{
  "abstract": "Introduction A chronic disease management programme anchored on a digital platform was scaled in Ghana, Kenya, Sierra Leone and Tanzania following successful pilot studies. We investigated blood pressure (BP) changes and their associated factors among patients with hypertension.Methods In this retrospective cohort study, the primary outcome was the relative reduction in BP and an absolute reduction in systolic BP (SBP) of >5 mm Hg at 6 (±2) months post-enrolment. We used the paired t-test, McNemar’s test and multivariable logistic regression to compare changes in mean SBP, compare changes in proportions and examine the association between patient characteristics and achieving >5 mm Hg SBP reduction, respectively.Results As of May 2024, 131 912 patients with hypertension had completed at least 6 months of the programme. The study cohort included 63 003 (48%) patients with documented enrolment and 6-month BP measurements. The mean age was 60.8 years (SD: 13.1) and 74.7% were female. Mean SBP and diastolic BP decreased by 8.3 mm Hg (95% CI −8.5 to −8.1; p <0.001) and 4.5 mm Hg (95% CI −4.7 to −4.4; p<0.001), respectively. Patients with uncontrolled SBP (≥140 mm Hg) at enrolment (n=38 079) experienced a mean SBP reduction of 18.1 mm Hg (95% CI −18.3 to −17.8; p<0.001). The proportion of patients with controlled BP increased from 35% at enrolment to 53% at 6 months. Factors associated with higher odds of >5 mm Hg SBP reduction included follow-up by community health workers (adjusted OR (AOR)=1.06; p=0.041), ≥3 medical reviews (AOR=1.16; p<0.001) and ≥8 BP assessments (AOR=1.35; p<0.001).Conclusion Significant BP improvements were observed under routine programme conditions among patients with 6-month documented measurements. Despite limitations in causal inference owing to the lack of a control arm and the high proportion of patients without a documented follow-up BP, the findings highlight the potential real-world value of digital-enabled community-based and decentralised care in hypertension management.",
  "authors": [
    {
      "affiliations": [
        "Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"
      ],
      "name": "Aziz Sheikh"
    },
    {
      "affiliations": [
        "Medtronic Labs, Nairobi, Kenya"
      ],
      "name": "Oren Nyambane Ombiro"
    },
    {
      "affiliations": [
        "College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone"
      ],
      "name": "Haja Ramatulai Wurie"
    },
    {
      "affiliations": [
        "Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi Urban, Tanzania",
        "Kilimanjaro Christian Medical Centre, Moshi Urban, Tanzania"
      ],
      "name": "Florida Muro"
    },
    {
      "affiliations": [
        "Faculty of Medicine, University of Limoges, Limoges, France"
      ],
      "name": "Julien Magne"
    },
    {
      "affiliations": [
        "Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"
      ],
      "name": "Rafael Perera-Salazar"
    },
    {
      "affiliations": [
        "Sheffield Centre for Health and Related Research, Division of Population Health, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK",
        "Jalorche Consulting, Nairobi, Kenya",
        "Centre for Health Economics and Decision Modelling, Health Economics and Decision Science Institute (HEDSCI), Nairobi, Kenya"
      ],
      "name": "James Odhiambo Oguta"
    },
    {
      "affiliations": [
        "Directorate of Non-Communicable Diseases, Government of Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone"
      ],
      "name": "Santigie Sesay"
    },
    {
      "affiliations": [
        "Christian Health Association of Ghana, Accra, Ghana"
      ],
      "name": "James Duah"
    },
    {
      "affiliations": [
        "Department of Health Care Management, Technische Universität Berlin, Berlin, Germany",
        "School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana"
      ],
      "name": "Daniel Opoku"
    },
    {
      "affiliations": [
        "Christian Social Services Commission, Tanzania, Dar es Salaam, Tanzania"
      ],
      "name": "Godfrey Thomas Kway"
    },
    {
      "affiliations": [
        "Division of Non-Communicable Diseases, Kenya Ministry of Health, Nairobi, Kenya"
      ],
      "name": "Elizabeth Onyango"
    },
    {
      "affiliations": [
        "Africa Healthcare Network, Dar Es Salaam, Tanzania"
      ],
      "name": "Ringo Ernest Mtei"
    },
    {
      "affiliations": [
        "Division of Non-Communicable Diseases, Kenya Ministry of Health, Nairobi, Kenya"
      ],
      "name": "Yvette Kisaka"
    },
    {
      "affiliations": [
        "Medtronic Labs, Nairobi, Kenya"
      ],
      "name": "Anne Stake"
    },
    {
      "affiliations": [
        "Medtronic Labs, Nairobi, Kenya"
      ],
      "name": "Jacob Musili Masai"
    },
    {
      "affiliations": [
        "Medtronic Inc, Minneapolis, Minnesota, USA"
      ],
      "name": "Xiaoxi Sun"
    },
    {
      "affiliations": [
        "Jalorche Consulting, Nairobi, Kenya",
        "School of Nursing, Moi University, Eldoret, Kenya"
      ],
      "name": "Sharonmercy Okemwa"
    },
    {
      "affiliations": [
        "University of Warwick Medical School, Coventry, UK"
      ],
      "name": "Tahir Bockarie"
    },
    {
      "affiliations": [
        "Medtronic Labs, Nairobi, Kenya"
      ],
      "name": "Eric Angula"
    },
    {
      "affiliations": [
        "Medtronic Labs, Nairobi, Kenya"
      ],
      "name": "Jesse Njunguru"
    },
    {
      "affiliations": [
        "Division of Non-Communicable Diseases, Kenya Ministry of Health, Nairobi, Kenya"
      ],
      "name": "Gladwell Gathecha"
    }
  ],
  "title": "Transforming hypertension management with digital technology: a retrospective cohort study in four sub-Saharan African countries",
  "uid": "80773d5c-06f5-503b-a209-76fae7869cb0"
}