Transforming Hypertension Management in Nigeria

Project: Research project

Project Details

Description

Elevated blood pressure (BP) is a leading modifiable risk factor for global cardiovascular disease morbidity and mortality. In Nigeria, the most populous country in sub-Saharan Africa, the prevalence of hypertension based on a BP threshold >140/90 mmHg in adults (>40 years) has been estimated to be 45%.1 Despite this very high burden, hypertension awareness (14-30%), treatment (<20%), and control (9%) rates are very low in Nigeria.2 A 2018 systematic review of 119 trials (n=55,641 participants) evaluating implementation strategies for improving BP control demonstrated that multi-level team-based care with non-physician health worker titration of BP lowering medicines was the most effective approach for lowering systolic BP (-7.1 mmHg [95% CI: -8.9, -5.2], 10 trials).3 The most effective patient-centered interventions for lowering systolic BP were health coaching (-3.9 mmHg [95% CI: -5.4, -2.3], 38 trials) and home BP monitoring (-2.7 mmHg [95% CI: -3.6, -1.7], 26 trials). Importantly, <20% of the studies in this systematic review were from low- and middle-income countries, and none were from sub-Saharan Africa. Translating these findings into routine clinical practice requires systems to track patients, performance review, algorithms, physicians to cede control to non-physicians, and non-physicians to cede control to and to support patients, much like how HIV care is structured throughout sub-Saharan Africa. Our pilot data (n=60) from Abuja, Nigeria already demonstrate feasibility and short-term efficacy in lowering systolic BP at 1 month with community health worker-led care (-10.5 mmHg [95% CI: -15.4, -5.5]) and home BP monitoring (-7.3 mmHg [95% CI: -11.7, -2.8]) compared with usual care. In this proposal, we will utilize implementation science methodologies including the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework to adapt, implement, and evaluate an evidence-based, multi-level intervention that includes: (1) system-level hypert
StatusFinished
Effective start/end date3/1/1912/31/21

Funding

  • National Heart, Lung, and Blood Institute (5R01HL144708-03)

Fingerprint

Explore the research topics touched on by this project. These labels are generated based on the underlying awards/grants. Together they form a unique fingerprint.