Home-based hypertension care is effective in rural South Africa

European Society of Cardiology

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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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DOI

10.1056/NEJMoa2509958 

Africa aging, health and socioeconomics study garners $25 million NIH award

University of Michigan

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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

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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.

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Credit: 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.

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Journal

PLOS Neglected Tropical Diseases

DOI

10.1371/journal.pntd.0013490 

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/)

 

What climate change means for the Mediterranean Sea

GEOMAR study highlights urgent need for action

Helmholtz Centre for Ocean Research Kiel (GEOMAR)

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Temperatures in the Mediterranean are currently rising to record levels. Instead of a refreshing dip, holidaymakers in places like Greece, Italy, and Spain, among other places, are now facing water temperatures up to 28°C or even higher. With an average water temperature of 26.9°C, July 2025 was the warmest since records began for the Mediterranean Sea, according to the Copernicus Earth Observation Service. Warming caused by climate change is considered – alongside stressors such as overfishing, pollution, and habitat destruction – a major factor threatening marine and coastal habitats. “The consequences of warming are not only projections for the future, but very real damages we are witnessing now. The continuing rise in temperatures, sea level and ocean acidification cause severe risks for the environment in and around the Mediterranean Sea,” says Dr. Abed El Rahman Hassoun, Biogeochemical Oceanographer at the Helmholtz Centre for Ocean Research Kiel.

Meta-study on climate change scenarios

Together with Prof. Dr. Meryem Mojtahid, Professor of Paleo-Oceanography at the University of Angers and at Laboratory of Planetology and geosciences (France), they have investigated the effects of climate change on marine and coastal ecosystems in the Mediterranean region. The projections of the meta-study are based on recognized climate scenarios of the IPCC (Intergovernmental Panel on Climate Change). The research team analyzed 131 scientific studies on Mediterranean published up to August 2023. For the first time, this resulted in a so-called 'burning ember' diagram for Mediterranean marine and coastal ecosystems – a risk assessment tool originally developed by the IPCC. “The diagram clearly shows how strongly climate change threatens key ecosystems. I hope our results will help raise awareness and inspire real action to protect these unique ecosystems,” says Meryem Mojtahid. The study also draws on the Research Initiative on Climate Change and Environmental Degradation in the Mediterranean Region (MedECC). In 2020, the initiative published the first Mediterranean Assessment Report under the name MAR1, thus playing a key role in consolidating knowledge on climate and environmental changes in the Mediterranean area.

Mediterranean as a “Climate Change Hotspot”: Every Tenth of a Degree Counts

The Mediterranean Sea – similar to the Baltic Sea or the Black Sea – is a semi-enclosed sea and connected to the global ocean only through the Strait of Gibraltar. As a result, the Mediterranean Sea is warming faster and acidifying more strongly than the open ocean. Between 1982 and 2019, the surface seawater temperature already increased by 1.3°C, while the global increase was only 0.6°C. Therefore, the IPCC also refers to the Mediterranean Sea as a 'hotspot of climate change'. Also, scientists consider it as a natural laboratory because it reacts faster and more strongly to climate pressures than the open ocean, while at the same time concentrating multiple drivers and stressors in a relatively small, well-observed system. “What happens in the Mediterranean often foreshadows changes to be expected elsewhere, so the Mediterranean Sea acts like an early warning system for processes that will later affect the global ocean,” says Abed El Rahman Hassoun."

If international climate protection targets are met in the coming years, some environmental changes could still be slowed. Two IPCC scenarios – known as RCPs, or Representative Concentration Pathways – can be used to illustrate this: In a medium emissions scenario (RCP 4.5), emissions will stabilise over the next few years thanks to moderate climate policies. Even in this case, the Mediterranean Sea is expected to warm by an additional 0.6 to 1.3 °C (compared to current values) in 2050 and 2100 respectively. In contrast, the high emissions scenario (RCP 8.5) describes the “business as usual” path with continuously rising emissions. In this scenario, additional warming would likely range between 2.7°C and 3.8°C by 2050 and 2100 respectively. Such warming, together with sea level rise and ocean acidification, would have significant disruptions on ecosystems: seagrass meadows would be lost, coral reefs might witness significant damages, and severe chain reactions would occur in food webs.

“These scenarios show: We can still make a difference! Every tenth of a degree counts!” says study leader Abed El Rahman Hassoun. “Political decisions made now will determine whether ecosystems in the Mediterranean Sea collapse, partially or totally, or remain functional feeding the ecosystem services they provide. At the same time, our study also shows that even with moderate climate protection and an additional 0.8°C warming, we must expect some consequences. Thus, our focus should be on minimizing the impacts as low as possible.”

Impacts on Marine Ecosystems

The researchers examined a wide range of marine ecosystems: from seagrass meadows to fish and macroalgae, as well as marine mammals and turtles. Warming and acidification of the Mediterranean are altering entire communities. Plankton species are shifting, and toxic algal blooms and bacteria are occurring more frequently. With an additional warming of 0.8°C, seagrass plants such as Posidonia oceanica would decline massively and disappear completely by 2100. Seaweed species such as Cystoseira would also decline, while populations of heat-loving invasive algae could increase. Fish stocks are under pressure from +0.8 °C as well: they could shrink by 30 to 40 percent, shift northwards, and make room for invasive species such as the lionfish, which threatens biodiversity. Corals, probably due to their long evolutionary history, are relatively more resilient than other ecosystems, as they are at moderate to high risk from +3.1 °C. Data on marine mammals and sea turtles are limited, but changes in feeding grounds, migration behavior, and energy budgets are likely to occur.

Coastal Ecosystems: Particularly Vulnerable

Due to the combined effect of warming and sea-level rise, coastal ecosystems in the Mediterranean Sea are especially vulnerable to the impacts of climate change. The zone affected includes areas up to ten meters above sea level, such as dunes and rocky coasts. Rising sea levels increase coastal erosion and thereby threaten the nesting sites of sea turtles – more than 60 percent could be lost. Even at an additional warming of just +0.8 °C, the risk rises significantly: sandy beaches and dunes are particularly endangered, and rocky coasts also lose habitat and biodiversity, although they are somewhat more resilient.

Wetlands, lagoons, deltas, salt marshes, and coastal aquifers are also affected and can experience considerable damage already at +0.8°C to +1.0°C. Here, the loss of important plant species, the spread of invasive species, and large-scale vegetation changes are very likely. At the same time, rising sea levels can lead to reduced precipitation and consequently water scarcity. From +1.0 °C onward, the risks are expected to increase further due to flooding and higher nutrient inputs.

“We found that Mediterranean ecosystems are remarkably diverse in how they respond to climate-related stress. Some are more resistant than others, but none are invincible”, says Meryem Mojtahid. “Only strict climate protection measures can keep the risks at a level to which ecosystems can still adapt. Through this study, we were able to make visible that even a comparatively small increase in temperature and other climate change-related stressors has significant effects. “Now it’s time to turn knowledge into action”, adds Abed El Rahman Hassoun.

Research Gaps

For several ecosystems, scientific studies for the assessment of risks are still limited. There are only few projections for deep-sea habitats, salt marshes, macroalgae, and megafauna. Significant geographical gaps also remain, particularly in the southern and eastern Mediterranean, leading to a possible underestimation of risks in underrepresented countries. Moreover, long-term observations that address multiple stressors such as pollution and invasive species simultaneously are lacking. Addressing these gaps will require stronger interdisciplinary research efforts and expanded monitoring, especially in underrepresented regions.

 

Background:

The IPCC (Intergovernmental Panel on Climate Change), also known as the World Climate Council, is the United Nations’ international expert body that assesses the current state of climate research. Its reports summarize scientific findings, highlight risks, and provide a basis for decision-making for policymakers and society. A well-known tool from the IPCC reports is the so-called “Burning Ember Diagram.” It visualizes the likelihood of harm to humans and nature depending on global warming. Orange and red areas indicate where risks become high and very high – similar to a “glowing ember,” which explains the name.

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Journal

Scientific Reports

DOI

10.1038/s41598-025-07858-x 

Method of Research

Meta-analysis

Article Title

Climate change risks on key open marine and coastal mediterranean ecosystems

3D printing “glue gun” can generate bone grafts directly onto fractures in animals

Cell Press

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Graphical abstract CREDIT Jeon et al. / Device

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Credit: Device / Jeon et al.

Scientists have developed a tool made from a modified glue gun that can 3D print bone grafts directly onto fractures and defects during surgery. The tool, described September 5th in the Cell Press journal Device, has been tested in rabbits to quickly create complex bone implants without the need for prefabricating in advance. What’s more, the team optimized the 3D-printed grafts for high structural flexibility, release of anti-inflammatory antibiotics, and promotion of natural bone regrowth at the grafting site.

Historically, bone implants have been made of metal, donor bone, or even more recently 3D-printed material. However, in cases involving irregular bone breaks, these implants must be designed and produced prior to surgery to allow for appropriate fitting.

“Our proposed technology offers a distinct approach by developing an in situ printing system that enables a real-time fabrication and application of a scaffold directly at the surgical site,” says Jung Seung Lee, co-author and associate professor of biomedical engineering at Sungkyunkwan University. “This allows for highly accurate anatomical matching even in irregular or complex defects without the need for preoperative preparation such as imaging, modeling, and trimming processes.”

The material fed into the glue gun is a filament comprised of two major components: a feature of natural bone known to promote healing called hydroxyapatite (HA) and a biocompatible thermoplastic called polycaprolactone (PCL). PCL can liquify in temperatures as low as 60°C, which when applied with a heat-modified glue gun, is cool enough to prevent tissue damage during surgical application while being able to conform to the jagged grooves of fractured bone. By adjusting the proportion of HA to PCL within the filament, the team can customize the hardness and strength of the grafts to fit different anatomical needs.

“Because the device is compact and manually operated, the surgeon can adjust the printing direction, angle, and depth during the procedure in real time,” says Lee. “Also, we demonstrated that this process could be completed in a matter of minutes. This highlights a significant advantage in terms of reducing operative time and improving procedural efficiency under real surgical conditions.”

Since infection is a common concern with surgical implants, the researchers incorporated vancomycin and gentamicin, two anti-bacterial compounds, into the filament. In both petri dish culture and liquid medium, the filament scaffold successfully inhibited the growth of E. coli and S. aureas, two common bacteria prone to cause infection post-surgery. Due to physical properties of HA and PCL within the filament, the drugs are released slowly and are able to diffuse directly onto the surgical site over several weeks.

“This localized delivery approach offers meaningful clinical advantages over systemic antibiotic administration by potentially reducing side effects and limiting the development of antibiotic resistance, while still effectively protecting against postoperative infection,” says Lee.

As a proof of concept, the device was tested on the severe femoral bone fractures in rabbits. Within 12 weeks after surgery, the team found no signs of infection or necrosis and greater bone regeneration outcomes when compared to rabbits grafted with bone cement—a sealing compound commonly used for treating bone defects.

“The scaffold was designed not only to integrate biologically with surrounding bone tissue but also to gradually degrade over time and be replaced by newly formed bone,” says Lee. “The results showed that the printing group exhibited superior outcomes in key structural parameters such as bone surface area, cortical thickness, and polar moment of inertia, suggesting more effective bone healing and integration.”

Next the team is setting their sights on optimizing the anti-bacterial potential of the scaffold even further and preparing the procedure for human trials.

“Clinical adoption will require standardized manufacturing processes, validated sterilization protocols, and preclinical studies in large animal models to meet regulatory approval standards,” says Lee. “If these steps are successfully achieved, we vision this approach becoming a practical and immediate solution for bone repair directly in the operating room.”

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Device, Jeon et al.“In situ printing of biodegradable implant for healing critical-sized bone defect” https://www.cell.com/device/fulltext/S2666-9986(25)00186-3

Device (@Device_CP), is a physical science journal from Cell Press along with Chem, Joule, and Matter. Device aims to be the breakthrough journal to support device- and application-oriented research from all disciplines, including applied physics, applied materials, nanotechnology, robotics, energy research, chemistry, and biotechnology under a single title that focuses on the integration of these diverse disciplines in the creation of the cutting-edge technology of tomorrow. Visit http://www.cell.com/device/home. To receive Cell Press media alerts, contact press@cell.com. 

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Journal

Device

DOI

10.1016/j.device.2025.100873 

Method of Research

Experimental study

Subject of Research

Animals

Article Title

In situ printing of biodegradable implant for healing critical-sized bone defect

Article Publication Date

5-Sep-2025