Effect of a Multicomponent Intervention on Antihypertensive Medication Intensification in Rural South Asia: Post Hoc Analysis of a Cluster RCT.

Journal Article (Journal Article)


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.


A post hoc analysis of a 2-year cluster-randomized controlled trial including 2,645 hypertensives aged ≥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: (i) the therapeutic intensity score (TIS) for all (and class-specific) antihypertensive medications; (ii) the number of antihypertensive medications in all trial participants.


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% confidence interval (CI, 0.03, 0.12); P = 0.002). In MCI compared with controls, a greater increase in the TIS of renin-angiotensin-aldosterone system blockers (0.05; 95% CI (0.02, 0.07); P < 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.


In rural communities in Bangladesh, Pakistan, and Sri Lanka, MCI led to a greater increase in antihypertensive medication intensification compared with the usual care among adults with hypertension.

Clinical trials registration

Trial Number NCT02657746.

Full Text

Duke Authors

Cited Authors

  • Feng, L; Jehan, I; de Silva, HA; Naheed, A; Khan, AH; Kasturiratne, A; Clemens, JD; Lim, CW; Hughes, AD; Chaturvedi, N; Jafar, TH

Published Date

  • September 2021

Published In

Volume / Issue

  • 34 / 9

Start / End Page

  • 981 - 988

PubMed ID

  • 34013966

Pubmed Central ID

  • PMC8457433

Electronic International Standard Serial Number (EISSN)

  • 1941-7225

International Standard Serial Number (ISSN)

  • 0895-7061

Digital Object Identifier (DOI)

  • 10.1093/ajh/hpab072


  • eng