Home-based care for hypertension in rural South Africa

Siedner, Mark J., Magula, Nombulelo, Mazibuko, Lusanda, Sithole, Nsika, Castle, Alison, Nxumalo, Siyabonga, Manyaapelo, Thabang, Abrahams-Gessel, Shafika, Gareta, Dickman, Orne-Gliemann, Joanna, Baisley, Kathy, Bachmann, Max O. and Gaziano, Thomas A. (2025) Home-based care for hypertension in rural South Africa. New England Journal of Medicine, 393 (13). pp. 1304-1314. ISSN 0028-4793

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Abstract

BACKGROUND: Poorly controlled hypertension is a common problem worldwide, particularly in low-resource settings.  METHODS: We conducted an open-label, randomized, controlled trial of a home-based model of hypertension care in South Africa. Adults with hypertension were assigned to receive home-based care, which consisted of patient monitoring of blood pressure, home visits from a community health worker (CHW) for data collection and medication delivery, and remote nurse-led decision making supported by a mobile application (CHW group); enhanced home-based care, which consisted of the same intervention but with blood-pressure machines transmitting readings automatically (enhanced CHW group); or standard care with clinic-based management (standard-care group). The primary outcome was the systolic blood pressure at 6 months. Secondary outcomes were the systolic blood pressure at 12 months and hypertension control at 6 and 12 months. Safety outcomes included adverse events, deaths, and retention in care.  RESULTS: A total of 774 adults underwent randomization. The mean age was 62 years; 76.0% of the participants were women, 13.6% had diabetes mellitus, and 46.5% had human immunodeficiency virus infection. The mean systolic blood pressure at 6 months was lower in the CHW group than in the standard-care group (difference, -7.9 mm Hg; 95% confidence interval [CI], -10.5 to -5.3; P<0.001) and was also lower in the enhanced CHW group than in the standard-care group (difference, -9.1 mm Hg; 95% CI, -11.7 to -6.4; P<0.001). The percentage of participants with hypertension control at 6 months was 32.5% in the standard-care group, as compared with 57.4% in the CHW group (relative risk, 1.76; 95% CI, 1.40 to 2.13) and 61.3% in the enhanced CHW group (relative risk, 1.89; 95% CI, 1.51 to 2.27). The improvements in systolic blood pressure and hypertension control with home-based care appeared to persist at 12 months. Severe adverse events and deaths occurred in 2.7% and 1.0% of the participants, respectively, and occurred in a similar percentage of participants across trial groups. Retention in care was observed in more than 95% of the participants in the CHW and enhanced CHW groups.  CONCLUSIONS: In South Africa, home-based hypertension care led to a significantly lower mean systolic blood pressure at 6 months than standard, clinic-based care. (Supported by the National Institutes of Health and others; IMPACT-BP ClinicalTrials.gov number, NCT05492955; South African National Clinical Trials Register number, DOH-27-112022-4895.).

Item Type:	Article
Uncontrolled Keywords:	cardiology general,clinical medicine general,comparative effectiveness,geriatrics,aging general,health care delivery,health it,hypertension (cardiology),hypertension (nephrology),international health policy,nephrology general,outpatient-based clinical medicine,quality of care,medicine(all),sdg 3 - good health and well-being ,/dk/atira/pure/subjectarea/asjc/2700
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Centres > Norwich Institute for Healthy Aging Faculty of Medicine and Health Sciences > Research Centres > Public Health Faculty of Science > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Health Services and Primary Care
Related URLs:	http://www.scopus.com/inward/record.url?...
Depositing User:	LivePure Connector
Date Deposited:	26 Nov 2025 14:30
Last Modified:	27 Nov 2025 10:30
URI:	https://ueaeprints.uea.ac.uk/id/eprint/101111
DOI:	10.1056/NEJMoa2509958

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