{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T17:31:17Z","timestamp":1790962277927,"version":"4.1.0"},"reference-count":15,"publisher":"BMJ","issue":"4","funder":[{"DOI":"10.13039\/100008273","name":"Novartis Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008273","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To evaluate the effectiveness of the Community-based Hypertension Improvement Project (ComHIP) in increasing hypertension control.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Lower Manya Krobo, Eastern Region, Ghana.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>All adult hypertensive community members, except pregnant women, were eligible for inclusion in the study. We enrolled 1339 participants, 69% of whom were female. A total of 552 had a 6-month visit, and 338 had a 12-month visit.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interventions<\/jats:title><jats:p>We report on a package of interventions where community-based cardiovascular disease (CVD) nurses were trained by FHI 360. CVD nurses confirmed diagnoses of known hypertensives and newly screened individuals. Participants were treated according to the clinical guidelines established through the project\u2019s Technical Steering Committee. Patients received three types of reminder and adherence messages. We used CommCare, a cloud-based system, as a case management and referral tool.<\/jats:p><\/jats:sec><jats:sec><jats:title>Primary outcome<\/jats:title><jats:p>Hypertension control defined as blood pressure (BP) under 140\/90\u2009mm Hg. Secondary outcomes: changes in BP and knowledge of risk factors for hypertension.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After 1\u2009year of intervention, 72% (95% CI: 67% to 77%) of participants had their hypertension under control. Systolic BP was reduced by 12.2\u2009mm Hg (95%\u2009CI: 14.4 to 10.1) and diastolic BP by 7.5\u2009mm Hg (95%\u2009CI: 9.9 to 6.1). Due to low retention, we were unable to look at knowledge of risk factors. Factors associated with remaining in the programme for 12\u2009months included education, older age, hypertension under control at enrolment and enrolment date. The majority of patients who remained in the programme were on treatment, with two-thirds taking at least two medications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Patients retained in ComHIP had increased BP control. However, high loss to follow-up limits potential public health impact of these types of programmes. To minimise the impact of externalities, programmes should include standard procedures and backup systems to maximise the possibility that patients stay in the programme.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2018-026799","type":"journal-article","created":{"date-parts":[[2019,4,3]],"date-time":"2019-04-03T11:26:49Z","timestamp":1554290809000},"page":"e026799","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":54,"title":["Can a nurse-led community-based model of hypertension care improve hypertension control in Ghana? Results from the ComHIP cohort study"],"prefix":"10.1136","volume":"9","author":[{"given":"Alma J","family":"Adler","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amos","family":"Laar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Prieto-Merino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reina M M","family":"Der","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debbie","family":"Mangortey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Dirks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Lamptey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo","family":"Perel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,4,2]]},"reference":[{"key":"2020050713480386000_9.4.e026799.1"},{"key":"2020050713480386000_9.4.e026799.2","first-page":"151","article-title":"1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension. Guidelines Subcommittee","volume":"17","author":"WHO","year":"1999","journal-title":"J Hypertens"},{"key":"2020050713480386000_9.4.e026799.3","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1016\/S0140-6736(14)61171-5","article-title":"Effects of blood pressure lowering on cardiovascular risk according to baseline body-mass index: a meta-analysis of randomised trials","volume":"385","author":"Ying","year":"2015","journal-title":"Lancet"},{"key":"2020050713480386000_9.4.e026799.4","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(90)91908-S"},{"key":"2020050713480386000_9.4.e026799.5","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b1665"},{"key":"2020050713480386000_9.4.e026799.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31134-5"},{"key":"2020050713480386000_9.4.e026799.7","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.107.093336"},{"key":"2020050713480386000_9.4.e026799.8","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.184182"},{"key":"2020050713480386000_9.4.e026799.9","doi-asserted-by":"crossref","unstructured":"Lamptey P , Laar A , Adler AJ , et al . Evaluation of a community-based hypertension improvement program (ComHIP) in Ghana: data from a baseline survey. BMC Public Health 2017;17:368.doi:10.1186\/s12889-017-4260-5","DOI":"10.1186\/s12889-017-4260-5"},{"key":"2020050713480386000_9.4.e026799.10","unstructured":"GSS. Population by Region, District, Locality of Residence, Age Groups and Sex, 2010. Accra, Ghana: Ghana Statistical Service. 2012 http:\/\/www.statsghana.gov.gh\/docfiles\/population_by_region_district_locality_of_residence_age_groups_and_sex,_2010.pdf (Accessed 22 Nov 2016)."},{"key":"2020050713480386000_9.4.e026799.11","doi-asserted-by":"crossref","first-page":"e1002561","DOI":"10.1371\/journal.pmed.1002561","article-title":"Health insurance coverage with or without a nurse-led task shifting strategy for hypertension control: A pragmatic cluster randomized trial in Ghana","volume":"15","author":"Ogedegbe","year":"2018","journal-title":"PLoS Med"},{"key":"2020050713480386000_9.4.e026799.12","doi-asserted-by":"publisher","DOI":"10.1111\/tmi.12210"},{"key":"2020050713480386000_9.4.e026799.13","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1111\/tmi.13078","article-title":"Compliance with follow-up and adherence to medication in hypertensive patients in an urban informal settlement in Kenya: comparison of three models of care","volume":"23","author":"Kuria","year":"2018","journal-title":"Trop Med Int Health"},{"key":"2020050713480386000_9.4.e026799.14","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1186\/s12913-015-1167-7","article-title":"Results of a hypertension and diabetes treatment program in the slums of Nairobi: a retrospective cohort study","volume":"15","author":"Werner","year":"2015","journal-title":"BMC Health Serv Res"},{"key":"2020050713480386000_9.4.e026799.15","doi-asserted-by":"crossref","first-page":"2172","DOI":"10.1097\/HJH.0000000000001070","article-title":"Accessing clinical services and retention in care following screening for hypertension and diabetes among Malawian adults: an urban\/rural comparison","volume":"34","author":"Musicha","year":"2016","journal-title":"J Hypertens"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2018-026799","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,9,26]],"date-time":"2020-09-26T01:47:20Z","timestamp":1601084840000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2018-026799"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4]]},"references-count":15,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2019,5,1]]},"published-print":{"date-parts":[[2019,4]]}},"alternative-id":["10.1136\/bmjopen-2018-026799"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2018-026799","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,4]]}}}