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Reading: Long-Term Outcomes of a Cohort of Hypertensive Subjects in Rural Ecuador

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Original Research

Long-Term Outcomes of a Cohort of Hypertensive Subjects in Rural Ecuador

Authors:

Juan Moreira,

Centro de Epidemiologia Comunitaria y Medicina Tropical, Esmeraldas, EC
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Monica Marquez Figueroa,

Centro de Epidemiologia Comunitaria y Medicina Tropical, Esmeraldas, EC
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Mariella Anselmi,

Centro de Epidemiologia Comunitaria y Medicina Tropical, Esmeraldas, EC
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Rosanna Prandi,

Centro de Epidemiologia Comunitaria y Medicina Tropical, Esmeraldas, EC
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Cintia Caicedo Montaño,

Centro de Epidemiologia Comunitaria y Medicina Tropical, Esmeraldas, EC
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Damon Bell,

Department of Mathematics, Universidad San Francisco de Quito, Quito, EC
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Oscar Betancour,

Fundación Salud, Ambiente y Desarrollo, Quito, EC
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Fabio Robusto,

Center for Outcomes Research and Clinical Epidemiology, Pescara, IT
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Tommaso Vannini,

Laboratory of Cardiovascular Prevention, Istituto di Ricerche Farmacologiche Mario Negri, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, IT
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Fausto Avanzini,

Laboratory of Cardiovascular Prevention, Istituto di Ricerche Farmacologiche Mario Negri, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, IT
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Gianni Tognoni,

Istituto di Anestesia e Rianimazione, Università degli Studi di Milano, Ospedale Maggiore, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, IT
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Maria Carla Roncaglioni ,

Laboratory of Cardiovascular Prevention, Istituto di Ricerche Farmacologiche Mario Negri, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, IT
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COHEMI Project Study Group

About COHEMI Project
COHEMI Project Study Group listed in the Online Appendix.
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Abstract

Background: In contrast with the abundance of global epidemiological descriptive data on cardiovascular diseases and their risk factors, information on the outcomes of real populations prospectively followed up in their life and care settings is much rarer, especially in low-income countries.

Objectives: This study sought to evaluate the feasibility and the overall results of a hypertension control program, based mainly on a network of community nonprofessional health promoters, in the poor rural region of Borbon (Ecuador).

Methods: This is a prospective cohort study describing the results of a program of hypertension diagnosis, treatment and follow-up from 2004 to 2015 in the area, carried out mainly by the health promoters.

Results: The number of hypertensive patients identified and followed over the years increased from 1,024 in 2004 to 1,733 in 2015. The percentage of patients with no visits during a year was reduced to <10%, whereas the proportion of hypertensive subjects attending all 4 scheduled annual checks approached and, in some years, exceeded 50%. From 2004 to 2015, the proportion of patients at high or very high cardiovascular risk progressively decreased from 26.6% in 2004 to 17.5% in 2015 (p for trend <0.01), whereas the proportion of hypertensive patients at low or very low risk increased from 30.4% in 2004 to 45.0% in 2015 (p for trend <0.01).

Conclusions: In a poor, disadvantaged area, a strategy of control mainly based on the involvement and responsibility of community health promoters (with health professionals as supporters more than direct actors) can achieve adequate follow-up of the population of hypertensive patients and improve their global cardiovascular risk level.

Highlights

  • Hypertension is increasingly recognized as a major cause of cardiovascular mortality and morbidity also in low-income countries, but little is known about how to face this common risk factor with limited economic and professional resources, particularly in remote rural areas.
  • In a poor disadvantaged area of the equatorial forest, hypertension diagnosis and control, mainly by nonprofessional local health promoters, can ensure adequate follow-up of the hypertensive population.
  • Over more than 10 years, the global cardiovascular risk has progressively declined.
  • Noncommunicable chronic diseases such as hypertension can be managed by giving local health promoters a pivotal role.
How to Cite: Moreira J, Figueroa MM, Anselmi M, Prandi R, Montaño CC, Bell D, et al.. Long-Term Outcomes of a Cohort of Hypertensive Subjects in Rural Ecuador. Global Heart. 2019;14(4):373–8. DOI: http://doi.org/10.1016/j.gheart.2019.09.001
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Published on 01 Dec 2019.
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