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

Journal article

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.

Authors: Sheikh, A; Ombiro, ON; Wurie, HR; Muro, F; Magne, J

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: BMJ Publishing Group
• Journal: BMJ Public Health
• Volume: 4
• Issue: 2
• Pages: e003394
• Article number: bmjph-2025-003394
• Publication date: 2026-05-01
• Acceptance date: 2026-04-22
• DOI: 10.1136/bmjph-2025-003394
• EISSN: 2753-4294
• ISSN: 2753-4294
• Language: English
• Keywords: Population Surveillance; Community Health; Digital Technology; Cardiovascular Diseases; Digital Health