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BACKGROUND: There are limited data on large-scale, multi-level implementation research studies to improve hypertension diagnosis, treatment, and control rates at the primary health care (PHC) level in Africa. We describe the characteristics, treatment, and control rates of patients with hypertension in public PHC centers in the Hypertension Treatment in Nigeria Program. METHODS: Data were collected from adults ≥18 years at 60 public PHC centers between January 2020 and November 2020. Hypertension treatment rates were calculated at registration and upon completion of the initial visit. Hypertension control rates were calculated based on systolic and diastolic blood pressures

More than 1.2 billion adults worldwide have hypertension. High retention in clinical care is essential for long-term management of hypertension, but 1-year retention rates are less than 50% in many resource-limited settings.To evaluate short-term retention rates and associated factors among patients with hypertension in primary health care centers in the Federal Capital Territory of Nigeria.In this cohort study, data were collected by trained study staff from adults aged 18 years or older at 60 public, primary health care centers in Nigeria between January 2020 and July 2021 as part of the Hypertension Treatment in Nigeria (HTN) Program. Patients with hypertension were registered.Follow-up visit for hypertension care within 37 days of the registration visit.The main outcome was the 3-month rolling average 37-day retention rate in hypertension care, calculated by dividing the number of patients who had a follow-up visit within 37 days of their first (ie, registration) visit in the program by the total number of registered patients with hypertension during multiple consecutive 3-month periods. Interrupted time series analyses evaluated trends in retention rates before and after the intervention phase of the HTN Program. Mixed-effects, multivariable regression models evaluated associations between patient-, site-, and area council-level factors, hypertension treatment and control status, and 37-day retention rate.In total, 10 686 patients (68.3% female; mean [SD] age, 48.8 [12.7] years) were included in the analysis. During the study period, the 3-month rolling average 37-day retention rate was 41% (95% CI, 37%-46%), with wide variability among sites. The retention rate was higher among patients who were older (adjusted odds ratio [aOR], 1.01 per year; 95% CI, 1.01-1.02 per year), were female (aOR, 1.11; 95% CI, 1.01-1.23), had a higher body mass index (aOR, 1.01; 95% CI, 1.00-1.02), were in the Kuje vs the Abaji area council (aOR, 2.25; 95% CI, 1.25-4.04), received hypertension treatment at the registration visit (aOR, 1.27; 95% CI, 1.07-1.50), and were registered during the postintervention period (aOR, 1.16; 95% CI, 1.06-1.26).The findings suggest that retention in hypertension care is suboptimal in primary health care centers in Nigeria, although large variability among sites was found. Potentially modifiable and nonmodifiable factors associated with retention were identified and may inform multilevel, contextualized implementation strategies to improve retention.

Abstract Importance: Out of the >1.2 billion adults with elevated blood pressure globally, treatment (42.5%) and control (20.5%) rates are very low, including in Nigeria, the most populous country in Africa. A treatment protocol that includes fixed-dose combination (FDC) therapy may improve hypertension control rates more efficiently and with no increase in adverse events compared with a standard treatment protocol. Objective: To determine the efficacy and safety of a treatment protocol that uses FDC therapy for hypertension control compared with Nigeria’s 2019 National Hypertension Treatment protocol from baseline to 6 months. Design, setting, and participants: Cluster randomized (1:1) trial among 60 primary health centers in Abuja, Nigeria, stratified by median case load and control rate. Eligible patients were adults ( > 18 years) who had a history of hypertension, persistently elevated blood pressure (SBP ≥140 mmHg or DBP ≥90 mmHg),or use of blood pressure lowering medications. Interventions: Sites were randomized to a protocol that started with and utilized 2- and 3-drug FDC therapy (Step 1: amlodipine 5 mg + losartan 50 mg) to a protocol that started with monotherapy (Step 1: amlodipine 5 mg) and added individuals medications. Results: Sixty sites, including 5,576 patients (mean [SD] age=49.2 [12.4] years; 70% female; mean [SD] baseline systolic/diastolic BP=155[SD]/96 [SD] mm Hg), were randomized. At 6-month follow-up, the rates of hypertension control for the FDC therapy and Nigeria’s 2019 National Hypertension Treatment protocol were 54.7% and 48.3%, respectively ( Figure 1 ). The final results will be added at a later date. Conclusion and relevance: A hypertension treatment protocol that used FDC therapy led to a higher hypertension control rate compared with a standard treatment protocol in Nigeria. These results may have relevance to protocols used in other large-scale hypertension control programs.

Introduction: More than 1.2 billion adults have hypertension globally, which contributes to more than 19 million deaths due to cardiovascular diseases each year. High retention in clinical care is essential for long-term management of hypertension, but 1-year retention rates are Objective: To describe retention rates and associated factors among patients with hypertension in primary health care centers in the Federal Capital Territory of Nigeria. Methods: Data were collected by trained study staff from adults ≥18 years at 60 public, primary healthcare centers between January 2020 and July 2021 as part of the Hypertension Treatment in Nigeria Program. The 3-month rolling average 37-day retention rate in hypertension care was calculated by dividing the number of patients that had a second visits within 37 days of their first visit by the total number of registered hypertensive patients over multiple consecutive 3-month periods. Regression models were created to evaluate associations between patient-, site-, area council-level factors, treatment and control status, and 37-day retention rate. Results: In total 10,686 patients (68.2% female, mean [SD] age = 48.8 [12.7] years) were included. Over the study period, the 3-month rolling average 37-day retention rate was 41% (95% CI: 37% – 46%, Figure 1 ) with wide variability. The retention rate was higher among patients who were older (adjusted OR (aOR) [95% CI]: 1.01 per year [1.007, 1.014]), female (aOR [95% CI]: 1.11 [1.002, 1.22]), higher BMI (aOR [95% CI]: 1.01 [1.002, 1.02]), Kuje area council (aOR [95% CI]: 2.29 [1.28, 4.09]), being treated at the first visit (aOR [95% CI]: 1.20 [1.08, 1.33]), and being controlled at the second visit (aOR [95% CI]: 1.33 [1.20, 1.47]). Conclusions: Retention in hypertension care is suboptimal in primary health care centers in Nigeria, although variability was seen. Modifiable factors associated with retention were identified and may be targets for multilevel, contextualized implementation strategies.

Aims Our aim is to compare the impact of the 2 most widely used methods of indexing left ventricular mass (LVM) on the distribution of abnormal left ventricular (LV) geometric patterns, in a large sample of untreated asymptomatic black hypertensive subjects. Methods and Results All patients with hypertension referred to the Cardiology unit of University of Abuja Teaching Hospital, Abuja, Nigeria from 2006 to 2013, who gave informed consent, and underwent physical examination and echocardiography. LVM indexation was classified into 4 geometric patterns after echocardiography: normal geometry, concentric hypertrophy, concentric remodeling, and eccentric hypertrophy. Concentric hypertrophy was the commonest geometric pattern and was detected in 33.6% to 39.5% of the patients. LVM/height2.7 was a better method to detect abnormal geometric pattern than LVM/BSA (P, The 2 most widely used methods of indexing left ventricular mass (LVM) on the distribution of abnormal left ventricular (LV) geometric patterns were applied in a large population of untreated asymptomatic black hypertensive subjects with no clinical evidence of coronary artery disease. Abnormal LV geometry was found in greater than 80% of the population, concentric hypertrophy was the commonest geometric pattern, and LVM indexed for height2.7 was a better method than LVM indexed for BSA in detecting LVH.