{"doi":"10.1056/nejmoa2509958","title":"Home-Based Care for Hypertension in Rural South Africa","abstract":"BACKGROUND: Poorly controlled hypertension is a common problem worldwide, particularly in low-resource settings. METHODS: We conducted an open-label, randomized, controlled trial of a home-based model of hypertension care in South Africa. Adults with hypertension were assigned to receive home-based care, which consisted of patient monitoring of blood pressure, home visits from a community health worker (CHW) for data collection and medication delivery, and remote nurse-led decision making supported by a mobile application (CHW group); enhanced home-based care, which consisted of the same intervention but with blood-pressure machines transmitting readings automatically (enhanced CHW group); or standard care with clinic-based management (standard-care group). The primary outcome was the systolic blood pressure at 6 months. Secondary outcomes were the systolic blood pressure at 12 months and hypertension control at 6 and 12 months. Safety outcomes included adverse events, deaths, and retention in care. RESULTS: A total of 774 adults underwent randomization. The mean age was 62 years; 76.0% of the participants were women, 13.6% had diabetes mellitus, and 46.5% had human immunodeficiency virus infection. The mean systolic blood pressure at 6 months was lower in the CHW group than in the standard-care group (difference, -7.9 mm Hg; 95% confidence interval [CI], -10.5 to -5.3; P<0.001) and was also lower in the enhanced CHW group than in the standard-care group (difference, -9.1 mm Hg; 95% CI, -11.7 to -6.4; P<0.001). The percentage of participants with hypertension control at 6 months was 32.5% in the standard-care group, as compared with 57.4% in the CHW group (relative risk, 1.76; 95% CI, 1.40 to 2.13) and 61.3% in the enhanced CHW group (relative risk, 1.89; 95% CI, 1.51 to 2.27). The improvements in systolic blood pressure and hypertension control with home-based care appeared to persist at 12 months. Severe adverse events and deaths occurred in 2.7% and 1.0% of the participants, respectively, and occurred in a similar percentage of participants across trial groups. Retention in care was observed in more than 95% of the participants in the CHW and enhanced CHW groups. CONCLUSIONS: In South Africa, home-based hypertension care led to a significantly lower mean systolic blood pressure at 6 months than standard, clinic-based care. (Supported by the National Institutes of Health and others; IMPACT-BP ClinicalTrials.gov number, NCT05492955; South African National Clinical Trials Register number, DOH-27-112022-4895.).","journal":"New England Journal of Medicine","year":2025,"id":512663,"datarank":0.41314906039396404,"base_score":2.5649493574615367,"endowment":2.5649493574615367,"self_citation_contribution":0.38474240361923057,"citation_network_contribution":0.028406656774733467,"self_endowment_contribution":0.38474240361923057,"citer_contribution":0.028406656774733467,"corpus_percentile":null,"corpus_rank":null,"citation_count":12,"citer_count":12,"citers_with_citation_signal":2,"citers_with_endowment":2,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9386,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT05492955"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":614575,"name":"Nombulelo Magula","orcid":"0000-0001-8625-9539","position":1,"is_corresponding":false},{"id":1010288,"name":"Lusanda Mazibuko","orcid":null,"position":2,"is_corresponding":false},{"id":1103091,"name":"Nsika Sithole","orcid":"0000-0003-2090-3453","position":3,"is_corresponding":false},{"id":1066929,"name":"Alison Castle","orcid":"0000-0001-7752-6236","position":4,"is_corresponding":false},{"id":371609,"name":"Siyabonga Nxumalo","orcid":"0000-0001-5931-1784","position":5,"is_corresponding":false},{"id":1136839,"name":"Thabang Manyaapelo","orcid":"0000-0002-5664-6295","position":6,"is_corresponding":false},{"id":749490,"name":"Shafika Abrahams‐Gessel","orcid":"0000-0003-4954-057X","position":7,"is_corresponding":false},{"id":250370,"name":"Dickman Gareta","orcid":"0000-0002-4004-5655","position":8,"is_corresponding":false},{"id":1136840,"name":"Joanna Orne‐Gliemann","orcid":"0000-0003-0359-4089","position":9,"is_corresponding":false},{"id":470804,"name":"Kathy Baisley","orcid":null,"position":10,"is_corresponding":false},{"id":471168,"name":"Max Bachmann","orcid":"0000-0003-1770-3506","position":11,"is_corresponding":false},{"id":501596,"name":"Thomas A. Gaziano","orcid":"0000-0002-5985-345X","position":12,"is_corresponding":false},{"id":69650,"name":"Mark J. Siedner","orcid":"0000-0003-3506-842X","position":0,"is_corresponding":true}],"reference_count":21,"raw_metadata":null,"created_at":"2026-07-19T02:48:06.263458Z","pmid":"40888742","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}