BACKGROUND: Research in industrialized countries has demonstrated that a key factor limiting the control of hypertension is poor patient adherence and that the most successful interventions for long-term adherence employ multiple strategies. Very little data exist on this question in low-income countries, wherein medication-taking behavior may be less well developed. METHOD: We conducted a treatment adherence trial of 544 patients [mean age ∼63 years, mean blood pressure (BP) ∼168/92 mmHg] with previously untreated hypertension in urban and rural Nigeria. Eligible participants were randomized to one of two arms: clinic management only, or clinic management and home visits. Both interventions included three elements: a community based, nurse-led treatment program with physician backup; facilitation of clinic visits and health education; and the use of diuretics and a β blocker as needed. After initial diagnosis, the management protocol was implemented by a nurse with physician backup. Participants were evaluated monthly for 6 months. RESULTS:Medication adherence was assessed with pill count and urine testing. Drop-out rates, by treatment group, ranged from 12 to 28%. Among participants who completed the 6-month trial, overall adherence was high (∼77% of participants took >98% of prescribed pills). Adherence did not differ by treatment arm, but was better at the rural than the urban site and among those with higher baseline BP. Hypertension control (BP <140/90 mmHg) was achieved in approximately 66% of participants at 6 months. CONCLUSION: This community-based intervention confirms relatively modest default rates compared with industrialized societies, and suggests that medication adherence can be high in developing world settings in clinic attenders.
RCT Entities:
BACKGROUND: Research in industrialized countries has demonstrated that a key factor limiting the control of hypertension is poor patient adherence and that the most successful interventions for long-term adherence employ multiple strategies. Very little data exist on this question in low-income countries, wherein medication-taking behavior may be less well developed. METHOD: We conducted a treatment adherence trial of 544 patients [mean age ∼63 years, mean blood pressure (BP) ∼168/92 mmHg] with previously untreated hypertension in urban and rural Nigeria. Eligible participants were randomized to one of two arms: clinic management only, or clinic management and home visits. Both interventions included three elements: a community based, nurse-led treatment program with physician backup; facilitation of clinic visits and health education; and the use of diuretics and a β blocker as needed. After initial diagnosis, the management protocol was implemented by a nurse with physician backup. Participants were evaluated monthly for 6 months. RESULTS: Medication adherence was assessed with pill count and urine testing. Drop-out rates, by treatment group, ranged from 12 to 28%. Among participants who completed the 6-month trial, overall adherence was high (∼77% of participants took >98% of prescribed pills). Adherence did not differ by treatment arm, but was better at the rural than the urban site and among those with higher baseline BP. Hypertension control (BP <140/90 mmHg) was achieved in approximately 66% of participants at 6 months. CONCLUSION: This community-based intervention confirms relatively modest default rates compared with industrialized societies, and suggests that medication adherence can be high in developing world settings in clinic attenders.
Authors: J S Kaufman; C N Rotimi; W R Brieger; M A Oladokum; S Kadiri; B O Osotimehin; R S Cooper Journal: J Hum Hypertens Date: 1996-07 Impact factor: 3.012
Authors: William M Schultz; Heval M Kelli; John C Lisko; Tina Varghese; Jia Shen; Pratik Sandesara; Arshed A Quyyumi; Herman A Taylor; Martha Gulati; John G Harold; Jennifer H Mieres; Keith C Ferdinand; George A Mensah; Laurence S Sperling Journal: Circulation Date: 2018-05-15 Impact factor: 29.690
Authors: Birinder K Mangat; Norm Campbell; Sailesh Mohan; Mark L Niebylski; Tej K Khalsa; Adel E Berbari; Lyne Cloutier; Roger Jean-Charles; John Kenerson; Daniel Lemogoum; Marcelo Orias; Eugenia Veiga; Xin-Hua Zhang Journal: J Clin Hypertens (Greenwich) Date: 2015-02-16 Impact factor: 3.738
Authors: Aimée M Lulebo; Mala A Mapatano; Patrick K Kayembe; Eric M Mafuta; Paulin B Mutombo; Yves Coppieters Journal: BMC Health Serv Res Date: 2015-12-24 Impact factor: 2.655