This series of evidences helped government in strengthening primary healthcare facilities for the hypertension care service. The Directorate General of Health Services (DGHS) already established a corner for NCD services at the sub-district hospitals and increased supplies of antihypertensive and lipid lowering drugs. In some sub-districts hospitals, the government deployed a trained nurse in the NCD corner for helping Physicians in measuring blood pressure and diabetes. Now patients are getting antihypertensive and anti lipid drugs for longer duration without cost.