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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 3, May/June 2020
e4
AFRICA
Cardiovascular Topics
Feasibility and effect of community health worker
support and home monitoring for blood pressure control
in Nigeria: a randomised pilot trial
Dike B Ojji, Abigail S Baldridge, Anthony I Orji, Lamkur G Shedul, Olubunmi I Ojji, Nonye B Egenti, Ada
M Nwankwo, Mark D Huffman
Abstract
In a three-arm, randomised, controlled trial among 60
Nigerian adults with hypertension, community health worker
support and home blood pressure monitoring led to greater
reductions in systolic blood pressure at four weeks compared
to the usual care.
Keywords:
measures, blood pressure, control, Nigeria
Submitted 21/9/19, accepted 23/10/19
Cardiovasc J Afr
2019;
30
: online publication
www.cvja.co.zaDOI: 10.5830/CVJA-2019-066
Raised blood pressure (BP) is a leading modifiable risk factor
for global cardiovascular disease morbidity and mortality.
1
Among Nigerian adults, the prevalence of hypertension, defined
as blood pressure
>
140/90 mmHg or patients taking blood
pressure medications has been estimated to be 28.9% (95% CI:
25.1–32.8) based on a 2015 systematic review and meta-analysis
of 27 studies (
n
=
27 122 participants).
2
In addition, there is a
high burden of complications from hypertension in Nigeria,
including hypertensive left ventricular hypertrophy,
3
hypertensive
heart failure,
4,5
chronic kidney disease,
6,7
and strokes.
8,9
Randomised trials have shown that a multi-level intervention
strategy at patient, provider and health-system levels is a more
effective approach for hypertension control than a strategy
that focuses on a single level. For example, in the Hypertension
Improvement Project, the greatest BP control was seen in the
group with both provider- and patient-level interventions.
10
Furthermore, while self-monitoring of BP has been associated
with better BP control among higher-risk patients, its effects
are greatest when coupled with system- or provider-level
co-interventions that provide individually tailored support.
11
Despite the high burden of hypertension in Nigeria and
the benefits of such multi-level strategies, no such multi-level
interventions have been tested in Nigeria. To address this gap,
we performed a pilot, three-arm, randomised trial to evaluate
the feasibility and effect of community health worker support
and self-home BP monitoring compared with usual care on BP
treatment and control at four weeks with the long-term goal of
testing these interventions in combination in the context of a
large-scale, system-level hypertension-control programme.
Methods
Between November and December 2017 we recruited eligible
adults between 30 and 79 years old from two primary care
centres in Abuja, Nigeria. Participants were eligible if they had a
previous diagnosis of hypertension and a systolic blood pressure
(SBP)
≥
140 mmHg and
<
180 mmHg and/or diastolic blood
pressure (DBP)
≥
90 mmHg and
<
110 mmHg who were either
untreated or on monotherapy. The study was approved by the
University of Abuja Human Research Ethical Committee and
all participants provided written, informed consent.
Blood pressures were measured by the community health
worker using an automated BP machine (Omron M3;
HEM-7131-E). BP measurements were taken after each
Cardiology Unit, Department of Medicine, College of
Health Sciences, University of Abuja and University of
Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
Dike B Ojji, MB BS, PhD, dike.ojji@uniabuja,edu,ng
Northwestern University, Feinberg School of Medicine,
Chicago, Illinois, USA
Abigail S Baldridge, MD
Disease Control Unit, Department of Health, Abuja
Municipal Area Council, Federal
Capital Territory, Nigeria
Anthony I Orji, MD
Department of Family Medicine, University of Abuja
Teaching Hospital, Gwagwalada, Abuja, Nigeria
Lamkur G Shedul, MD
Department of Community Medicine, University of Abuja
Teaching Hospital, Gwagwalada, Abuja, Nigeria
Olubunmi I Ojji, MD
Nonye B Egenti, MD
Department of Community Medicine, College of Health
Sciences University of Abuja and University of Abuja
Teaching Hospital, Gwagwalada, Abuja, Nigeria
Ada M Nwankwo, MD
Department of Preventive Medicine, Northwestern
University, Feinberg School of Medicine, Chicago, Illinois,
USA
Mark D Huffman, MD
Short Communication