The Nigerian antihypertensive adherence trial: a community-based randomized trial Journal Article


Authors: Adeyemo, A; Tayo, B. O.; Luke, A; Ogedegbe, O.; Durazo-Arvizu, R; Cooper, R. S.
Article Title: The Nigerian antihypertensive adherence trial: a community-based randomized trial
Abstract: BACKGROUND: Research in industrialized countries has demonstrated that a key factor limiting the control of hypertension is poor patient adherence and that the most successful interventions for long-term adherence employ multiple strategies. Very little data exist on this question in low-income countries, wherein medication-taking behavior may be less well developed. METHOD: We conducted a treatment adherence trial of 544 patients [mean age approximately 63 years, mean blood pressure (BP) approximately 168/92 mmHg] with previously untreated hypertension in urban and rural Nigeria. Eligible participants were randomized to one of two arms: clinic management only, or clinic management and home visits. Both interventions included three elements: a community based, nurse-led treatment program with physician backup; facilitation of clinic visits and health education; and the use of diuretics and a beta blocker as needed. After initial diagnosis, the management protocol was implemented by a nurse with physician backup. Participants were evaluated monthly for 6 months. RESULTS: Medication adherence was assessed with pill count and urine testing. Drop-out rates, by treatment group, ranged from 12 to 28%. Among participants who completed the 6-month trial, overall adherence was high ( approximately 77% of participants took >98% of prescribed pills). Adherence did not differ by treatment arm, but was better at the rural than the urban site and among those with higher baseline BP. Hypertension control (BP 140/90 mmHg) was achieved in approximately 66% of participants at 6 months. CONCLUSION: This community-based intervention confirms relatively modest default rates compared with industrialized societies, and suggests that medication adherence can be high in developing world settings in clinic attenders.
Journal Title: Journal of hypertension
Volume: 31
Issue: 1
ISSN: 1473-5598; 0263-6352
Publisher: Unknown  
Journal Place: England
Date Published: 2013
Start Page: 201
End Page: 207
Language: eng
DOI/URL:
Notes: GR: D43 TW009140/TW/FIC NIH HHS/United States; GR: D43TW009140/TW/FIC NIH HHS/United States; GR: R01 HL67883/HL/NHLBI NIH HHS/United States; JID: 8306882; CIN: J Hypertens. 2013 Jan;31(1):47-8. PMID: 23221931; NIHMS427132; OID: NLM: NIHMS427132 [Available on 01/01/14]; OID: NLM: PMC3530610 [Available on 01/01/14]; PMCR: 2014/01/01 00:00; ppublish