Pedron, Sara, Hanselmann, Michael, Burns, Jacob, Rich, Alexander, Peters, Annette, Heier, Margit, Schwettmann, Lars, Bor, Jacob H., Bärnighausen, Till, and Laxy, Michael
Background: Hypertension represents one of the major risk factors for cardiovascular morbidity and mortality globally. Early detection and treatment of this condition is vital to prevent complications. However, hypertension often goes undetected, and even if detected, not every patient receives adequate treatment. Identifying simple and effective interventions is therefore crucial to fight this problem and allow more patients to receive the treatment they need. Therefore, we aim at investigating the impact of a population-based blood pressure (BP) screening and the subsequent "low-threshold" information treatment on long-term cardiovascular disease (CVD) morbidity and mortality. Methods and findings: We examined the impact of a BP screening embedded in a population-based cohort study in Germany and subsequent personalized "light touch" information treatment, including a hypertension diagnosis and a recommendation to seek medical attention. We pooled four waves of the KORA study, carried out between 1984 and 1996 (N = 14,592). Using a sharp multivariate regression discontinuity (RD) design, we estimated the impact of the information treatment on CVD mortality and morbidity over 16.9 years. Additionally, we investigated potential intermediate outcomes, such as hypertension awareness, BP, and behavior after 7 years. No evidence of effect of BP screening was observed on CVD mortality (hazard ratio (HR) = 1.172 [95% confidence interval (CI): 0.725, 1.896]) or on any (fatal or nonfatal) long-term CVD event (HR = 1.022 [0.636, 1.641]) for individuals just above (versus below) the threshold for hypertension. Stratification for previous self-reported diagnosis of hypertension at baseline did not reveal any differential effect. The intermediate outcomes, including awareness of hypertension, were also unaffected by the information treatment. However, these results should be interpreted with caution since the analysis might not be sufficiently powered to detect a potential intervention effect. Conclusions: The study does not provide evidence of an effect of the assessed BP screening and subsequent information treatment on BP and behavior, but also on long-term CVD mortality and morbidity. Future studies should consider larger datasets to detect possible effects and a shorter follow-up for the intermediate outcomes (i.e., BP and behavior) to detect short-, medium-, and long-term effects of the intervention along the causal pathway. Sara Pedron and colleagues investigate whether a simple messaging intervention delivered to individuals with high blood pressure could motivate healthcare seeking behaviour, lifestyle changes, or improved health outcomes. Author summary: Why was this study done?: High blood pressure (BP), or hypertension, if untreated, increases the risk of severe health issues and death. This issue is relevant globally, affecting high-income countries as well as low- and middle-income countries, where the problem is even more serious. Understanding efficient ways to identify people with hypertension and encourage them to seek treatment is very important to improving the health of populations. What did the researchers do and find?: We assessed whether a simple message, given in the form of a letter to individuals identified as having high BP, which motivated them to visit their general practitioner to discuss the high BP, led to a reduced risk of stroke, heart attack, and other forms of heart disease, or to changes in lifestyle. To do so, we used data for 14,592 individuals from a long-running study in southern Germany, which reports data on its participants from 1984 to 1985, 1989 to 1990, 1994 to 1995, and 1999 to 2001. To determine whether providing people with high BP information through this simple message improved cardiovascular health, we compared their health and behavior to the health and behavior of individuals with very similar BP who did not receive the information over a period of 17 years. We did not find evidence that providing information to individuals with high BP led to improved health or behavior during the study. Specifically, individuals just above the threshold for hypertension (that received a diagnosis) were not less likely than individuals just below the threshold (that did not receive the diagnosis) of dying from CVD (HR = 1.172 [95% CI: 0.725, 1.896]) or of suffering any (fatal or nonfatal) long-term CVD event (HR = 1.022 [0.636, 1.641]). What do these findings mean?: The findings of our study could mean multiple different things: that the messaging and follow-up provided to people with high BP needs to be more intense if they are to be motivated to act; that health and behavior of these people did change over a short but not over a long time period; or that our study was too small to accurately detect an improvement in health and behavior due to the provided information. In the future, similar yet larger studies from Germany and elsewhere that measure changes in health and behavior over a short-, medium-, and long-term period would be helpful in addressing this question. [ABSTRACT FROM AUTHOR]