Bringing blood pressure care into people’s homes significantly improved hypertension control in rural South Africa.
This is according to the results of a clinical trial, presented at the European Society of Cardiology Congress 2025 in Madrid, Spain, and simultaneously published in the New England Journal of Medicine. Co-investigators of the study included University of KwaZulu-Natal’s (UKZN) Head of Internal Medicine, Professor Nombulelo Magula; Dr Thomas Gaziano, from Mass General Brigham (MGB) and Harvard Medical School and Professor Mark Siedner from Africa Health Research Institute (AHRI), South Africa and MGB-USA. The trial was conducted in partnership with the KwaZulu-Natal Provincial Department of Health.
Hypertension is the primary risk factor for stroke, heart disease, and kidney disease, which are leading causes of death in South Africa. Despite the wide availability of low-cost, effective therapies, hypertension control remains extremely poor. IMPACT-BP was an open-label, randomised controlled trial conducted by AHRI based in KwaZulu-Natal, in which patients were recruited from two public-sector primary healthcare clinics.
The IMPACT-BP clinical trial tested whether a simple, home-based model of care – combining blood pressure self-monitoring, community health worker support, and nurse-led, technology-supported clinical care – could improve blood pressure control. A total of 774 patients were enrolled. The average age was 62 years, with 76% being women, 14% having diabetes, and 47% living with HIV.
The results show significantly improved hypertension control rates (from around 58% to more than 80%), indicating that patients can safely and effectively manage their chronic conditions at home when adequately supported.
Of particular significance was the programme’s success in a community that has historically had low access to care. “Achieving hypertension control in over 80% of people in rural South Africa is a clear example that equitable health care access can be achieved in under-resourced 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,” said Magula.
“We need new and better models of chronic disease care to address the multiple causes of poor hypertension care, which include clinics with long wait times, the cost of transport to clinics, and lack of engagement with patients to help manage their own care,” explained the IMPACT-BP trial’s co-principal investigator, Professor Mark Siedner from Africa Health Research Institute (AHRI), South Africa, (MGB), USA. “Our trial aimed to get at the heart of these issues, by testing whether transferring care from the clinic to patient’s homes, teaching them to monitor their own disease, partnering with community health workers and empowering nurses with decision-support technology could improve blood pressure control in a low-resourced area of rural South Africa.”
“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,” said Gaziano.
The study was funded by the United States National Institutes of Health and the Wellcome Trust.
