番茄社区

A comprehensive workplace and community program successfully improved blood pressure (BP) control among workers in China and even promoted elements of a healthy lifestyle, a randomized trial showed.

The proportion of participants with BP controlled to <140/90 mm Hg started out similarly at baseline between intervention and control groups (19.5% vs 20.1%) but significantly favored the workplace-based intervention arm by 24 months (66.2% vs 44.0%, OR 1.77, 95% CI 1.58-2.00).

Moreover, the control rate was associated with greater reductions in alcohol consumption, perceived stress, and excessive salt intake at that time point, according to researchers led by Zengwu Wang, MD, PhD, of Fuwai Hospital in Beijing, reporting online in .

They estimated that the magnitude of BP lowering observed would correspond to a more than 20% reduction in stroke and more than 10% decrease in coronary heart disease, given that hypertension is a risk factor for cardiovascular disease (CVD).

"Generalizing this intervention to other countries or less structured workplace environments may help to improve BP control and reduce CVD-related events and deaths among employees," Wang's group suggested, noting that workplace wellness programs are recommended by the American Heart Association.

American cardiology societies advocate 130/80 mm Hg as the BP target for the general population.

Study authors conducted the cluster-randomized clinical trial at 60 workplaces across 20 urban regions in China. Employees who were eligible and agreed to participate were randomized 2:1 to the intervention or control arms.

The 4,166 participants had a mean age of 46.3 years, and 82.8% were men. At baseline, average BP clocked in at 145.0/91.9 mm Hg.

The workplace-based component of the intervention comprised the following:

• CVD health education using lectures, posters, and text messages
• Diet education and healthy foods accessible in the workplace cafeteria
• Smoking ban in the workplace
• Redesigned workstations and office layouts to decrease sedentary behavior
• Physical activity encouraged with exercise breaks during working hours and indoor/outdoor sports facilities provided
• Stress management with guided meditation and tai chi
• Annual health checkups and feedback to identify key risk factors

Patients in the intervention arm were also asked to visit community health centers monthly for hypertension management that included BP measurement, drug treatment, evaluation of medication compliance, and follow-up care.

"They took a lot of what has been advocated in U.S. workplace wellness programs and packaged it nicely," commented Ron Goetzel, PhD, of IBM Watson Health and Johns Hopkins University in Bethesda, Maryland. He was not involved with the study but has evaluated workplace health programs to improve their efficiency in terms of both cost and health. His group helped develop the self-assessment form for employers and the with educational materials and practical tool kits.

The trial interventions are "absolutely in line with what would be recommended by the CDC, NIH, experts in the field of workplace health promotion," he said. "This is how you ought to do it."

One might argue this was an even higher-dose, higher-fidelity version of what has been provided in the workplace in the U.S. for decades, Goetzel told 番茄社区 (an IBM spokesperson was present during the phone interview).

Controls in the study received routine care and were seen at community health centers only at baseline and again at the end of 2 years.

BP decreased over follow-up by 10.5/7.3 mm Hg for the intervention group and 4.7/3.6 mm Hg for the control group. Thus, the treatment effect of the intervention was a 5.8/3.6 mm Hg reduction (both components P<0.001), Wang and colleagues reported.

No treatment-related serious adverse events occurred in either group.

"The current strategies enabled the achievement of significant changes in BP classification and lifestyle behaviors except those associated with smoking and overweight or obesity," the investigators acknowledged.

Limitations of the trial include the over-representation of men and the sample size being too small to show differences in clinical events, the authors said.

"What I would have liked is an economic analysis. How much did this actually cost? Recognizing that China is a different economy than us, in the U.S., most of these programs are paid for by the employer," Goetzel noted.

Nevertheless, the Chinese trial is important for being a randomized trial, he said, given that the main complaint lodged against workplace intervention studies has been their observational nature. Two notable exceptions were a and -- although both tested interventions that were far less intensive than what was described by the Chinese group, according to Goetzel.

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