Intensive Blood Pressure Strategy on Cardiovascular Diseases in Patients With Metabolic Syndrome: Post Hoc Analysis of a Clinical Trial.

Summary

In a post hoc analysis of the CRHCP cluster-RCT including 18,076 hypertensive patients with metabolic syndrome, community nonphysician-led intensive BP control to <130/80 mmHg reduced MACE versus usual care (1.58% vs 2.42% per year; HR 0.65). Mean achieved BP was 126/73 mmHg vs 147/82 mmHg. This supports task-shifted, protocolized BP management to improve outcomes in high-risk populations.

Key Findings

• Among 18,076 patients, intensive BP management achieved 126.3/73.0 mmHg vs 147.3/82.0 mmHg with usual care.
• MACE reduced with intensive strategy (1.58% vs 2.42% per year; HR 0.65; 95% CI 0.57–0.74).
• Implementation delivered by trained nonphysician professionals under physician supervision across three provinces.

Clinical Implications

Task-shifted, supervised intensive BP management targeting <130/80 mmHg should be considered in community programs for patients with metabolic syndrome and hypertension to reduce stroke, MI, HF, and CV death. Protocols, training, and monitoring frameworks are essential.

Limitations

• Post hoc analysis; potential for residual confounding at cluster and individual levels.
• Generalizability beyond rural Chinese settings and resource structures requires validation.

Future Directions

Cost-effectiveness analyses, adaptation in urban/other health systems, and implementation trials comparing models of task-shifted care and BP targets.