Transforming Hypertension Treatment in Nigeria Using a Type II Hybrid, Interrupted Time Series Design (HTN)

May 19, 2025 updated by: Mark Huffman, Washington University School of Medicine
The purpose of the Transforming Hypertension Treatment in Nigeria Program is to improve awareness, treatment, and control of hypertension in Nigeria through the adaptation, implementation, and evaluation of the effectiveness and implementation of a system-level hypertension control program.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

This study includes the implementation and evaluation of a culturally- and contextually-adapted intervention package based on the Kaiser Permanente Northern California and World Health Organization HEARTS programs for hypertension diagnosis and treatment at primary health centers in Abuja, Nigeria. The intervention has been adapted based on a local needs' assessment including evidence synthesis and specific exploration of health care workers' knowledge, attitudes, and behaviors related to hypertension, causes, consequences, and treatment, including fixed-dose combination and patient self-management, and patients' knowledge, attitudes, and behaviors related to hypertension, causes, consequences, and treatment. Implementation pathways have been developed with particular attention to overcoming modifiable system- and patient-level barriers to hypertension treatment and control across capability, intentional, and system domains using the Consolidated Framework for Implementation Research. Preparedness and capacity have been assessed at primary health centers (e.g. available staff; information systems; use of clinical guidelines) through an adapted Service Availability and Readiness Assessment (SARA) instrument during the formative work for this study. The multi-level implementation package includes: 1) patient registration and empanelment (health system level), 2) standard treatment protocol (national policy level), 3) encouragement of fixed-dose combination therapy (health system level), 4) team-based care (health worker level), and 5) home blood pressure monitoring and health coaching (patient-level).

Study Type

Interventional

Enrollment (Actual)

21922

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Nigeria
      • Abaji, Nigeria
        • Agyana PHC
      • Abaji, Nigeria
        • Central PHC
      • Abaji, Nigeria
        • Gawu PHC
      • Abaji, Nigeria
        • Low Cost PHC
      • Abaji, Nigeria
        • Naharati PHC
      • Abaji, Nigeria
        • New Township Clinic
      • Abaji, Nigeria
        • Rimba PHC
      • Abaji, Nigeria
        • Yaba PHC
      • Bwari, Nigeria
        • Byazhin PHC
      • Bwari, Nigeria
        • Dei-Dei PHC
      • Bwari, Nigeria
        • Kawu PHC
      • Bwari, Nigeria
        • Kogo PHC
      • Bwari, Nigeria
        • Mpape PHC
      • Bwari, Nigeria
        • Sabon Gari PHC
      • Bwari, Nigeria
        • Shere PHC
      • Bwari, Nigeria
        • Ushafa PHC
      • Gwagwalada, Nigeria
        • Anagada PHC
      • Gwagwalada, Nigeria
        • Dagiri CPHC
      • Gwagwalada, Nigeria
        • Dobi PHC
      • Gwagwalada, Nigeria
        • Dukpa PHC
      • Gwagwalada, Nigeria
        • Gwagwalada Township Clinic
      • Gwagwalada, Nigeria
        • Gwako PHC
      • Gwagwalada, Nigeria
        • Old-Kutunku PHC
      • Gwagwalada, Nigeria
        • Paikon PHC
      • Gwagwalada, Nigeria
        • Rafin Zurfi PHC
      • Gwagwalada, Nigeria
        • Yimi PHC
      • Gwagwalada, Nigeria
        • Zuba PHC
      • Kuje, Nigeria
        • Chukuku PHC
      • Kuje, Nigeria
        • Gaube CPHC
      • Kuje, Nigeria
        • Gudunkarya PHC
      • Kuje, Nigeria
        • Gwargada PHC
      • Kuje, Nigeria
        • Kiyi PHC
      • Kuje, Nigeria
        • Kuje PHC
      • Kuje, Nigeria
        • Kujekwa PHC
      • Kuje, Nigeria
        • Pegi PHC
      • Kwali, Nigeria
        • Ashara PHC
      • Kwali, Nigeria
        • Dabi Bako CPHC
      • Kwali, Nigeria
        • Dafa PHC
      • Kwali, Nigeria
        • Gomani PHC
      • Kwali, Nigeria
        • Kwaita Hausa PHC
      • Kwali, Nigeria
        • Kwaita Model PHC
      • Kwali, Nigeria
        • Kwali PHC
      • Kwali, Nigeria
        • Petti PHC
      • Kwali, Nigeria
        • Wako PHC
      • Kwali, Nigeria
        • Yangoji PHC
    • Abuja Municipal Area Council
      • Abuja, Abuja Municipal Area Council, Nigeria
        • Dakwa PHC
      • Abuja, Abuja Municipal Area Council, Nigeria
        • Gbagarape PHC
      • Abuja, Abuja Municipal Area Council, Nigeria
        • Gidan Mangoro PHC
      • Abuja, Abuja Municipal Area Council, Nigeria
        • Gosa PHC
      • Abuja, Abuja Municipal Area Council, Nigeria
        • Gwagwa PHC
      • Abuja, Abuja Municipal Area Council, Nigeria
        • Jikwoyi PHC
      • Abuja, Abuja Municipal Area Council, Nigeria
        • Kagini PHC
      • Abuja, Abuja Municipal Area Council, Nigeria
        • Karon Majigi PHC
      • Abuja, Abuja Municipal Area Council, Nigeria
        • Karshi PHC
      • Abuja, Abuja Municipal Area Council, Nigeria
        • Karu PHC
      • Abuja, Abuja Municipal Area Council, Nigeria
        • Kuchingoro PHC
      • Abuja, Abuja Municipal Area Council, Nigeria
        • Lugbe PHC
      • Abuja, Abuja Municipal Area Council, Nigeria
        • New Garki Apo PHC
      • Abuja, Abuja Municipal Area Council, Nigeria
        • Orozo PHC
      • Abuja, Abuja Municipal Area Council, Nigeria
        • Pykassa PHC

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

14 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Adults (≥18 years).
  • Elevated blood pressure (Systolic Blood Pressure ≥ 130 mmHg or Diastolic Blood Pressure ≥ 80 mmHg) documented or measured by a health care professional (e.g., physician, Community Health Extension Worker, or Community Health Officer).

Exclusion Criteria:

  • Individuals who are not yet adults (minors)
  • Prisoners or other detained individuals.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Health Services Research
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Primary Health Care Centers
Selected primary health care centers in Abuja will implement a culturally- and contextually-adapted intervention package based on the Kaiser Permanente Northern California and World Health Organization HEARTS programs for hypertension diagnosis and treatment.
Other: Evidence-based fixed-dose combination protocol based treatment
The intervention has been adapted based on a local needs' assessment including exploration of health care workers and patient's knowledge, attitudes, and behaviors related to HTN, causes, consequences, and treatment. Implementation pathways have been developed with particular attention to overcoming modifiable barriers to HTN treatment and control across capability, intentional, and system domains using CFIR. Sites will randomly be assigned to receive either: Step 1 amlodipine 5mg; Step 2 amlodipine 5 mg + losartan 50 mg (as 2 separate pills); Step 3 amlodipine 10 mg + losartan 100 mg (as 4 separate pills); Step 4 amlodipine 10/losartan 100/HCTZ 25 (as 2 single pill combo) or Step 1 amlodipine 5mg; Step 2 amlodipine 5 mg + losartan 50 mg (as 1 single pill combo); Step 3 amlodipine 10 mg + losartan 100 mg (as 2 single pill combo); Step 4 amlodipine 10/losartan 100/HCTZ 25 (as 2 single pill combo).

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change from Baseline Slope of Treatment Rate
Time Frame: Through study completion, 45 months
Hypertension treatment using any blood pressure lowering drug. Treatments rates are calculated monthly, over 9 months of baseline and 39 months of intervention.
Through study completion, 45 months
Change from Baseline Slope of Control Rate
Time Frame: Through study completion, 45 months
Hypertension control is defined as a Systolic Blood Pressure <140 mmHg and Diastolic Blood Pressure <90 mmHg. Control rates are calculated monthly, over 9 months of baseline and 39 months of intervention.
Through study completion, 45 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Washington University School of Medicine

Collaborators

National Heart, Lung, and Blood Institute (NHLBI)
Resolve to Save Lives
University of Abuja Teaching Hospital

Investigators

  • Principal Investigator: Mark D Huffman, MD, MPH, Northwestern University Feinberg School of Medicine
  • Principal Investigator: Dike B Ojji, MD, PhD, University of Abuja Teaching Hospital

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

February 1, 2020

Primary Completion (Actual)

December 31, 2023

Study Completion (Actual)

December 31, 2023

Study Registration Dates

First Submitted

November 5, 2019

First Submitted That Met QC Criteria

November 6, 2019

First Posted (Actual)

November 8, 2019

Study Record Updates

Last Update Posted (Estimated)

May 20, 2025

Last Update Submitted That Met QC Criteria

May 19, 2025

Last Verified

December 1, 2024

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • UATH/HREC/PR/2019/002
  • 1R01HL144708-01 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

Individual patient data will be shared through NHLBI BioLINCC.

IPD Sharing Time Frame

Data will be available within 1 year of study conclusion.

IPD Sharing Access Criteria

Access to study data will be managed through NHLBI BioLINCC.

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • SAP
  • ANALYTIC_CODE

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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