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Population Based Strategies for Effective Control of High Blood Pressure in Pakistan

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00327574
Recruitment Status : Unknown
Verified May 2006 by Aga Khan University.
Recruitment status was:  Active, not recruiting
First Posted : May 18, 2006
Last Update Posted : May 26, 2006
Wellcome Trust
Imperial College London
Information provided by:
Aga Khan University

Brief Summary:

Studies have established that high blood pressure (BP) is the most common risk factor for cardiovascular disease (CVD). Despite a heavy burden of hypertension (33% of all persons aged 45 years and over), there are no reliable data on comparative strategies to manage hypertension in Pakistan. Our Wellcome Trust funded pilot study in Karachi, Pakistan on 320 adults aged 40 years and over showed that the prevalence of hypertension (95% CI) was 40.3% (34.9-45.7%), and CVD was 32.5% (27.6-37.8%).

We will now conduct a study with two components: 1) cross sectional study to determine the prevalence of CVD, and its determinants in Karachi, Pakistan; and 2) prospective, 2x2 factorial design, cluster allocation intervention study to evaluate the impact of a i) Population approach of household health education (HHE) by community health workers (CHW) on BP levels of population aged 5 years or over in low-middle income communities of Karachi; and ii) High-Risk approach of special BP management administered by intensively trained local general practitioners on BP levels of hypertensive subjects aged > = 40 years from the above population.

The cost effective BP control strategy would serve as a model for a much-needed national level hypertension control programme in Pakistan, and possibly other developing countries in South Asia.

We hypothesize that 1) HHE delivered by trained CHW is superior to no HHE in lowering BP levels of the population; and 2) management of hypertension by specially trained GPs is better than usual care provided in the communities of Karachi in lowering blood pressure of hypertensive subjects.

Condition or disease Intervention/treatment Phase
Hypertension Cardiovascular Disease Obesity Diabetes Kidney Disease Behavioral: Home heath education +/_ GP training Not Applicable

Detailed Description:

The proposed study will be conducted among the low and middle-income population in Karachi. This population is likely to be particularly prone to CVD, has the poorest access to quality care, and is often prescribed expensive drugs by GPs.

Screening visit: The Community Health Workers (CHW) will pay home visits to invite all subjects aged 5 years or over to participate in the survey. The screening would have three levels: 1) Household screening for subjects aged 5 years and over (n= 17,850 individuals, 3000 households). 2) Adult screening for individuals aged 40 years or over (n= 4200 individuals). 3) Hypertensive adults screening (n= 1860 individuals) for those identified to have hypertension on adult screening will be invited for re-measurement of BP to confirm hypertension.

Intervention Effectiveness Study: This is a 2x2 factorial design, cluster allocation intervention study comparing controls with intervention by primary care GP, with or without health education. The main comparisons relate to the reduction of BP in a) all household members (aged > 5 years), and b) hypertensive adults (aged > 40 years).

Interventions: The sample will be assigned to four intervention groups:

  • Group A: Routine care.
  • Group B: Routine care plus Health Education
  • Group C: Care provided by trained GP
  • Group D: Care provided by trained GP plus Health Education.

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Study Type : Interventional  (Clinical Trial)
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: Single
Primary Purpose: Prevention
Study Start Date : June 2004
Study Completion Date : September 2007

Resource links provided by the National Library of Medicine

Primary Outcome Measures :
  1. Cross sectional: The prevalence (95% confidence intervals) of CVD, hypertension, diabetes, albuminuria, and mean values of lipid.
  2. Intervention study: Changes in systolic and diastolic BP,
  3. b) body mass index (BMI), e) waist hip ratio, and f) tobacco use from baseline to 2 year follow up visit
  4. Cost Outcome Measures: These will be computed for hypertensive adults.
  5. Primary outcomes: incremental cost per mm reduction in SBP, and DBP for each of the three intervention arms.
  6. the three intervention arms

Secondary Outcome Measures :
  1. Secondary Effect Outcomes: a) Proportion of subjects with mean follow-up BP less than 140/90 mm Hg,
  2. and changes in b) BMI, c) waist hip ratio, and f) tobacco use.
  3. Cost outcomes: the total cost per intervention and cost per subjects

Information from the National Library of Medicine

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Ages Eligible for Study:   5 Years and older   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • All subjects aged 5 years or over residing in randomly selected communities

Exclusion Criteria:

  • Those who have severe co-morbid conditions
  • Pregnancy
  • Unable to give informed consent

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00327574

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Aga Khan University
Karachi, Sind, Pakistan, 74800
Sponsors and Collaborators
Aga Khan University
Wellcome Trust
Imperial College London
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Principal Investigator: Tazeen H Jafar, MD MPH Aga Khan University
Publications automatically indexed to this study by Identifier (NCT Number):
Layout table for additonal information Identifier: NCT00327574    
Other Study ID Numbers: GR 070854
First Posted: May 18, 2006    Key Record Dates
Last Update Posted: May 26, 2006
Last Verified: May 2006
Additional relevant MeSH terms:
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Kidney Diseases
Cardiovascular Diseases
Urologic Diseases