Mobile health technology to prevent progression of pre-hypertension in urban settings of Latin America
The main object of this study is to evaluate the efficacy of a viable and sustainable primary care intervention to lower blood pressure and prevent the progression of pre-hypertension and hypertension in individuals who attend health care centres in poor areas in three countries of Latin America (Argentina, Guatemala, and Peru).
Adolfo Rubinstein, Andrea Beratarrechea, Adrian Alasino, Carolina Carrara, Manuel Ramirez, Homero Martinez, Paola Letona, Julissa Salguero, Rebecca Kanter, Jaime Miranda, Francisco Diez Canseco, Antonio Bernabe, Juan Carlos Saravia
Almost half of the adult population in Latin American urban areas is hypertensive. According to studies conducted in other settings, although half of these subjects with high blood pressure are still pre-hypertensive, the rate of progression to hypertension is high (10-20% per year). The main objective of this protocol is to assess the effectiveness of an affordable and sustainable primary healthcare intervention to reduce blood pressure and to prevent the progression from pre-hypertension to hypertension in individuals living in poor urban areas of Argentina, Guatemala, and Peru. In order to determine the effects of the intervention we used a cell phone-based technology (mHealth) that includes short message service (SMS) and individual phone calls to promote changes in lifestyle aimed at reducing participants´ blood pressure. The intervention is also aimed at helping participants become more informed, motivating them to manage their own health; providing specific individualized interventions; and improving patient-practitioner relationships.
The study is designed as a proof-of-concept intervention study to be conducted in three Latin American countries with a broad range of healthcare contexts and settings. This randomized clinical trial (RCT) has three-phases: phase one is a preparatory phase focused on the development and validation of culturally appropriate messages and logarithms aimed at promoting changes in unhealthy lifestyles; phase two includes the RCT´s one-year intervention phase, where intensive education (intervention group) will be compared with standard care (control group); and phase three is a six-month post-intervention follow up.
A total of 637 subjects (30-60 years old) were recruited for the study212 in Guatemala and Argentina, and 213 in Peru from primary healthcare centers and clinics located in low-income urban areas, and were randomized into the study groups. Anthropometric measurements included blood pressure and behavioral risk factors (exercise, diet, stress, smoking and alcohol drinking habits), and were taken at the beginning of the study, at 6 and 12 months (during the intervention), and 6 months after the completion of the intervention.
The study is also aimed at assessing the feasibility, acceptance, cost-effectiveness and implementation of the intervention process.
Randomized clinical control trial