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Home-Based Care for Hypertension in Rural South Africa
Mark J Siedner1,2,3,4, Nombulelo Magula2, Lusanda Mazibuko1
1Africa Health Research Institute, Durban, South Africa.
The New England Journal of Medicine
|September 1, 2025
Summary
Home-based hypertension care significantly lowered systolic blood pressure in South Africa. This model improved hypertension control compared to standard clinic-based management, showing sustained benefits at 12 months.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Health Services Research
Background:
- Hypertension management remains a global challenge, especially in resource-limited settings.
- Poorly controlled hypertension contributes to significant morbidity and mortality worldwide.
Purpose of the Study:
- To evaluate the effectiveness of a home-based hypertension care model in South Africa.
- To compare home-based care with enhanced features against standard clinic-based management.
Main Methods:
- An open-label, randomized controlled trial involving 774 adults with hypertension.
- Intervention groups received home-based care with community health worker support and remote nurse-led decision-making, with one group featuring automated blood pressure monitoring.
- The control group received standard clinic-based care.
Main Results:
- Home-based care significantly reduced systolic blood pressure at 6 months compared to standard care (CHW group: -7.9 mm Hg; enhanced CHW group: -9.1 mm Hg).
- Hypertension control rates were higher in home-based care groups (76.9% CHW, 82.8% enhanced CHW) versus standard care (57.6%) at 6 months.
- Benefits persisted at 12 months, with high retention rates (>95%) and similar safety profiles across groups.
Conclusions:
- Home-based hypertension care models are effective in improving blood pressure control in South Africa.
- This approach offers a viable alternative to standard clinic-based management, particularly in low-resource settings.
- The study demonstrates the potential for technology-supported, community-based interventions to enhance chronic disease management.
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