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Original Investigation
March 4, 2020

Effect of a Workplace-Based Multicomponent Intervention on Hypertension Control: A Randomized Clinical Trial

Author Affiliations
  • 1Division of Prevention and Community Health, National Center for Cardiovascular Disease, The State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
  • 2School of Public Health, Department of Social Medicine and Health Education, Peking University, Beijing, China
  • 3School of Medicine, Department of Epidemiology, Jinan University, Guangzhou, China
  • 4Department of Cardiology, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
JAMA Cardiol. 2020;5(5):567-575. doi:10.1001/jamacardio.2019.6161
Key Points

Question  Can a multicomponent, workplace-based intervention strategy that combines workplace health promotion and standardized management of hypertension improve blood pressure control among employees?

Findings  In this cluster randomized clinical trial of 4166 employees with hypertension from 60 workplaces, after a 24-month intervention, the intervention group had significantly higher blood pressure control and a net reduction in systolic and diastolic blood pressure of 5.8 and 3.6 mm Hg compared with the control group.

Meaning  Results of this trial suggest that a multicomponent intervention may represent an effective addition to workplace programs to control hypertension with a community health center intervention accompanied by monthly visits.

Abstract

Importance  A workplace-based intervention could be an effective approach to managing high blood pressure (BP). However, few studies to date have addressed hypertension control among the Chinese working population.

Objective  To assess the effect of a workplace-based, multicomponent intervention strategy on improving BP control.

Design, Setting, and Participants  A cluster randomized clinical trial of a hypertension management program was conducted from January 2013 to December 2014 in 60 workplaces across 20 urban regions in China. Workplaces were randomized to either the intervention group (n = 40) or control group (n = 20). Employee participants in each workplace were asked to complete a cross-sectional survey. Data analysis on an evaluable population was conducted from January 2016 to January 2017.

Interventions  The 2-year intervention included 2 components: (1) a workplace wellness program for improving employees’ cardiovascular health and (2) a guidelines-oriented hypertension management protocol with a community health center intervention accompanied by monthly visits for achieving BP control over a period of 24 months.

Main Outcomes and Measures  The primary outcome was the change in BP control rate from baseline to 24 months among employees with hypertension in the intervention and control groups. The secondary outcomes were the changes in BP level and lifestyle factors by the end of the trial.

Results  Overall, 4166 participants (3178 in the intervention group and 988 in the control group) were included (mean [SD] age, 46.3 [7.6] years; 3451 men [82.8%]). Blood pressure control rate at baseline was 19.5% in the intervention group and 20.1% in the control group. After 24 months of the intervention, the BP control rate for the intervention group compared with the control group was significantly higher (66.2% vs 44.0%; odds ratio, 1.77; 95% CI, 1.58-2.00; P < .001). The intervention effect on systolic BP level was −5.8 mm Hg (95% CI, −6.8 to −4.9 mm Hg; P < .001) and on diastolic BP level was −3.6 mm Hg (95% CI, −4.4 to −2.9 mm Hg; P < .001). The BP control rate showed a gradual increment throughout the whole duration in the intervention group. Moreover, greater reduction was reported in the rates of drinking (−18.4%; 95% CI, −20.6% to −16.2%; P < .001), perceived stress (−22.9%; 95% CI, −24.8% to −21.1%; P < .001), and excessive use of salt (−32.0%; 95% CI, −33.7% to −30.4%; P < .001).

Conclusions and Relevance  This trial found that a workplace-based, multicomponent intervention appeared to be more effective than usual care, leading to measurable benefits such as lower blood pressure, improved hypertension control, and adoption of healthy lifestyle habits. The intervention can therefore be considered for large-scale use or inclusion in hypertension control programs in workplaces in China and other countries.

Trial Registration  Chinese Clinical Trial Registry No. ChiCTR-ECS-14004641

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