Digital home-based monitoring for patients with hypertension and type 2 diabetes in Ghana

Background Long-term conditions such as high blood pressure and type 2 diabetes are growing concerns in Sub-Saharan Africa, where routine clinic-based monitoring can be difficult. Digital health tools may help support home-based care, yet evidence from the region remains limited. This study examines whether a smartphone-based remote monitoring system can support long-term management of high blood pressure and fasting blood glucose among adults receiving care in Accra, Ghana. Methods We followed 481 adults aged 18-85 years with high blood pressure and/or type 2 diabetes who recorded home measurements through a smartphone remote-monitoring platform while attending three outpatient clinics. High blood pressure control was defined by age-specific thresholds, and fasting blood glucose control was defined as values below 7.0 millimoles per litre. We analysed changes in home measurements over time and identified factors associated with achieving control at twelve months. We also examined predictors of early blood pressure control using time-to-event analysis. Results Both systolic and diastolic blood pressure decrease significantly within six months and remain lower at twelve months and beyond. Individuals who begin with uncontrolled values show the largest improvements. Although overall fasting blood glucose does not change significantly, those uncontrolled at baseline show a meaningful decline over time. After one year, the proportion of individuals with controlled blood pressure increases from 39 percent to 62 percent, and most participants who start uncontrolled achieve at least one controlled reading during follow-up. Conclusions Smartphone-supported home monitoring is feasible in an urban African setting and is associated with meaningful long-term improvement in blood pressure. While reductions in fasting blood glucose are less consistent, the findings indicate that digital health tools can support chronic disease care and highlight opportunities to strengthen strategies for improving blood glucose control over time.