Table 2.
Study characteristics
| Participants | Intervention (IG) vs control (CG) group | Results on adherence and BP | |||||
| Name (design) | Country | n | Age (years)/females | Hypertension; SBP/DBP (mm Hg) | Description | Follow-up (months) | IG vs CG; treatment effect (95% CI) |
| Educational strategies for patients (11 RCTs) | |||||||
| Adeyemo et al24 (RCT) |
Nigeria (mixed) | 668 | 62.7±10.0/66% | Mild to moderate 167.4±19.2/91.8±12.3 |
Home visits by nurses and clinic management (community based, nurse-led treatment programme with physician backup; facilitation of clinic visits and health education; use of diuretics and a beta blocker as needed) vs clinic management | 6 |
Excellent adherence (missed ≤2 pills per month): worse in IG: 72.5% vs 79.0%; ORa 0.524 (0.30 to 0.75) BP control: no difference 65.0% vs 66.3%; RR 0.98 (0.87 to 1.11) |
| Ayodapo and Olukokun27 (RCT) |
Nigeria (mixed) | 322 | 60.9±10.0/51% | MAP: 106.4±8.3 | Counselling on lifestyle behaviours (physical activity, fruit and vegetable consumption, alcohol consumption, smoking) over 30–45 min, reminders (telephone calls/SMS) vs usual care | 3 |
Met recommendations on: physical activity: better in IG: 22.4% vs 6.2%; RR 3.60 (1.85 to 7.00) fruit and vegetable consumption: better in IG: 71.4% vs 66%; RR 1.74 (1.41 to 2.15) alcohol consumption: better in IG: 100% vs 87.6%; RR 1.14 (1.08 to 1.21) smoking: no difference: 83.9% vs 78.5%; RR 1.05 (0.95 to 1.17) BP: MAP: lower in IG: 94.6±8.1 vs 106.2±7.6 mm Hg; MD −9.8 (−11.5 to −8.1) |
| Bobrow et al28 (PACTR2014 11000724141) (RCT) |
South Africa (urban) |
1372 | 54.3±11.5/72% | Mild to moderate 135.4±17.5/83.4±12.1 |
Mobile phone text messages on behaviour change techniques (IG2: interactive with information and possibility to response vs IG1: only information on hypertension, motivation to take medications and reminders) vs usual care | 12 |
Adherence (days with medication ≥80%): higher with IG: 59.7% vs 62.8% vs 49.4%; RR 1.12 (1.01 to 1.23) IG2 vs CG: ORa 1.86 (1.39 to 2.49) IG1 vs CG: ORa 1.60 (1.20 to 2.16) BP: slightly lower with IG1 SBP: 132.7±17.5 vs 132.1±16.6 vs 134.3±17.3 mm Hg IG2 vs CG: MDa −1.6 mm Hg (−3.7 to 0.6) IG1 vs CG: MDa −2.2 mm Hg (−4.4 to −0.04) BP control: slightly better with IG: 65% vs 65% vs 58% IG1 vs CG: ORa 1.42 (1.03 to 1.95) IG2 vs CG: ORa 1.41 (1.02 to 1.95) |
| Bolarinwa et al29 (PACTR2016 06001671335) (RCT) |
Nigeria (urban) | 299 | 61.1±10.8/77% | 140.0±22.9/86.9±11.9 | Task-shifting (driven by trained and professionally competent nurses) home-based follow-up care (BP and BMI monitoring, medical advice and counselling at home) vs usual care | 12 | Medical adherence: better with IG: low: 4% vs 16.6%, medium: 17.5% vs 34.7%, high: 78.5% vs 48.7% BP control: better with IG: 85.9% vs 76.7%; RR 1.12 (1.00 to 1.25) |
| Labhardt et al36 (cluster RCT) | Cameroon (rural) | 187 | 59.9±12.5/64% | Mild to moderate 175.8/100.7 |
Reminder letters in case of missing follow-up (IG2) vs financial incentive (1 month free treatment for regular attenders) (IG1) vs usual care in nurse-led facilities | 12 |
Adherence: retention rate: 60% vs 65% vs 29%; lower risk of loss to follow-up from the programme and better adherence in IG IG2 vs CG: HRa: 0.38 (0.24 to 0.61) IG1 vs CG: HRa: 0.44 (0.27 to 0.72) Adherence (≥80%): 38% vs 35% vs 10% IG2 vs CG: MDa: 28% (14% to 42%) IG1 vs CG: MDa: 25% (13% to 37%) BP: no differences in SBP in retained patients Costs: In IG1: average monthly cost per patient for antihypertensive medication: €1.1±0.9, transport: €1.1±1.0 |
| Owolabi et al56 (NCT01900756) (RCT) |
Nigeria (mixed) |
400* | 57.2±11.7/37% | All stroke (n=400); 138.3±23.6/83.0±15.2 stroke and uncontrolled hypertension (SBP/DBP >140/90 mm Hg) (n=168) 158.7±21.7/92.5±15.6 |
Chronic care model components of delivery system redesign (increased follow-up visits, pre-appointment phone texts), self-management support (patient report card, post-clinic follow-up phone texts, waiting room educational video) and clinical information systems (patient report card as part of medical chart, hospital registry) vs standardised usual care (risk factor identification and control) and phone contact information | 12 |
BP: No difference for all patients after stroke: SBP: 136.5±22.3 vs 136.2±21.2 mm Hg Patients with uncontrolled hypertension: SBP: 145.1±22.6 vs 148.5±22.8 mm Hg |
| Sarfo et al58 (NCT02568137) (cluster RCT) |
Ghana (urban) |
60* | 55±13/35% | Stroke and uncontrolled hypertension; 143.8±26.7/90.5±15.7 |
Nurse-led, multilevel approach with m-Health technology for monitoring and reporting BP measurement and tailored motivational text messages vs usual care | 9 |
Adherence: modified MMA score: no difference: 13±1.5 vs 13±1.7 BP: BP control: no difference: 47% vs 40%; ORa: 1.24 (0.83 to 1.84) SBP <140 mm Hg: better in IG: 73% vs 43% DBP <90 mm Hg: better in CG: 47% vs 77% |
| Saunders et al60 (RCT) |
South Africa (urban) |
224 | 65% between 40 and 50/73% | Mild to moderate; n.r. 116.6 |
Reminder letters and home visits by fieldworkers and patient-retained records for self-monitoring of medication compliance and BP control vs usual care (appointment system and health education) | 6 |
Adherence (treatment received) over 6 months: higher for newly treated (135.5±48.9 vs 95.0±60.0 days) and infrequent attenders (168.4±16.4 vs 116.7±56.9 days) of 180 days >80% of treatment: better for newly treated (59% vs 29%; p<0.001) and infrequent attenders (87% vs 42%; p<0.001) BP: DBP: lower for newly treated patients (93.4 vs 100.5 mm Hg; MD: 7.1 mm Hg (0.5 to 13.7), no difference for infrequent attenders: 97.5 vs 94.7 mm Hg; MD: −2.8 mm Hg (−6.9 to 1.3)) |
| Stewart et al61 (RCT) |
South Africa (urban) | 83 | Late middle-aged/n.r. | All hypertensives; 146.4±18.5/93.5±11.1 |
Telephonic intervention (educational and home-based exercise programme+support of a healthcare practitioner and a family member) vs control group (educational and home-based exercise programme only) | 6 |
Adherence: better with IG: 62.8%±34.5% vs 39.3±42.8%; p=0.007 BP: no difference: SBP: 142±16 vs 144±20 mm Hg; MD: −2 mm Hg (−10.3 to 6.3) DBP: 92±12 vs 91±10 mm Hg, change: MD: 1 mm Hg (−4.0 to 6.0) |
| Vedanthan et al64 (NCT01844596) (cluster RCT) |
Kenya (rural) | 1460 | 54.2±16.4/58% | All hypertensives; 159.4±19.5/89.7±12 |
Tailored behavioural communication (smartphone (IG2) or paper-based (IG1)) vs usual care | 12 |
Adherence (linkage to care): best results with IG2, worse with IG1: IG2 vs CG: ORa: 1.21 (0.70 to 2.01) IG1 vs CG: ORa: 0.64 (0.43 to 0.91) IG2 vs IG1: ORa: 1.95 (1.23 to 3.01) BP: no difference SBP: 149.4±20.8 vs 150.2±21.6 vs 150.0±22.9 mm Hg, change: −13.1±20.5 vs −8.4±24.0 vs −9.7±25.1 mm Hg IG2 vs CG: MDa: −2.13 mm Hg (−4.89 to 0.42) IG1 vs CG: MDa: −0.06 mm Hg (−3.61 to 3.20) IG2 vs IG1: MDa: −2.07 mm Hg (−5.14 to 1.12) DBP: no difference: 91.3±12.7 vs 91.0±14.1 vs 90.1±13.7 mm Hg, change: 1.5±12.7 vs 0.4±15.2 vs 0.1±14.7 mm Hg BP control: no difference: IG2 vs CG: ORa: 0.95 (0.61 to 1.38) IG1 vs CG: ORa: 0.97 (0.63 to 1.42) IG2 vs IG1: ORa: 1.00 (0.69 to 1.40) |
| Wahab et al66 (RCT) |
Nigeria (urban) | 35* | 58.1±10.5/34% | All patients with stroke; 138.3±24.2/85.0±12.4 |
Feasibility of a nurse-led Intervention (education and skill building, BP monitor with review, phone calls) vs usual care | 0.5 |
Adherence: no difference, but improvement in both groups: MMA score: 7.32±0.93 vs 7.03±1.36 BP: no difference SBP: 137.5±23.0 vs 133.1±18.2 mm Hg; MD: 4.40 mm Hg (−9.4 to 18.2) DBP: 84.1±9.7 vs 84.2±13.1 mm Hg; MD −0.1 mm Hg (−7.7 to 7.5) |
| Educational strategies for healthcare professionals (5 RCTs) | |||||||
| Fairall et al32 (ISRCTN20283604) (cluster RCT) |
South Africa (rural) | 4393 | 52 (IQR 43–62)/73% | Mild to moderate 139±23.6 90±13.2 |
Education of nurses on NCD care (nurse training in educational outreach sessions with a primary care programme to expand their role in NCD care, authorisation to prescribe an expanded range of drugs on NCDs) vs usual training | 14 |
Adherence: no difference BP: BP controlled: no difference: 33% vs 32%; RR 1.01 (0.2 to 1.8) |
| Goudge et al34 (ISRCTN12128227) (cluster RCT) |
South Africa (rural) | 4722 | 56.6±19.4/56% | Hypertension: 46.6%, of them: 53.4%, on treatment and controlled: 8.6%, on treatment and uncontrolled: 9%, not on treatment: 29% | Support of nurses by health workers (eg, assistance with booking appointments, retrieve and fill patient files, health education, measurements in the vital signs queue, prepacking of medications, reminders to appointment for patients) to provide chronic disease care vs usual care | 18 | No hypertension: 50.9% vs 52.9% Adherence and BP: no difference on treatment and controlled: 11.3% vs 11.2% on treatment and uncontrolled: 13.0% vs 13.2% not on treatment: 24.9% vs 22.7% undiagnosed: 24.1% vs 22.2% taking medication: 24.3% vs 24.4% |
| Gyamfi et al35 (NCT01802372) (cluster RCT) |
Ghana (mixed) | 757 | 58.0±12.4/60% | Mild to moderate 155.9±12.1/89.6±10.8 |
Training of nurses in task-shifting for hypertension control+health insurance coverage vs health coverage | 12 | BP: improvement in both groups, but no difference between groups: SBP: 137.1±27.5 vs 138.4±27.3 mm Hg; change: −19.5±18.0 vs −16.6±17.9 mm Hg; MD: −2.9 mm Hg (−6.9 to 1.0) DBP: 79.8±22.9 vs 81.8±22.8 mm Hg; change −9,3±11.5 vs 8.7±18.7 mm Hg; MD −0.6 mm Hg (−2.9 to 1.7) BP control: 55.2% vs 49.9% (MD 5.2% (−1.8% to 12.4%)) |
| Mendis et al52 (cluster RCT) | Nigeria (mixed) | 1188 | 55±4.7/58% | Mild to moderate 153.2±12.4/94±9.7 |
Education of healthcare workers and patients with a simple cardiovascular risk management package vs usual care | 12 |
Adherence: higher with IG Attended visits: 90.1% vs 74.5% quit smoking: 100% vs 74.4% (p=0.023) Increased fruit consumption: 93.4% vs 18.8% (p<0.0001) Increased vegetable consumption: 14.2% vs 7.0% (p=0.0002) BP: higher decrease in IG SBP: −11.0±15.4 vs −6.6±20.6 mm Hg; MD −4.4 mm Hg (−6.7 to −2.1) DBP: −5.4±10.0 vs −2.0±13.2 mm Hg; MD −3.4 mm Hg (−4.9 to −1.9) |
| Steyn et al62 (PACTR2013 03000493351) (cluster RCT) |
South Africa (urban) |
920 | 60.3±11.1/79% | All hypertensives 151.2±26.7/87.1±12.4 |
Multifaced intervention to implement national guidelines (structured record of national guidelines and visits to train clinicians) vs usual care (passive dissemination) at primary care level | 12 |
BP: no difference SBP: 161±28.9 vs 158.2±29.5 mm Hg; MD 2.8 mm Hg (−1.2 to 6.8) DBP: 88.1±13 vs 87.1±12.6 mm Hg; MD 1.00 mm Hg (−0.73 to 2.73) controlled BP: 23.1% vs 26% |
| Individualised treatment (3 RCTs) | |||||||
| Akintunde et al25 (ISRCTN69440037) (RCT) {Akintunde, 2017 #4980} (ISRCTN69440037) |
Nigeria, Kenya, South Africa (urban) | 105 | 56.6±14.3/53% | Uncontrolled 170.9±19.2/85.6±21.8 |
Physiologically individualised care (guided by their physiological phenotype, based on plasma renin and aldosterone) vs usual care | 12 |
BP: lower in IG SBP: 139.4±17.4 vs 152.6±12.3 mm Hg; MD −13.2 mm Hg (−19.4 to −7.0) DBP: 84.0±11.0 vs 89.6±7.0 mm Hg; MD −5.6 mm Hg (−9.4 to −1.8) BP control: 50.0% vs 11.1% (p=0.0001) |
| Okeahialam et al55 (RCT) |
Nigeria (urban) | 181 | 49.7±14.2/61% | Mild to moderate 150.3±14.8/93.7±9.6 |
Chronotherapy: drug intake in the night (22:00) vs drug intake in the morning (10:00) | 3 |
BP: higher decrease in IG SBP: −18.1±17.9 vs −14.1±14.7 mm Hg; MD −4.0 mm Hg (−9.0 to 1.0) DBP: −15.6±12.2 vs −8.7±10.2 mm Hg; MD −6.9 mm Hg (−10.4 to −3.4) |
| Physical activity (4 RCTs) | |||||||
| Aweto et al26 (RCT) |
Nigeria (urban) |
50 | 45±12.3/58% | Mild to moderate 138.7±10.9/79.9±9.3 |
Dance movement therapy (50 min) vs educational sessions, both 2×/week over 4 weeks | 1 |
BP: lower in IG SBP: 119.9±8.3 vs 135.5±11.6 mm Hg; MD −15.6 mm Hg (−22.4 to −8.8) DBP: 70.9±7.2 vs 74.1±7.7 mm Hg; MD −3.2 mm Hg (−8.1 to 1.7) |
| Lamina37 (RCT) |
Nigeria (urban) |
485 | 58.5±6.8/0% | Mild to moderate, stable 165.4±13.2/98.1±4.6 |
Training programmes on bicycle ergometer, 3×/week, 45–60 min: interval training (IG2) vs continuous training (IG1) vs usual care over 8 weeks | 2 |
BP: lower in IG SBP: 150.4±16.7 vs 154.4±12.6 vs 163.5±14.9 mm Hg; MD −11.1 mm Hg (−14.8 to −7.4) DBP: 95±5 vs 94.4±8.8 vs 96.1±2.7 mm Hg; MD −1.4 mm Hg (−2.6 to −0.2) |
| Maruf et al51 (ISRCTN81952488) (RCT) |
Nigeria (urban) |
120 | 52.8±8.4 (range 38–65)/71% | Mild to moderate, 155.7±11.4/93±10 |
Aerobic dance training (3×/week, 45 min) vs usual care over 12 weeks | 3 |
BP: lower in IG SBP: 135.3±5.6 vs 142.4±4.7 mm Hg; MD: −7.1 mm Hg (−9.3 to −4.9) DBP: 82.2±3.4 vs 83.9±2.8 mm Hg; MD: −1.7 mm Hg (−3.0 to −0.4) |
| Khalid et al63 (RCT) |
Egypt (urban) |
30 | 52.8±2.4, 40–50/100% | Postmenopausal hypertensives 151±6.2/94.5±4.2 |
Moderate aerobic exercise training (40 min, 3×/week) by walking on a treadmill vs usual care over 8 weeks | 2 |
BP: lower in IG SBP: 124±5.6 vs 145±6.7 mm Hg; MD: −21.0 mm Hg (−25.8 to −16.2) DBP: 85±5.4 vs 95±3.7 mm Hg; MD: −10.0 mm Hg (−13.7 to −6.3) |
| Modified nutrition (1 RCT) | |||||||
| Charlton et al31 (RCT) |
South Africa (urban) | 92 | 61.1±7/84% | Mild to moderate 134.6±15.7/81.1±8.1 |
Food-based dietary strategy (modified food, salt replacement, +500 mL of maas (fermented milk) vs control (same quantities of the targeted foods of standard commercial composition, 500 mL/day artificially sweetened cool drink) | 2 |
BP: lower in IG SBP: 132.5±15.8 vs 127.5±15.8 mm Hg; MDa: −6.2 mm Hg (−11.4 to −0.9) DBP: 82.2±9.5 vs 79.2±11.4 mm Hg; MDa: −0.6 mm Hg (−3.0 to 1.8) |
*Tertiary prevention.
BMI, body mass index; BP, blood pressure; DBP, diastolic blood pressure; MAP, mean arterial pressure; MD, mean difference; MDa, adjusted mean difference; MMA, Morisky medication adherence; n, number of randomised participants; NCD, non-communicable disease; n.r, not reported; ORa, adjusted OR; RCT, randomised controlled trial; RR, relative risk; SBP, systolic blood pressure; SMS, short message service.