‘Package’ of hypertension interventions in Nigeria improves BP treatment, control
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Key takeaways:
- A community health worker-led package of interventions across primary care practices in Nigeria improved BP treatment and control.
- BP control rates increased from 23% to 56% during the multilevel intervention.
PHILADELPHIA — A large multilevel hypertension treatment protocol package led by community health workers in Nigeria was associated with improvements in high blood pressure treatment and control, a speaker reported.
“Despite the large and growing burden of BP-related diseases, the global hypertension cascade of care, including in Nigeria, is poorly implemented and thus ineffective,” Dike Ojji, MBBS, PhD, of the department of medicine, faculty of clinical sciences at the University of Abuja in Nigeria, said during a late-breaking science presentation at the American Heart Association Scientific Sessions.
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Multilevel interventions
Ojji and colleagues evaluated the implementation and effectiveness of the Hypertension Treatment in Nigeria program, an NIH-funded research program initiated in 2019 and conducted across 60 primary care facilities in Federal Capital Territory, Nigeria. The program is based on the WHO HEARTS technical package and Kaiser Permanente Northern California Hypertension Control Program. The multilevel intervention included:
- standard treatment protocol (national policy level);
- patient registration and empanelment (health system level);
- prioritization of fixed-dose combination therapy (health system level);
- team-based care led by community health workers (health worker level); and
- home BP monitoring and health coaching (patient level).
Additional strategies included free or reduced cost medications, public health messaging and community mobilization and quarterly supportive supervision, Ojji said. The researchers collected baseline data from registered patients with hypertension, defined as a BP of 140/90 mm Hg or higher or taking antihypertensive medications. The co-primary effectiveness outcomes were change in slope of monthly treatment and BP control rates (< 140/90 mm Hg) before and after the implementation periods. Secondary effectiveness outcomes included change in monthly mean systolic and diastolic BP and rates of multidrug, fixed-dose combination therapy prescriptions. Co-primary implementation outcomes included reach, effectiveness, adoption, implementation, maintenance, acceptability and cost; safety outcomes included adverse events of special interest, defined as changes in serum potassium and serum creatinine and serious adverse events.
Data were available for 21,038 participants registered from 2020 to October 2023. The mean age of patients was 48 years at baseline and 66% were women. At enrollment, mean systolic BP was 154 mm Hg and mean diastolic BP was 96 mm Hg.
Researchers found that the program was associated with a significant increase in the 3-month rolling average treatment and control rates from baseline through October 2023; however, the changes in slope were greater during the pre-implementation period, Ojji said. Treatment rate rose from 76% at baseline to 97% in October 2023 (P < .001).
BP improved “significantly and substantially” during the study period, Ojji said, with the control rate rising from 23% at baseline to 56% in October 2023 (P < .001). The program was also associated with a large increase in the availability and use of fixed-dose combination therapy, from 43% at baseline to 97% by October 2023.
Ojji noted that there were higher than anticipated baseline treatment and control rates, as well as variable retention in care during the long study period. Additionally, the interrupted time series study design limits causal inference.
Ojji said the researchers plan to pursue a scale-up of the hypertension program to Nigeria’s six geopolitical regions, collaborating with the Federal Ministry of Health and the National Primary Care Board Development Agency.
Addressing barriers to BP control
Yvonne Commodore-Mensah, PhD, MHS, RN, associate professor of nursing and cardiovascular nurse epidemiologist at Johns Hopkins School of Nursing and the Bloomberg School of Public Health, called the recruitment of more than 21,000 patients for the hypertension program impressive, adding that the trial effectively addressed the hurdles to BP control by improving access to treatment and continuity of care.
“When we think about scalability, this [issue] is not just limited to the sub-Saharan African region,” Mensah said. “How can we extend our impact to underserved areas in other countries? This is an excellent example of what is possible when we have collaboration between high- and low-income countries ... to address this issue of BP control.”
Reference:
- WHO. HEARTS: Technical package for cardiovascular disease management in primary health care. https://www.who.int/publications/i/item/WHO-NMH-NVI-19-8. Published April 1, 2021. Accessed Nov. 21, 2023.
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Ojji D, et al. LBS.07. From local to global: Achieving equity in prevention. Presented at: American Heart Association Scientific Sessions; Nov. 11-13, 2023; Philadelphia.
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