Primary health care for hypertension by nurses in rural and urban sub-Saharan Africa

To implement a nurse-led protocol for the care of hypertension, 5 clinics were established in Yaounde (urban) and Bafut (rural) in Cameroon. International guidelines were adapted and 10 nurses were trained. The initial cohort of patients was referred from a field survey. The program proceeded for 26months and 454 patients (45% urban) were registered in the clinics. Relative to urban participants, rural participants were more often women (59% vs 45%, P = .002) and less likely to have diabetes (7.2% vs 41.2%, P < .001). Between baseline and final visits, systolic and diastolic blood pressures dropped by 11.7 mm Hg (95% confidence interval, 8.9-14.4) and 7.8 (95% confidence interval, 5.9-9.6), respectively (P < .001). These changes were consistent in subgroups and after adjustment. Most dropouts occurred around the initial visit and among urban participants and nondiabetics. Nurse-led clinics are effective for improving hypertension care in these settings and require implementation and validation through controlled trials. © 2009 Wiley Periodicals, Inc.