Abstract 021: The Effectiveness of a Community Health Worker-Led Intensive Blood Pressure Intervention on Coronary Heart Disease and Heart Failure

Background: Coronary heart disease (CHD) and heart failure are increasing in China and represent significant public health and economic challenges. Although community health worker (CHW)-led interventions have shown effectiveness in blood pressure (BP) control within low-resource environments, their impact on CHD and heart failure is yet to be fully documented. Objectives: This study estimated the effectiveness of a CHW-led intensive BP intervention on risk of myocardial infarction and heart failure. Methods: The China Rural Hypertension Control Project (CRHCP) included 33,995 hypertensive patients from 326 villages in rural China. We randomly assigned 163 villages to a non-physician community healthcare provider-led intervention and 163 villages to usual care. In the intervention group, trained non-physician community healthcare providers (NPCHPs) initiated and titrated antihypertensive medications according to a simple stepped-care protocol to achieve a systolic BP (SBP) goal of <130 mmHg and a diastolic BP (DBP) goal of <80 mmHg, with supervision from primary care physicians. The primary outcomes were myocardial infarction and heart failure, with secondary analyses exploring fatal and nonfatal myocardial infarction. Results: Over 48 months, the net reduction in SBP was 22.0 mmHg (95% CI: 20.6-23.4) and in DBP was 9.3 mmHg (8.7-10.0) in the intervention group compared to usual care. During follow-up, we observed 174 myocardial infarction events (0.26% yearly rate) in intervention compared to 204 (0.32% yearly rate) in usual care participants. The NPCHP-led intervention demonstrated a 19% reduction in myocardial infarction (HR=0.81; 95% CI: 0.67-0.99). Notably, nonfatal myocardial infarction was reduced by 23% (HR=0.77; 0.62-0.96), although no significant reduction was observed for fatal events (HR=0.88; 0.63-1.53). For heart failure, we observed 107 events (0.16% yearly rate) in the intervention group compared to 147 (0.23% yearly rate) in usual care group, corresponding to a 32% reduction in heart failure (HR=0.68; 0.54-0.85). Conclusion: This study provides compelling evidence that intensive BP control, led by NPCHPs, is effective at reducing CHD and heart failure among rural residents in China. This NPCHP-led intervention is both cost-effective and feasible for implementation in low-resource settings. These findings support the scale-up of the CRHCP intervention across low- and middle-income countries to reduce the global burden of CHD and heart failure.