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Policy engagement is an essential component of implementation research for scaling up interventions targeting non-communicable diseases (NCDs). It refers to the many ways that research team members, implementers and policymakers, who represent government decision-making, connect and interact to explore common interests. Well-conducted engagement activities foster co-production, local contextualization and assist in the successful translation of research evidence into policy and practice. We aimed to identify the challenges and facilitators to policy engagement during the early implementation phase of scale-up research studies. This qualitative study was focused on the research projects that were funded through the Global Alliance for Chronic Diseases in the 2019 round. Nineteen project teams opted to participate, with these studies implemented in 20 countries. Forty-three semi-structured stakeholder interviews, representing research, implementation and government were undertaken between August 2020 and July 2021. Transcripts were open-coded using thematic analysis to extract 63 codes which generated 15 themes reflecting both challenges and facilitators to undertaking policy engagement. Knowledge of the local government structures and trusting relationships provided the foundation for successful engagement and were strengthened by the research. Four cross-cutting concepts for engagement were identified and included: (1) the importance of understanding the policy landscape; (2) facilitating a network of suitable policy champions, (3) providing an environment for policy leaders to genuinely contribute to co-creation and (4) promoting two-way learning during researcher–policymaker engagement. We recommend undertaking formative policy analysis to gain a strategic understanding of the policy landscape and develop targeted engagement plans. Through engagement, researchers must facilitate cohesive vision and build a team of policy champions to advocate NCD research within their networks and spheres of influence. Ensuring equitable partnerships is essential for enabling local ownership and leadership. Further, engagement efforts must create a synergistic policymaker–researcher lens to promote the uptake of evidence into policy. [ABSTRACT FROM AUTHOR]

Key Points: Question: Among Black African adults with hypertension, how effective and safe is a low-dose triple-pill protocol compared with standard-care protocol for lowering blood pressure? Findings: In this randomized trial in Nigeria among 300 Black African patients with uncontrolled hypertension who were either untreated or receiving a single blood pressure–lowering drug, treatment with low-dose triple-pill protocol, compared with standard-care protocol, for 6 months significantly reduced home systolic blood pressure (by 5.8 mm Hg), with no increase in discontinuation of trial treatment due to adverse events. Meaning: Compared with standard-care protocol, treatment with a low-dose triple-pill protocol can improve blood pressure lowering. Importance: With the high burden of hypertension in sub-Saharan Africa, there is a need for effective, safe and scalable treatment strategies. Objective: To compare, among Black African adults, the effectiveness and safety of a novel low-dose triple-pill protocol compared with a standard-care protocol for blood pressure lowering. Design and Setting: Randomized, parallel-group, open-label, multicenter trial conducted in public hospital–based family medicine clinics in Nigeria. Participants: Black African adults with uncontrolled hypertension (≥140/90 mm Hg) who were untreated or receiving a single blood pressure–lowering drug. Interventions: Participants were randomly allocated to low-dose triple-pill or standard-care protocols. The triple-pill protocol involved a novel combination of telmisartan, amlodipine, and indapamide in triple one-quarter, one-half, and standard doses (ie, 10/1.25/0.625 mg, 20/2.5/1.25 mg, and 40/5/2.5 mg), with accelerated up-titration. The standard-care protocol was the Nigeria hypertension treatment protocol starting with amlodipine (5 mg). Main Outcomes and Measures: The primary effectiveness outcome was the reduction in home mean systolic blood pressure, and the primary safety outcome was discontinuation of trial treatment due to adverse events, both from randomization to month 6. Results: The first participant was randomized on July 19, 2022, and the last follow-up visit was on July 18, 2024. Among 300 randomized participants (54% female; mean age, 52 years; baseline mean home blood pressure, 151/97 mm Hg; and clinic blood pressure, 156/97 mm Hg), 273 (91%) completed the trial. At month 6, mean home systolic blood pressure was on average 31 mm Hg (95% CI, 28 to 33 mm Hg) lower in the triple-pill protocol group and 26 mm Hg (95% CI, 22 to 28 mm Hg) lower in the standard-care protocol group (adjusted difference, −5.8 mm Hg [95% CI, −8.0 to −3.6]; P <.001]). At month 6, clinic blood pressure control (<140/90 mm Hg) was 82% vs 72% (risk difference, 10% [95% CI, −2% to 20%]) and home blood pressure control (<130/80 mm Hg) was 62% vs 28% (risk difference, 33% [95% CI, 22% to 44%]) in the triple-pill compared with the standard-care protocol group; these were 2 of 21 prespecified secondary effectiveness end points. No participants discontinued trial treatment due to adverse events. Conclusions and Relevance: Among Black African adults with uncontrolled hypertension, a low-dose triple-pill protocol achieved better blood pressure lowering and control with good tolerability compared with the standard-care protocol. Trial Registration: Pan African Clinical Trials Registry Identifier: PACTR202107579572114 This randomized clinical trial compares the effectiveness and safety of a novel low-dose triple-pill protocol, compared with a standard-care protocol, for blood pressure lowering among Black African adults in Nigeria. [ABSTRACT FROM AUTHOR]

Introduction. Studies on the relationship between a family history of hypertension and left ventricular hypertrophy are sparse. We evaluated this relationship in patients with essential hypertension. Methods. A total of 1668 patients with essential hypertension were consecutively enrolled in the prospective Federal Medical Centre Abuja Hypertension Registry. First‐degree family history was defined by the presence of a known history of hypertension in any or both parents, siblings, and children. Echocardiographic left ventricular hypertrophy was diagnosed using the criteria of the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Results. The prevalence of a family history of hypertension, echocardiographic, and electrocardiographic left ventricular hypertrophy were 61.7%, 46.8%, and 30.8%, respectively. After multivariable adjustment, paternal history of hypertension [OR: 1.56, CI: 1.20–2.05, p = 0.001] was associated with an increased risk of echocardiographic left ventricular hypertrophy, while maternal history of hypertension [OR: 0.72, CI 0.58–0.91, p = 0.006] was associated with a reduced risk. Age ≥50 years (p = 0.026), duration of hypertension ≥1 year (p = 0.047), and heart failure (p < 0.001) were associated with an increased risk of left ventricular hypertrophy, while male sex (p < 0.001) was associated with a reduced risk. Conclusion. Our study showed that a paternal history of hypertension is associated with an increased left ventricular hypertrophy risk among patients with essential hypertension, while maternal history is protective. [ABSTRACT FROM AUTHOR]

The article discusses the integration of a hypertension treatment program into Nigeria's primary healthcare system. Nigeria has a high prevalence of hypertension, but low rates of awareness, treatment, and control. The Hypertension Treatment in Nigeria (HTN) Program was launched in 2020 to improve hypertension care across primary healthcare centers. Since its inception, the program has enrolled over 21,000 patients and increased hypertension control rates. The article also highlights the importance of engaging stakeholders and policymakers in addressing the burden of hypertension and discusses the outcomes of a stakeholder meeting held to assess the HTN Program and identify collaboration opportunities. Overall, the article concludes that the HTN Program has made significant progress and can serve as a template for integrating hypertensive services into primary care nationally. [Extracted from the article]

Excess dietary sodium consumption is a leading risk factor for hypertension and cardiovascular diseases (CVD). In Nigeria, where over 27 million people are affected by hypertension, the average daily salt intake exceeds the World Health Organization's recommendation. The Nigeria Sodium Study (NaSS) was established to evaluate the implementation and scale-up of policy actions to reduce salt intake in Nigeria. Preliminary findings from the NaSS suggest that Nigerian adults consume twice the recommended level of daily sodium, with bouillon emerging as a major source. The study also highlights the importance of multi-sectoral engagement and high-quality data for evidence-informed policymaking. [Extracted from the article]