Key Points:
- A community- and family-based intervention can reduce systolic blood pressure (SBP) across both hypertensive and normotensive adults in rural Chinese villages.
- The intervention blends lifestyle education, low-sodium salt substitution, BP monitoring, physical exercise and enhanced treatment access through a village-based team approach.
- The cluster-randomized trial (80 villages, 8,000 participants) shows promise for scalable models in low-resource rural settings.
- The program highlights the value of engaging families and non-clinical actors (family health instructors, village doctors) to broaden BP control beyond individual patients.
Hypertension (HTN) remains a major driver of cardiovascular disease globally, with rural areas in China facing particularly low rates of BP control. The Healthy Family Program (NCT06427096) was designed to shift the focus from treating only individuals with HTN to engaging entire families and communities in BP management. The trial aims to test whether a multifaceted family-centered strategy in 80 villages in rural China can improve BP control in adults aged 40-80 years, regardless of baseline HTN status.
This was an open-label, parallel-group, cluster-randomized trial (villages as units) in rural China. Villages (n = 80) were randomly assigned in a 1:1 ratio to either the intervention or usual-care control group. The intervention included: (1) establishing a BP-management team led by a “family health instructor”, collaborating with village doctors and family leaders; and (2) delivering six core strategies: healthy-lifestyle education, provision of low-sodium (“salt substitute”), weight management, regular physical activity, home/self-blood-pressure monitoring, and appropriate antihypertensive treatment if indicated. The primary outcome was the change in systolic blood pressure (SBP) from baseline to 6 months in all participants.
The intervention group achieved an average reduction in SBP of about 10 mmHg compared with the control group during the initial 6-month period. Additionally, at 6 months post-intervention (aka at 12 months), the SBP remained on average 3.7 mmHg lower in the intervention villages versus control villages.
These findings suggest that a family- and village-based multifaceted approach may produce meaningful reductions in blood pressure across a broad population, not just among those already hypertensive. Engaging families and village-based health infrastructure appears to enhance sustained behavior change and monitoring. The model may be particularly valuable in low-resource rural settings, where access to traditional clinic-based care is limited. Key questions remain about cost-effectiveness, long-term sustainability beyond 12 months, and whether similar results will hold when rolled out at scale in diverse rural settings. The approach shifts focus from individual patient management to community and family ecosystems for BP control. The significance of this approach is best summarized by these remarks from one of the trial investigators: “Most BP programs focus on treatment for people with high BP, whereas our study included the whole family regardless of their BP levels,” said Xin Du, MD, PhD. “In many cultures, families share the responsibility of caring for one another and promoting a healthy lifestyle. In our study, family leaders played a critical role in implementing the program by supporting a healthy diet high in vegetables, fruits and legumes, and low in sodium, fat and sugar.”
