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.
  
  
  METHODS
  We conducted a treatment adherence trial of 544 patients [mean age ∼63 years, mean blood pressure (BP) ∼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 β 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 (∼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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA.
authors.forename: Adebowale
authors.initials: A
authors.lastname: Adeyemo
authors.forename: Bamidele O
authors.initials: BO
authors.lastname: Tayo
authors.forename: Amy
authors.initials: A
authors.lastname: Luke
authors.forename: Olugbenga
authors.initials: O
authors.lastname: Ogedegbe
authors.forename: Ramon
authors.initials: R
authors.lastname: Durazo-Arvizu
authors.forename: Richard S
authors.initials: RS
authors.lastname: Cooper
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006792:House Calls / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D011203:Poverty; D057184:Practice Patterns, Nurses' / Q000706:statistics & numerical data*; D016903:Drug Monitoring
chemical_list: D000959:Antihypertensive Agents