The Nigerian antihypertensive adherence trial: a community-based randomized trial
Adebowale Adeyemo1, Bamidele O Tayo, Amy Luke
1Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA.
Journal of Hypertension
|November 10, 2012
Summary
Patient adherence to hypertension medication can be high in developing countries. This study in Nigeria found good medication adherence and hypertension control in a community-based, nurse-led program.
Area of Science:
- Public Health
- Cardiology
- Global Health
Background:
- Poor patient adherence is a key factor limiting hypertension control in industrialized nations.
- Successful long-term adherence interventions utilize multiple strategies.
- Limited data exist on hypertension adherence in low-income countries.
Purpose of the Study:
- To assess medication adherence and hypertension control in a developing country setting.
- To evaluate the effectiveness of a community-based, nurse-led intervention for hypertension management.
Main Methods:
- A randomized trial involving 544 patients with untreated hypertension in urban and rural Nigeria.
- Intervention arms: clinic management only vs. clinic management with home visits.
- Both arms included a nurse-led program, facilitated visits, health education, and medication (diuretics and beta-blockers).
Main Results:
- Overall adherence was high (approx. 77% took >98% of pills) among completers.
- Hypertension control (BP <140/90 mmHg) was achieved in approx. 66% of participants after 6 months.
- Adherence was better at rural sites and among those with higher baseline blood pressure.
Conclusions:
- Community-based interventions can achieve high medication adherence in developing countries.
- Default rates were modest compared to industrialized nations.
- Clinic attenders in developing settings can achieve good medication adherence.
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