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NIH-supported Hypertension Research Projects in Low- and Middle-Income Countries

As part of the landmark research initiative to reduce the impact of hypertension, as supported by four member organizations of the Global Alliance for Chronic Diseases, the NIH is funding five research projects. Below are descriptions of each NIH-supported research project.

Argentina
Ghana
Kenya
Nigeria
Peru

Country:

Argentina

Funding Institution:

The National Heart, Lung, and Blood Institute (NHLBI), part of the U.S. National Institutes of Health (NIH)

Administrating Institution:

Tulane University, Health Sciences Center New Orleans, Louisiana, USA

LMIC* Institution(s):

Institute for Clinical Effectiveness and Health Policy Buenos Aires, Argentina

Research Title:

Comprehensive approach for hypertension prevention and control in Argentina

Principal Investigator:

Dr. Jiang He

LMIC Principal Investigator:

Dr. Adolfo Rubinstein

Funding Amount:

$2,083,675

Research Duration:

5 years

* Low- and middle-income country

Summary:

This study will test the effectiveness of a comprehensive approach to hypertension (high blood pressure) prevention and control, which will include health care provider education, a home-based intervention for patients and their families (lifestyle modification and home blood pressure monitoring), and a mobile health intervention.

Primary objective:

Conduct a cluster-randomized trial to test whether a comprehensive intervention program within a national public primary care system will improve hypertension prevention and control among uninsured hypertensive patients and their families in Argentina.

Specific aims:

a. Test whether a comprehensive intervention program will lower systolic and diastolic blood pressure among hypertensive patients and their families over an 18-month period, compared to usual care.

b. Evaluate whether a comprehensive intervention program will improve hypertension control (blood pressure <140/90 mmHg, or <130/80 mmHg for patients with diabetes or chronic kidney disease) among hypertensive patients over an 18-month period, compared to usual care.

c. Estimate the cost-effectiveness of this comprehensive intervention program compared to usual care.

This implementation research will have a high impact on public health because it will generate urgently needed data on effective, practical, and sustainable intervention programs to prevent and control hypertension in low- and middle-income countries.

To learn more about this project, please visit the GACD webpage.


Country:

Ghana

Funding Institution:

The National Heart, Lung, and Blood Institute (NHLBI), part of the U.S. National Institutes of Health (NIH)

Administrating Institution:

New York University School of Medicine New York City, New York, USA

LMIC* Institution:

NKrumah University of Science and Technology Kumasi, Ghana

Research Title:

Task shifting and blood pressure control in Ghana: a cluster-randomized trial

Principal Investigator:

Dr. Olugbenga Ogedegbe

LMIC Principal Investigator:

Dr. Jacob Plange-Rhule

Funding Amount:

$2,117,296

Research Duration:

5 years

* Low- and middle-income country

Summary:

Interventions targeted at blood pressure control are urgently needed to address the cardiovascular disease epidemic and associated morbidity, mortality, and societal costs in sub-Saharan Africa. This project will follow 640 patients with hypertension (high blood pressure) in 32 community health centers in Ghana using a cluster-randomized trial design.

Primary objective:

Evaluate the comparative effectiveness of the World Health Organization CVD-Risk Management Package targeted at cardiovascular risk assessment and blood pressure control delivered by community health nurses versus provision of health insurance coverage on blood pressure reduction.

Specific aims:

a. Evaluate the effect of the WHO Package vs. provision of health insurance coverage on blood pressure control.

b. Evaluate the effect of the WHO Package vs. provision of health insurance coverage on lifestyle behaviors.

c. Evaluate sustainability of the intervention effects one year after the trial is completed.

Findings from this study will provide policymakers and other stakeholders with information needed to recommend efficient cost-effective policy with regards to comprehensive cardiovascular risk reduction in patients with hypertension in low-resource settings.

To learn more about this project, and to watch Dr. Olugbenga Ogedegbe describe this research project, please visit the GACD webpage.


Country:

Kenya

Funding Institution:

The National Heart, Lung, and Blood Institute (NHLBI), part of the U.S. National Institutes of Health (NIH)

Administrating Institution:

Mount Sinai School of Medicine New York City, New York, USA

LMIC* Institution:

Moi Teaching and Referral Hospital Eldoret, Kenya

Research Title:

Optimizing linkage and retention to hypertension care in rural Kenya

Principal Investigator:

Dr. Valentin Fuster

LMIC Principal Investigator:

Dr. Jemima Kamano

Funding Amount:

$2,104,519

Research Duration:

5 years

* Low- and middle-income country

Summary:

Hypertension is the leading global risk factor for mortality, and the global cost of suboptimal blood pressure is estimated to be nearly $1 trillion over the next decade. This project therefore aims to address a singularly critical health and development issue for low- and middle-income countries.

Primary objective:

Use a multi-disciplinary implementation research approach to address the challenge of linking and retaining hypertensive individuals to a hypertension management program.

Specific aims:

a. Identify the facilitators and barriers to linking and retaining individuals with high blood pressure to a hypertension care delivery program, using a combination of qualitative research methods.

b. Evaluate the effectiveness of community health workers equipped with a tailored behavioral communication strategy and a smart phone-based tool in improving linkage and reducing blood pressure among hypertensive patients, by conducting a cluster-randomized trial.

c. Evaluate the incremental cost-effectiveness of each intervention arm of the cluster-randomized trial.

The results of this work will add to the emerging body of knowledge on scalable and sustainable strategies for effectively managing hypertension and related chronic diseases in low- and middle-income countries as well as in resource-poor settings in the United States and other high-income countries.

To learn more about this project, and to watch Dr. Jemima Kamano describe this research project, please visit the GACD webpage.


Country:

Nigeria

Funding Institution:

The National Institute of Neurological Disorders and Stroke (NINDS), part of the U.S. National Institutes of Health (NIH)

Administrating Institution:

University of California San Diego, California, USA

LMIC* Institution:

University of Ibadan Ibadan, Nigeria

Research Title:

Tailored Hospital-based Risk Reduction to Impede Vascular Events after Stroke (THRIVES)

Principal Investigator:

Dr. Bruce Ovbiagele

LMIC Principal Investigator:

Dr. Mayowa Owolabi

Funding Amount:

$2,126,772

Research Duration:

5 years

* Low- and middle-income country

Summary:

The need to improve stroke preventive care is particularly pressing in developing countries where resources are few and the burden of stroke is disproportionately heavy. This research seeks to develop an effective and sustainable way of reducing the devastating impact of stroke in a low-income region of the world with poor medical infrastructure.

Primary objective:

Determine whether a culturally sensitive, multi-pronged, post-discharge intervention can significantly reduce blood pressure, enhance achievement of guideline-recommended targets for risk factor control, and lower recurrent vascular events in low- and middle-income country (Nigeria).

Specific aims:

a. Obtain information on barriers to and facilitators of adherence to guideline-recommended biomarker goals for vascular risk reduction after stroke, and develop interventions that can be tested in a subsequent randomized clinical trial of secondary stroke risk reduction.

b. Conduct a randomized clinical trial of the THRIVES intervention (described in Aim A) versus standard post-discharge management in stroke patients from four hospitals in Nigeria.

c. Explore whether the THRIVES intervention shows potential efficacy in reducing the rate of subsequent primary vascular events, compared with standard care.

d. Estimate the cost-impact and cost-effectiveness of the THRIVES post-discharge intervention, compared with usual and standard care.

To learn more about this project, please visit the GACD webpage.


Country:

Peru

Funding Institution:

The National Institute of Neurological Disorders and Stroke (NINDS), part of the U.S. National Institutes of Health (NIH)

Administrating Institution:

Johns Hopkins University, Bloomberg School of Public Health Baltimore, Maryland, USA

LMIC* Institution:

Universidad Peruana Cayetano Heredia Lima, Peru

Research Title:

Launching a salt substitute to reduce blood pressure at the population level

Principal Investigator:

Dr. Robert H. Gilman

LMIC Principal Investigator:

Dr. Jaime Miranda

Funding Amount:

$2,029,249

Research Duration:

5 years

* Low- and middle-income country

Summary:

Optimization and initiation of public health strategies to reduce blood pressure levels and hypertension in low- and middle-income countries will require region-specific approaches that run in parallel with national strategies.

Primary objective:

Implement, using a stepped wedge trial design, a population-level intervention to replace high-sodium salt for a salt substitute (2/3 sodium chloride and 1/3 potassium chloride) to reduce blood pressure levels among adults aged 20 years and over in the semi-urban area of Tumbes.

Specific aims:

a. Assess the predisposition of villagers, authorities, and other potential stakeholders to incorporate the new salt substitute into daily cooking among, in order to inform and construct an intervention in the local communities and ensure successful implementation.

b. Implement and assess the impact of an intervention using a salt substitute on blood pressure at the population level using a stepped wedge trial design.

c. Determine and analyze costs and efficacy of this implementation strategy.

This study will be the first pragmatic intervention in a Latin-American country to implement a salt substitute at the population level. It will provide important information to develop appropriate local strategies applicable to other.

To learn more about this project, and to watch Dr. Antonio Bernabe-Ortiz describe this research project, please visit the GACD webpage.


Last Updated: January 24, 2013

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