@article{discovery10128645,
           title = {Effect of a multicomponent intervention on antihypertensive medication intensification in rural South Asia: post-hoc analysis of a cluster RCT},
          number = {9},
          volume = {34},
            year = {2021},
            note = {This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions.},
         journal = {American Journal of Hypertension},
           pages = {981--988},
           month = {September},
        abstract = {BACKGROUND: Inadequate treatment of hypertension is a widespread problem, especially in South Asian countries where cardiovascular disease mortality rates are high. We aimed to explore the effect of a multicomponent intervention (MCI) on antihypertensive medication intensification among rural South Asians with hypertension. METHODS: A post-hoc analysis of a two-year cluster-randomized controlled trial including 2645 hypertensives aged{$\ge$} 40 years from 30 rural communities, 10 each, in Bangladesh, Pakistan, and Sri Lanka. Independent assessors collected information on participants' self-reports and physical inspection of medications. The main outcomes were the changes from baseline to 24 months in the following: 1) the therapeutic intensity score (TIS) for all (and class specific) antihypertensive medications; 2) the number of antihypertensive medications in all trial participants. RESULTS: At 24 months, the mean increase in the TIS score of all antihypertensive medications was 0.11 in the MCI group and 0.03 in the control group, with a between-group difference in the increase of 0.08 (95\% CI (0.03, 0.12); P=0.002). In MCI compared to controls, a greater increase in the TIS of renin angiotensin-aldosterone system blockers (0.05; 95\% CI (0.02, 0.07); P{\ensuremath{<}}0.001) and calcium channel blockers (0.03; 95\% CI (0.00, 0.05);p=0.031) , and in the number of antihypertensive medications (0.11, 95\% CI (0.02, 0.19);P=0.016) was observed. CONCLUSIONS: In rural communities in Bangladesh, Pakistan, and Sri Lanka, MCI led to a greater increase in antihypertensive medication intensification compared to the usual care among adults with hypertension. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT02657746.},
             url = {https://doi.org/10.1093/ajh/hpab072},
          author = {Feng, L and Jehan, I and de Silva, A and Naheed, A and Khan, HAH and Kasturiratne, A and Clemens, JD and Lim, CW and Hughes, AD and Chaturvedi, N and Jafar, TH and COBRA-BPS Study Group, {}},
        keywords = {South Asia, community health workers, hypertension, medications intensification, multicomponent intervention, physicians}
}