Improving Blood Pressure Control and Health Systems With Community Health Workers

In this issue of JAMA, He and colleagues report the results of the Hypertension Control Program in Argentina, a community health worker–led, home-based intervention that aimed to lower blood pressure among 1432 low-income adults with uncontrolled hypertension in Argentina. Compared with usual care, the intervention lowered systolic blood pressure by 6.6 mm Hg (95% CI, 4.6-8.6 mm Hg) and diastolic blood pressure by 5.4 mm Hg (95% CI, 4.0-6.8 mm Hg). This program led to a remarkable 21% absolute difference in the proportion of individuals with controlled blood pressure, defined as a systolic and diastolic blood pressure less than 140/90 mm Hg (73% in the intervention group vs 52% in the usual care group). After 18 months, the mean-adjusted total cost related to the intervention and to health care was $103 (95% CI, $61-$144) higher per participant in the intervention group than in the control group ($178.6 vs $67.6 in total costs, respectively), which was approximately 5% of Argentina’s annual per capita health spending of $1322 in 2015.