Transforming hypertension management with digital technology: a retrospective cohort study in four sub-Saharan African countries

Introduction: A chronic disease management programme anchored on a digital platform was scaled in Ghana, Kenya, Sierra Leone and Tanzania following successful pilot studies. We investigated blood pressure (BP) changes and their associated factors among patients with hypertension. Methods: In this retrospective cohort study, the primary outcome was the relative reduction in BP and an absolute reduction in systolic BP (SBP) of >5 mm Hg at 6 (±2) months post-enrolment. We used the paired t-test, McNemar's test and multivariable logistic regression to compare changes in mean SBP, compare changes in proportions and examine the association between patient characteristics and achieving >5 mm Hg SBP reduction, respectively. Results: 0.001), respectively. Patients with uncontrolled SBP (≥140 mm Hg) at enrolment (n=38 079) experienced a mean SBP reduction of 18.1 mm Hg (95% CI -18.3 to -17.8; p5 mm Hg SBP reduction included follow-up by community health workers (adjusted OR (AOR)=1.06; p=0.041), ≥3 medical reviews (AOR=1.16; p