Launching a salt substitute to reduce blood pressure at the population level-Peru

描述(由申请人提供)：高血压是一种静止性疾病，是全球范围内心血管疾病和中风日益流行的主要原因，特别是在低收入和中等收入国家(LMIC)。对于LMIC来说，尤其重要的是在相对较小的年龄出现中风，这是高血压的许多并发症之一，从而影响个人、他们的家庭和社区的健康和生产力？高血压控制率低，缺乏维持正常血压的战略，特别是在低收入中等收入国家，反映了在保健和其他系统中有效和负担得起的实施的挑战。 这项建议旨在评估以减少钠和增加钾(普通盐换成低钠、高钾盐替代品)为基础的人群水平干预对20岁及以上成年人血压的影响。这类战略的执行必须让所有潜在参与者参与，从村民、他们的家人和农村地区领导人到地方机构和地方、区域和国家当局。因此，我们提出了以下具体目标：(1)评估村民、当局和其他潜在利益相关者对将新盐替代品纳入日常烹饪的易感模式，包括实施的可行性；(2)在人口层面实施和评估使用盐替代品的干预措施对血压的影响；以及(3)使用成本效益分析来确定这一实施战略的成本和效果。 干预部分将涉及一个务实的实验设计，阶梯式楔形试验设计，以在以下几个群组中逐步随机实施我们的干预 定性探索和媒体宣传活动的时期。因此，这项研究将包括收集基线信息以确定可能的干预方法的定性和定量方法，同时向社区和广泛的利益攸关方通报该战略。然后，我们将进行干预，并在干预期间和结束时监测其影响。 我们认为，有关当地利益攸关方的组织将提供一个强有力的平台，以引入这一创新的干预措施，并获得可靠的衡量标准来评估其影响。除了这些方法上的优势外，我们的提议还具有创新性，因为它真正解决了自构思以来的各种潜在的背景挑战，从而检验了真正的实施努力，扩大规模的可能性很高。 相关性：优化和启动公共卫生战略，以降低低收入和中等收入国家(如秘鲁)的血压水平和高血压，将需要采取与国家战略并行的区域具体办法。这里提出的这项研究可能是拉丁美洲国家在人口层面实施盐替代品的第一次务实干预。它将为制定适用于其他资源受限环境的适当当地战略提供重要信息。

DESCRIPTION (provided by applicant): Hypertension is a silent condition and a major contributor worldwide to the growing pandemic of cardiovascular disease and stroke, especially in low- and middle-income countries (LMIC). Of particular importance for LMIC is the presentation at relatively young ages of stroke, one of the many complications from hypertension, thus affecting the health and productivity of the individual, their families, and ther community? Poor control rates for hypertension and a lack of strategies to maintain normal blood pressure, particularly in LMICs, reflect the challenges of effective and affordable implementation in health care and other systems. This proposal aims to estimate the impact of a population-level intervention based on sodium reduction and potassium increase (exchange of ordinary salt for a low-sodium, high-potassium salt substitute) on blood pressure among adults aged 20 years and over. The implementation of this type of strategy must involve all potential participants, from villagers, their families and lcal leaders to local institutions and local, regional and national authorities. Thus, we propose the following specific aims: (1) to assess predisposition patterns towards incorporating the new salt substitute into daily cooking among villagers, authorities and other potential stakeholders, including the feasibility of the implementation; (2) to implement and assess the impact of an intervention using the salt substitute on blood pressure at the population level; and (3) to determine costs and efficacy of this implementation strategy using cost-effectiveness analysis. The intervention component will involve a pragmatic experimental design, the stepped wedge trial design, to progressively implement our intervention at random in several clusters following a period of qualitative exploration and media campaigns. Thus, this study will include qualitative and quantitative methodologies for collecting baseline information to determine potential methods of intervention, while informing the community and a wide range of stakeholders of the strategy. We will then perform the intervention and monitor its effects both during the intervention and at the conclusion. We believe that the organization of involved local stakeholders will provide a strong platform to introduce this innovative intervention and to obtain solid metrics to evaluate its impact. In addition to these methodological strengths, our proposal is innovative because it truly addresses various potential contextual challenges since its conception so that a true implementation effort is tested, with a high likelihood of scaling-up. RELEVANCE: Optimization and initiation of public health strategies to reduce blood pressure levels and hypertension in low and middle income countries (i.e. Peru) will require region-specific approaches that run in parallel with national strategies. The study proposed here will be perhaps the first pragmatic intervention in a Latin- American country to implement a salt substitute at the population level. It will provide important information to develop appropriate local strategies applicable to other resource-constrained settings.