Effectiveness of a targeted primary preventive intervention in a high-risk group identified using an efficiency score from data envelopment analysis: a randomised controlled trial of local residents in Japan

• Published in: BMJ open Vol. 13; no. 5; p. e070187
• Main Authors: Nakamura, Sho, Kanda, Satoru, Endo, Hiroko, Yamada, Emiko, Kido, Miki, Sato, Shoko, Ogawa, Iku, Inoue, Rina, Togashi, Masanori, Izumiya, Ken, Narimatsu, Hiroto
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 16.05.2023; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Angina pectoris; Antihypertensive Agents - therapeutic use; Antihypertensives; Blood pressure; Blood Pressure - physiology; Creatinine; Data envelopment analysis; Disease prevention; Efficiency; Epidemiology; Health risk assessment; Heart attacks; Humans; Hypertension; Hypertension - drug therapy; Hypertension - prevention & control; Intervention; Japan; Linear programming; preventive medicine; Risk Factors; risk management; Salt; Japan; risk management; hypertension; preventive medicine
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2022-070187

ObjectiveTo determine whether a minimal intervention based on the data envelopment analysis (DEA)-identified efficiency score effectively prevents hypertension.DesignRandomised controlled trial.SettingTakahata town (Yamagata, Japan).ParticipantsResidents aged 40–74 years belonged to the information provision group for specific health guidance. Participants with a blood pressure ≥140/90 mm Hg, those taking antihypertensive medication, or those with a history of cardiac diseases were excluded. Participants were consecutively assigned based on their health check-up visit at a single centre from September 2019 to November 2020 and were followed up at the check-up in the following year, until 3 December 2021.InterventionA targeted approach using minimal intervention. Target was identified using DEA and 50% of participants with higher risk were targeted. The intervention was notifying the results of their risk of hypertension according to the efficiency score obtained by the DEA.Primary outcome measuresA reduction in the proportion of participants who developed hypertension (≥140/90 mm Hg or taking antihypertensive medication).ResultsA total of 495 eligible participants were randomised, and follow-up data were available for 218 and 227 participants in the intervention and control groups, respectively. The risk difference for the primary outcome was 0.2% (95% CI −7.3 to 6.9) with 38/218 (17.4%) and 40/227 (17.6%) events in the intervention and control group, respectively (Pearson’s χ2 test, p=0.880). The adjusted OR of the effect of the intervention was 0.95 (95% CI 0.56 to 1.61, p=0.843), and that of the efficiency score (10-rank increase) was 0.81 (95% CI 0.74 to 0.89, p<0.0001).ConclusionsMinimal intervention to a high-risk population stratified by DEA was not effective in reducing the onset of hypertension in 1 year. The efficiency score could predict the risk of hypertension.Trial registration numberUMIN000037883