Volume 6, Issue 3

Background. Hypertension control remains poor in low- and middle-income countries (LMICs), where physician shortages limit access to continuous care. Community health workers (CHWs) are increasingly deployed to screen, educate, monitor and support people with hypertension, but the size and determinants of their effect remain uncertain. Methods. We searched MEDLINE, Embase, CINAHL, the Cochrane Central Register of Controlled Trials and Global Index Medicus from inception to December 31, 2025, for randomized trials of CHW-led interventions among adults with hypertension in LMICs. Two reviewers independently screened records, extracted data and assessed risk of bias with RoB 2. Random-effects meta-analyses pooled mean differences in systolic blood pressure (SBP) and risk ratios (RR) for blood pressure control. Results. Eighteen trials with 33,940 participants from 17 countries were included, 12 of them cluster randomized. Compared with usual care, CHW interventions reduced SBP by a mean of 4.9 mm Hg (95% CI 3.2–6.6; 16 trials; I² = 78%) and diastolic blood pressure by 2.4 mm Hg (95% CI 1.5–3.3; 15 trials), and increased blood pressure control (RR 1.31, 95% CI 1.19–1.44; 14 trials). Reductions were larger when CHWs titrated medication under a protocol (6.8 vs 3.5 mm Hg; p for interaction = 0.012). Certainty of evidence was moderate for both primary outcomes. Conclusions. CHW-led interventions produce clinically meaningful blood pressure reductions in LMICs, particularly when CHWs can adjust treatment within structured protocols linked to primary care. Sustained financing, supervision and integration with national hypertension programs are needed to deliver these gains at scale.