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HOPE 4 Study


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La Dra. Silvia Valbuena López señala las principales conclusiones del estudio presentado en ESC Congress 2019.

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HOPE 4 Study

  1. 1. Silvia Valbuena LópezHOPE-4 Study 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 The Lancet. doi:
  2. 2. Silvia Valbuena LópezHOPE-4 Study BACKGROUND • Hypertension is one of the major determinants of CVD • Hypertension control is one of the most efficient interventions to prevent CVD • 80% of all CVD deaths occur in low- and middle income countries • Yet, the rate of detection and control is low • Combined blood pressure + LDL lowering has the potential to reduce CVD events by >50%
  3. 3. Silvia Valbuena LópezHOPE-4 Study 1. Identify barriers for hypertension control through systematic reviews and health systems appraisals in middle-income countries (Colombia and Malaysia) 2. Develop a community-based comprehensive intervention 3. Evaluation in a cluster-randomized controlled trial GOALS OF THE STUDY
  4. 4. Silvia Valbuena LópezHOPE-4 Study
  5. 5. Silvia Valbuena LópezHOPE-4 Study METHODS • Parallel group, cluster-randomized, controlled trial. Open-label • 30 urban and rural communities from Colombia and Malaysia • Communities randomized to usual care or a comprehensive CV risk detection and management programme for 12 months • Inclusion  ≥ 50 years with new or uncontrolled hypertension (SBP > 140 mmHg) • Endpoints - Primary  difference in Framingham Risk Score (FRS) after 1 year - Secondary  • Difference in SBP • Proportion of patients with controlled SBP • LDL, colesterol and glucose levels • Smoking and other health behaviours
  6. 6. Silvia Valbuena LópezHOPE-4 Study STUDY FLOW
  7. 7. Silvia Valbuena LópezHOPE-4 Study RESULTS
  8. 8. Silvia Valbuena LópezHOPE-4 Study RESULTS. SUBGROUP ANALYSIS OF FRS
  9. 9. Silvia Valbuena LópezHOPE-4 Study LIMITATIONS • Complex intervention  intervention by health worker + free medication + involvement of family/friends  which one is effective??? • 4 visits + 1 with GP compared to 1 brief visit in the control group  lack of attention to controls may have biased results • Durability of these results beyond supervisión period
  10. 10. Silvia Valbuena LópezHOPE-4 Study CONCLUSIÓN Una estrategia de atención mediante trabajadores sanitarios guiado con algoritmos en tablet, que involucra a atención primaria y al entorno familiar, además de proporcionar medicación antihipertensiva y estatinas gratuitas, sustancialmente mejoró el riesgo CV y el control de la tensión arterial