Lancet commentary shines light on ground-breaking research

Duke Kunshan Professor Lijing L. Yan and Biraj Karmacharya, from Dhulikhel Hospital in Nepal, have written a commentary for leading health publication The Lancet on ground-breaking research into managing cardiovascular disease.

Dr. Yan led the review of a study titled “The China Rural Hypertension Control Project (CRHCP),” which used non-physician healthcare provider-led intensive blood pressure intervention to tackle high levels of cardiovascular disease in parts of rural China.

“The CRHCP study provided powerful evidence on the cardiovascular benefits of an intensive non-physician healthcare provider-led intervention,” their commentary says, including a 33% reduction in cardiovascular disease death.

Lijing L. Yan, professor of global health in the Global Health Research Center at Duke Kunshan

High blood pressure is consistently ranked as the top modifiable health risk factor globally, claiming 11.3 million lives in 2021, but management of it is poor, particularly in low- and middle- income countries. The CRHCP, led by Professor Yingxian Sun, director of the Department of Cardiovascular Medicine at the First Affiliated Hospital of China Medical University, and Professor Jiang He, director of Tulane University Translational Science Institute in the United States, was a large-scale trial aimed at tackling the issue, which included 326 villages and 33,995 participants aged 40 years or older with untreated blood pressure issues. It involved training village doctors to conduct health coaching with patients, advise on lifestyle changes and monitor medication adherence, as well as performance-based payments. All project participants also received electronic blood pressure monitors and by 36 months more than 90 percent had received free antihypertensive medications with costs supported by research grants.

The follow up study, authored by He, Sun and others, revealed the project’s success, including substantial reduction in blood pressure and risks for fatal and non-fatal cardiovascular diseases.

The commentary suggested areas where future improvements could be made, such as examining scalability of the project outside China and making use of information and communication technology to support healthcare. Nevertheless, the implications of this study are “far-reaching,” according to Yan and Karmacharya.

Lijing L. Yan (front row, far right) and Biraj Karmacharya (back row, fifth from right) on the Duke Kunshan University campus for the World Heart Federation’s Emerging Leaders Program in 2018

“Disseminations of its findings and lessons learned beyond China will enlarge the impacts of the study,” their commentary says. “When equipped with implementation research on its transferability and ways to contextualize the interventions in different settings such as Kenya, Nepal, and Peru, intensive non-physician provider-led interventions offers hope for improving cardiovascular health in China and other low- and middle-income countries.”

Yan is a professor of global health in the Global Health Research Center at DKU. She is also affiliated with the School of Public Health, Wuhan University and the Peking University Institute for Global Health and Development. Karmacharya is chief of the Department of Public Health and Community Programs at Dhulikhel Hospital, School of Medical Sciences, Kathmandu University, in Dhulikhel, Nepal.

Improving cardiovascular health in rural China and beyond

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