Primary Health Care for Hypertension by Nurses in Rural and Urban Sub‐Saharan Africa
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Key result
Nurse-led protocol-driven care for hypertension in Cameroon significantly reduced systolic blood pressure by 11.7 mm Hg and diastolic blood pressure by 7.8 mm Hg.
Why the study?
Does nurse-led protocol-driven care improve blood pressure control in patients with hypertension in rural and urban Sub-Saharan Africa?
Population
454 patients with known or newly diagnosed hypertension in rural and urban Cameroon. 45% urban and 55% rural.
Design
Cohort
Follow-up
median 6 months (25th-75th percentiles: 3-9 months)
Authors
Discussion
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Implication
Supports nurse-led hypertension care in Sub-Saharan Africa; hypothesis-generating pending randomized confirmation.
Key Points
- Evaluate the clinical feasibility and effectiveness of an adapted nurse-led primary care protocol for managing hypertension in rural and urban health clinics.
- Adapted international hypertension management guidelines and trained 10 nurses across 5 primary care clinics located in Yaounde and Bafut, Cameroon.
- Enrolled a cohort of 454 participants (45% urban) referred from a field survey and monitored blood pressure changes over a 26-month implementation period.
- Systolic blood pressure decreased by an average of 11.7 mm Hg (95% CI, 8.9–14.4; P < .001) and diastolic blood pressure fell by 7.8 mm Hg (95% CI, 5.9–9.6; P < .001) from baseline to final visits.
- Rural participants were more frequently female (59% vs 45%, P = .002) and less likely to have diabetes (7.2% vs 41.2%, P < .001) than urban participants, with patient dropouts primarily concentrated around the initial visit.
Study Design
Type
Cohort (n=454)
Multicenter
Yes
Structured PICO
Does nurse-led protocol-driven care improve blood pressure control in patients with hypertension in rural and urban Sub-Saharan Africa?
P
Population
454 patients with known or newly diagnosed hypertension (SBP ≥140 mm Hg and/or DBP ≥90 mm Hg) in rural and urban Cameroon. 45% urban (n=204) and 55% rural (n=250).
I
Intervention
Nurse-led protocol-driven care for hypertension, including stepwise drug prescription (starting with thiazide diuretics, followed by beta-blocker or calcium channel blocker, then methyldopa/nifedipine/propranolol) and nonpharmacologic measures.
O
Outcome
Change in systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) levels between the final and baseline visitsurrogate
Main Result
p-value: p=<0.001
Implementation of a nurse-led, protocol-driven hypertension clinic in rural and urban Sub-Saharan Africa significantly reduced systolic and diastolic blood pressures.
Limitations
- Large initial dropout rate
- Unblinded assessment of end points
- Absence of a comparative arm
- Inability to assess the levels of other cardiovascular risk factors at baseline and monitor them during follow-up
- Inability to assess patients for target organ damage
- High dropout rate
- Inability to assess other cardiovascular risk factors at baseline and monitor them during follow-up
Cite This Study
Kengne et al. (2009) conducted a cohort in Hypertension (n=454). Nurse-led protocol-driven care was evaluated on Change in systolic blood pressure between baseline and final visit (95% CI 8.9-14.4, p=<0.001). Nurse-led protocol-driven care for hypertension in Cameroon significantly reduced systolic blood pressure by 11.7 mm Hg and diastolic blood pressure by 7.8 mm Hg.
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