A strategy of integrating group medical visits with microfinance groups for patients with diabetes or hypertension in western Kenya led to significant reductions in systolic blood pressure (SBP), said researchers presenting their findings Nov. 17 during AHA 2020.

The study randomized 2,890 individuals of whom 69.9% were women to either usual care (multicomponent facility-based care), usual care plus microfinance groups (UC-MF), group medical visits only (GMV), and group medical visits plus microfinance (GMV-MF). The primary outcome was one-year change in SBP, and key secondary outcomes were diastolic blood pressure (DBP) and cardiovascular disease risk (QRISK3 score).

According to researchers, the average baseline SBP was 157.5 mmHg and DBP was 92.5 mmHg. Mean SBP for individuals in all four patient groups showed substantial declines, with the greatest declines found in the GMV (-14.7 mmHG) and GMV-MF (-16.4 mmHG) groups. Adjusted model estimates showed that relative to usual care, the mean reduction in SBP was 3.5 mmHg greater for GMV-MF, 3.4 mmHg greater for GMV, and 1.5 mmHg greater in the UC-MF group.

Secondary analysis showed a beneficial effect of GMV-MF on DBP and QRISK3 score compared to usual care. Additionally, pre-specified subgroup analysis showed that women had greater SBP reductions than men from the GMV and GMV-MF groups, while individuals with lower wealth indices experienced greater SBP reductions in the UC-MF and GMV-MF groups.

“Incorporating social determinants of health into care delivery for chronic diseases can improve outcomes, especially for subgroups of patients,” said Rajesh Vedanthan, MD, MPH, FACC. He suggested that group medical visits might be particularly beneficial for women, while microfinance groups might be more useful for individuals with lower socioeconomic status.

Clinical Topics: Prevention, Hypertension

Keywords: AHA Annual Scientific Sessions, AHA20, Diabetes Mellitus, Hypertension

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