Home-based hypertension care is effective in rural South Africa
European Society of Cardiology
Madrid, Spain – 1 September 2025: Home-based hypertension care led to reductions in systolic blood pressure and improvements in hypertension control in South Africa, according to late-breaking research presented in a Hot Line session today at ESC Congress 20251 and simultaneously published in the New England Journal of Medicine.
“Hypertension is the primary risk factor for stroke and heart disease, which are leading causes of death in South Africa. Despite the wide availability of low-cost, effective therapies, hypertension control remains extremely poor in resource-limited settings. Obstacles include a lack of patient confidence to manage their own hypertension care, overcrowded clinics with long wait times and the cost of transport to clinics,” explained the IMPACT-BP trial’s Co-Principal Investigator Doctor Thomas Gaziano from Mass General Brigham (MGB) and Harvard Medical School, Boston, USA. “Our trial aimed to assess the effectiveness and implementation of reliable, home-based, technology-supported interventions to improve blood pressure control in low-resourced rural South Africa.”
IMPACT-BP was an open-label, randomised controlled trial conducted at the Africa Health Research Institute (AHRI) in KwaZulu-Natal, South Africa, in which patients were recruited from two public-sector primary healthcare clinics. The implementation study was designed with Co-Principal Investigator, Doctor Mark Siedner of AHRI and MGH, Professor Nombulelo Magula of the University of KwaZulu-Natal, and the KwaZulu-Natal Provincial Department of Health.
Adult patients were eligible if they had evidence of uncontrolled hypertension as defined by South African Department of Health Guidelines: two measurements of systolic blood pressure (SBP) >140 mmHg and/or diastolic BP (DBP) >90 mmHg, taken a minimum of 6 months apart.
Patients were randomised to one of three strategies: 1) standard-of-care, clinic-based blood pressure (BP) management; 2) home-based BP self-monitoring supported by the provision of BP machines, community health workers (CHWs) who conducted home visits for data collection and medication delivery, and remote nurse-led care assisted by a mobile application with decision support; or 3) an enhanced CHW group in which BP machines included cellular technology to transmit BP readings automatically to the mobile application. The primary outcome was change in SBP from enrolment to 6 months.
In total, 774 patients were randomised. The mean age was 62 years, 76% were women, 14% had diabetes and 47% were living with HIV.
Compared with standard-of-care, mean SBP at 6 months was lower in the CHW group (−7.9 mmHg; 95% confidence interval [CI] −10.5 to −5.3; p<0.001) and the enhanced CHW group (−9.1 mmHg; 95% CI −11.7 to −6.4; p<0.001). In the standard-of-care group, hypertension control at 6 months was 57.6% compared with 76.9% in the CHW group and 82.8% in the enhanced CHW group. Improved BP with home-based care appeared to persist at 12 months.
Severe adverse events (2.7%) and deaths (1.0%) were uncommon overall and similar across groups. Retention in care remained more than 95% in both intervention groups, with patients reported to have enjoyed managing their own hypertension.
Summarising, Doctor Siedner said, “This study is an important example of how making models of chronic disease care more convenient – taking it from the clinic to patients’ homes and letting them play a major role in their own care – can substantially improve hypertension outcomes.”
Of particular value was that the programme was successful in a community that has historically had low access to care. Professor Magula concluded: “Achieving hypertension control in over 80% of people in a predominantly Black African community in rural South Africa is a clear example that equitable health care access can be achieved in disadvantaged communities. Similar models of care that address structural barriers could be considered to improve hypertension control in other remote and resource-limited settings. Expansion of the model to include the care of people with multiple comorbidities may also be valuable.”
Notes to editor
This press release accompanies a presentation at ESC Congress 2025.
It does not necessarily reflect the opinion of the European Society of Cardiology.
Funding: The study was funded by the US National Institutes of Health and the Welcome Trust.
Disclosures: Doctor Gaziano, Doctor Siedner and Professor Magula have no disclosures to report related to this trial.
References and notes:
1‘IMPACT-BP: Implementation of a combination intervention for sustainable blood pressure control in rural South Africa’ presented during HOT LINE 9 on 1 September 2025 at 09:21 to 09:34 in Madrid (Main Auditorium).
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Africa aging, health and socioeconomics study garners $25 million NIH award
University of Michigan
A groundbreaking effort to better understand changing demographics in Kenya—and the resulting pressures on the country’s health system—has received a multi-million-dollar grant from the National Institutes of Health.
The Longitudinal Study of Health and Ageing in Kenya, or LOSHAK, is a collaboration between the Department of Population Health at Aga Khan University in Nairobi and the University of Michigan Institute for Social Research.
A fieldworker interviews in Kilifi County, rural Kenya, gathering data for the LOSHAK aging study.
The project received enabling support from the U-M Center for Global Health Equity and the AKU Medical College and is co-led by Joshua Ehrlich, the Paul R. Lichter Research Professor of Ophthalmology and Visual Sciences and a Research Associate Professor at the ISR, and his collaborator, Anthony Ngugi, Associate Professor and Chair of the AKU Department of Population Health and Associate Dean for Research in the Medical College in East Africa.
“Thanks in part to improved health services and access, life expectancy in Kenya is increasing. The irony is that these trends create new challenges for the very healthcare and economic systems that enabled them. Now, there is a need to adapt and innovate,” said Ehrlich, MD, MPH.
While sub-Saharan Africa currently has one of the world’s youngest populations, the proportion of older adults is rising faster than anywhere else, thanks to increased life expectancy and the growing use of contraceptives and family planning services. By 2050, the continent’s share of people aged 60 and older is expected to nearly triple. In Kenya, where LOSHAK is focused, the number of adults aged 60 and older is projected to increase fourfold in the next 30 years.
The five-year, $23.6 million grant (R01AG093721) will be allocated between AKU and U-M, enabling Ehrlich and Ngugi to survey thousands of Kenyans as they seek to fully understand drivers of health and economic well-being in later life, in addition to the long-term implications of emerging population trends.
“These demographic shifts will stress economic systems and create new demands for healthcare delivery, from elder care to chronic disease management and cancer treatments,” said Ngugi, PhD, MSc. “Looking ahead, policy makers will need the best possible data to understand and care for LMIC populations that look much different from those typically seen today.”
At the heart of LOSHAK are two complementary surveys, each designed to align with established international research networks. The first “Core” survey will target roughly 6,500 Kenyans aged 45 and older throughout the entire country. It will gather a range of health, social, and economic information. The survey will be deployed in more than a dozen languages, reflecting the country’s linguistic diversity. It is intended to harmonize with a global family of similar aging studies modeled after the U.S. Health and Retirement Study.
Nested within the Core survey is a second study of about 2,300 individuals in the Coast Region of Kenya aged 65 and older, focused on identifying risk factors for cognitive impairment, Alzheimer’s disease, and related conditions. This cognitive survey follows the Harmonized Cognitive Assessment Protocol, connecting it to an international network of comparable health studies as well.
Finally, the research team plans to incorporate environmental and physical activity data from wearable devices, as well as biomarker data from collected blood samples, checking for signs of inflammatory diseases and other chronic health conditions. The award will allow the team to establish a long-term survey cohort, laying the foundation for future studies to examine other dimensions of population aging.
All of the information gathered through LOSHAK will be publicly available to researchers for comparison alongside harmonized studies around the world, providing insights to academics, government officials, and policymakers across the African continent and beyond. Because chronic diseases, dementia, and caregiving pressures are nearly universal, the project’s impact is not necessarily confined to Kenya—or even sub-Saharan Africa—but could inform care anywhere, including in the United States.
“Our ultimate goal is to turn data into action—helping to shape health and economic systems that are ready to care not just for today’s population, but for older adults of the future too, no matter where they live,” said Ehrlich.
Written by Craig McCool
Reintroducing native African catfish into Lake Victoria reduced snail hosts and lowered schistosomiasis infection intensity in primary-school-aged children
PLOS
image:
Professor Andrew S. Brierley records field notes during the stocking of African catfish (Clarias gariepinus) as part of a schistosomiasis biocontrol project on the shores of Lake Victoria, Tanzania.
view moreCredit: Dr. Andrew Whiston, Founder & CEO, Rastech Ltd. (CC-BY 4.0, https://creativecommons.org/licenses/by/4.0/)
In your coverage, please use this URL to provide access to the freely available paper in PLOS Neglected Tropical Diseases: https://plos.io/4mMI0r3
Article title: Stocking African catfish in Lake Victoria provides effective biocontrol of snail vectors of Schistosoma mansoni
Author countries: United Kingdom, Uganda, Tanzania, Australia, United States
Funding: This research was funded by a Royal Society grant (CHL\R1\180111 ; www.royalsociety.org) awarded to ASB, SK and RK, a NERC Belmont Forum grant (NE/T013591/1; www.ukri.org) awarded to ASB and GDL and a MRC Harmonised Impact Acceleration Grant (www.ukri.org) awarded to ASB, FA, SK, and RK. GADL and AJC were partially supported by the USA National Science Foundation (# ICER-2024383 through the Belmont Collaborative Forum on Climate, Environment and Health), and by USA-NSF DEB #2011179 under the program Ecology and Evolution of Infectious Diseases. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Journal
PLOS Neglected Tropical Diseases
Method of Research
Experimental study
Subject of Research
People
Map showing study region (southern shores of Lake Victoria, Tanzania).
Credit
Proud R, et al., 2025, PLOS Biology, CC-BY 4.0 (https://creativecommons.org/licenses/by/4.0/)
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