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Single-pill combinations (SPCs) of three low-dose antihypertensive drugs can improve hypertension control but are not widely available. A key issue for any combination product is the contribution of each component to efficacy and tolerability. This trial compared a new triple SPC called GMRx2, containing telmisartan, amlodipine, and indapamide, with dual combinations of components for efficacy and safety.

The prevalence of hypertension, the commonest risk factor for preventable disability and premature deaths, is rapidly increasing in Africa. The African Control of Hypertension through Innovative Epidemiology, and a Vibrant Ecosystem [ACHIEVE] conference was convened to discuss and initiate the co-implementation of the strategic solutions to tame this burden toward achieving a target of 80% for awareness, treatment, and control by the year 2030. Experts, including the academia, policymakers, patients, the WHO, and representatives of various hypertension and cardiology societies generated a 12-item communique for implementation by the stakeholders of the ACHIEVE ecosystem at the continental, national, sub-national, and local (primary) healthcare levels.

Hypertension is a leading preventable and controllable risk factor for cardiovascular and cerebrovascular diseases and the leading preventable risk for death globally. With a prevalence of nearly 50% and 93% of cases uncontrolled, very little progress has been made in detecting, treating, and controlling hypertension in Africa over the past thirty years. We propose the African Control of Hypertension through Innovative Epidemiology and a Vibrant Ecosystem (ACHIEVE) to implement the HEARTS package for improved surveillance, prevention, treatment/acute care of hypertension, and rehabilitation of those with hypertension complications across the life course. The ecosystem will apply the principles of an iterative implementation cycle by developing and deploying pragmatic solutions through the contextualization of interventions tailored to navigate barriers and enhance facilitators to deliver maximum impact through effective communication and active participation of all stakeholders in the implementation environment. Ten key strategic actions are proposed for implementation to reduce the burden of hypertension in Africa.

Combinations of cardiovascular medications taken in a single pill — known as polypills — are effective but not widely used, requiring a global shift from physicians, regulators and drug developers.

Intake of trans-fatty acids (TFAs) is an established risk factor for cardiovascular disease. In April 2023, Nigeria passed regulations limiting TFA content in foods, fats, and oils, but the current level of TFA exposure in the Nigerian population is unknown. We assessed TFA biomarkers in dried blood spots from Nigerian adults in the Federal Capital Territory before policy enforcement to establish a baseline for future evaluation.

Objectives:To estimate the potential health gains, costs, and cost-effectiveness of a mandatory limit on industrial trans fatty acids (iTFA) in the Nigerian food supply.Methods:We used Markov cohort models to estimate the effect on ischemic heart disease (IHD) burden, costs, and cost-effectiveness of a mandatory iTFA-limit (≤2% of all fats) for foods in Nigeria. Data on demographics, IHD epidemiology, and trans-fatty acid intake were derived from the 2019 Global Burden of Disease Study. We calculated the IHD burden attributable to iTFA by comparing the current trans-fatty acid intake to counterfactual settings with complete elimination of iTFA intake. Policy implementation costs (including government costs for legislation and monitoring, and industry costs for product reformulation), avoided IHD events and deaths, health-adjusted life years (HALYs) gained, and healthcare costs saved were estimated over 10 years and lifetime of the Nigerian population. Incremental cost-effectiveness ratios using net costs (i.e., implementation costs minus healthcare cost savings) and HALYs gained (both discounted at 3%) were used to assess cost-effectiveness.Results:Over the first 10 years, elimination of iTFA intake was estimated to prevent 9,996 (95% uncertainty interval: 8,870; 11,118): IHD deaths and 66,569 (58,862; 74,083) IHD events, and to save 90 million USD (78; 102) in total healthcare costs. The corresponding estimates over the lifetime were 259,934 (228,736; 290,191), 479,308 (95% UI: 420,472; 538,177), and ~518 (450; 587). Policy implementation costs (government plus industry) were estimated as 18 million USD (12; 25) over the first 10 years, and 27 million USD (20; 35) over the population lifetime. The intervention was estimated to be cost-saving. Findings were robust across several deterministic sensitivity analyses (Figure).Conclusions:Our findings support legislating a mandatory limit of iTFAs as a cost-saving strategy to avert substantial numbers of IHD events and deaths in Nigeria.

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Introduction:Previous hypertension research has evaluated retention using cross-sectional study designs. However, longitudinal analyses are likely more useful to identify areas for improving retention.Objective:To describe longitudinal retention patterns among patients with hypertension in primary care in 6 Federal Capital Territory council areas in Nigeria.Methods:The Hypertension Treatment in Nigeria Program implemented a multi-level intervention package in 60 centers in Nigeria. Baseline and follow-up data were collected from January 2020 to December 2021. Healthcare workers scheduled patients for a follow-up appointment at each visit, for which one month was recommended. Retention was measured by the patient presenting to the clinic for a follow-up visit within 7 days of the scheduled appointment.Results:14,346 patients (68.7% female, mean [SD] age = 49.1 [12.6] years) were included with 61,320 documented visits, among which 14,975 were registration visits and 46,345 were follow-up visits. 9,490 (66.2%) patients had ≥1 follow-up visit. Fig 1demonstrates longitudinal patterns for 37-day retention by council area, in which Kuje has the highest follow-up rate (55.6%) while variability was seen across areas. The median (IQR) time to the scheduled appointment was 30 days (28, 31), and observed time to follow-up visit was 32 days (29, 42). 40,759 (66.5%) appointments were scheduled ≤ 30 days, 58,773 (95.8%) appointments were scheduled ≤ 37 days, and 282 appointments (0.5%) were scheduled ≥ 60 days after the previous visit. Among documented follow-up visits, 16,524 (35.7%) occurred within 30 days of the prior visit, 32,145 (69.4%) occurred within 37 days, and 31,344 (67.6%) were within 7 days of the scheduled appointment.Conclusions:Retention in hypertension is widely variable within individuals, over time, and across council areas. Longitudinal retention analyses provide robust assessments to develop tailored strategies to improve retention.

Most previous studies on diastolic function in diabetics are confounded by coexisting ischemic heart disease, obesity and hypertension. Therefore, there may be advantages in studying patients with diabetes mellitus in developing nations where confounding variables are less prevalent. The aim of this study was to assess the effect of type-2 diabetes mellitus on left ventricular diastolic function in normotensive subjects in Nigeria.