Transforming hypertension management with digital technology: a retrospective cohort study in four sub-Saharan African countries

Introduction A chronic disease management programme anchored on a digital platform was scaled in Ghana, Kenya, Sierra Leone and Tanzania following successful pilot studies. We investigated blood pressure (BP) changes and their associated factors among patients with hypertension. Methods In this retrospective cohort study, the primary outcome was the relative reduction in BP and an absolute reduction in systolic BP (SBP) of >5 mm Hg at 6 (±2) months post-enrolment. We used the paired t-test, McNemar’s test and multivariable logistic regression to compare changes in mean SBP, compare changes in proportions and examine the association between patient characteristics and achieving >5 mm Hg SBP reduction, respectively. Results As of May 2024, 131 912 patients with hypertension had completed at least 6 months of the programme. The study cohort included 63 003 (48%) patients with documented enrolment and 6-month BP measurements. The mean age was 60.8 years (SD: 13.1) and 74.7% were female. Mean SBP and diastolic BP decreased by 8.3 mm Hg (95% CI −8.5 to −8.1; p < 0.001) and 4.5 mm Hg (95% CI −4.7 to −4.4; p < 0.001), respectively. Patients with uncontrolled SBP (≥140 mm Hg) at enrolment (n=38 079) experienced a mean SBP reduction of 18.1 mm Hg (95% CI −18.3 to −17.8; p<0.001). The proportion of patients with controlled BP increased from 35% at enrolment to 53% at 6 months. Factors associated with higher odds of >5 mm Hg SBP reduction included follow-up by community health workers (adjusted OR (AOR)=1.06; p=0.041), ≥3 medical reviews (AOR=1.16; p<0.001) and ≥8 BP assessments (AOR=1.35; p<0.001). Conclusion Significant BP improvements were observed under routine programme conditions among patients with 6-month documented measurements. Despite limitations in causal inference owing to the lack of a control arm and the high proportion of patients without a documented follow-up BP, the findings highlight the potential real-world value of digital-enabled community-based and decentralised care in hypertension management.