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

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: https://doi.org/10.1016/S0140-6736(19)31949-X

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. 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. Silvia Valbuena LópezHOPE-4 Study

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. Silvia Valbuena LópezHOPE-4 Study
STUDY FLOW

7. Silvia Valbuena LópezHOPE-4 Study
RESULTS

8. Silvia Valbuena LópezHOPE-4 Study
RESULTS. SUBGROUP ANALYSIS OF FRS

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. 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