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New research grant awarded to help cut heart disease in South Asia

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A new international collaboration has received a £2 million award to fund research into combatting the rising numbers of deaths in rural South Asia caused by cardiovascular disease.

The three year COBRA-BPS (Control of Blood Pressure and Risk Attenuation – Bangladesh, Pakistan and Sri Lanka) trial aims to discover cost-effective ways to lower high blood pressure among adults living in the region. It will be conducted by the London School of Hygiene & Tropical Medicine, Singapore's Duke-National University of Singapore (NUS) Medical School, and their international collaborators.

The award comes from the UK Department for International Development (DFID), Medical Research Council and Wellcome Trust.

Hypertension, or high blood pressure, is a major risk factor for heart attack, stroke, and other vascular diseases. They are often under-recognised in developing countries but are rapidly growing causes of death and disability. Lowering blood pressure is thought to be the single most important way to avert heart attacks and strokes.

The study will test low-cost strategies by health workers and doctors to lower blood pressure among adults and reduce their risk of heart disease in three sites – Bangladesh, Pakistan and Sri Lanka – key countries in South Asia where the burden of hypertension is growing rapidly. These include:

  • Providing education in patients' homes about lowering their blood pressure through diet and exercise
  • Improving referrals to trained doctors using simple checklists, training doctors and nurses in management of hypertension including the use of low-cost medicines,
  • Having special counters at health clinics to provide tailored assistance for patients with high blood pressure.

The researchers will compare these strategies to those provided in regular healthcare to determine if they lower blood pressure among individuals with hypertension, and if they are cost-effective.

COBRA-BPS is led by principal investigator Professor Tazeen Jafar of Duke-NUS with co-investigators based in the three countries. The study will enrol 2,500 individuals in 30 rural communities in the three South Asian countries.

Dr Shah Ebrahim, Honorary Professor of Public Health at the London School of Hygiene & Tropical Medicine and the lead UK based study collaborator, said: "High blood pressure is a major cause of cardiovascular disease throughout the world. Controlling high blood pressure is critical but in many countries we do not understand how to make best use of local resources to achieve better outcomes for patients. This large trial will be of relevance to many other countries."

Non-communicable diseases account for 63% of global deaths (37 million annually and rising), with 80% occurring in low and middle income countries. This growing epidemic is a particular problem in South Asia, where people tend to get heart disease at a younger age, causing a greater loss of productive years of life and serious economic consequences for the developing countries in the region. The World Health Organisation says that the social and economic costs of non-communicable diseases make their prevention and control a major priority for the 21st century.

All three South Asian countries involved in COBRA-BPS have recently prioritised action on tackling non-communicable diseases like heart disease. The study will provide important information for policymakers on specifically how to address rising rates of hypertension among their populations.

Dr Jafar, Professor of Health Services and systems research at Duke-NUS and Professor of Global Health at Duke Global Health Institute in North Carolina, USA, said: "High blood pressure is the leading risk factor for premature deaths globally. The findings from COBRA-BPS are likely to provide a road-map for effective blood pressure lowering strategies that are sustainable and can be integrated in the public healthcare systems in the three countries, and have the potential for saving millions of lives and reducing human suffering in South Asia and possibly other regions."

The study is funded by the joint global health trials scheme, a partnership of DFID, the Medical Research Council and The Wellcome Trust, which aims to generate new knowledge about interventions to improve health in low and middle income countries that can be quickly implemented.

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Notes to editors

About COBRA-BPS: The COBRA-BPS trial has been funded by the UK Department of International Development, Medical Research Council and The Wellcome Trust through their Joint Global Health Trials Scheme. The principal investigator, Dr Tazeen Jafar, is a full professor of health services and systems research at Duke-NUS Medical School in Singapore.

About the London School of Hygiene & Tropical Medicine

The London School of Hygiene & Tropical Medicine is a world-leading centre for research and postgraduate education in public and global health, with 3,900 students and more than 1,000 staff working in over 100 countries. The School is one of the highest-rated research institutions in the UK, and among the world's leading schools in public and global health. Our mission is to improve health and health equity in the UK and worldwide; working in partnership to achieve excellence in public and global health research, education and translation of knowledge into policy and practice. http://www.lshtm.ac.uk

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