The study analysed routinely collected data from more than 63,000 patients receiving care at 246 health facilities in Ghana, Kenya, Sierra Leone and Tanzania between 2019 and 2024. The programme combined mobile technology, local clinics and training for community health workers to support blood pressure monitoring, follow-up care, and health education for people living with long-term conditions.
Researchers from the Nuffield Department of Primary Care Health Sciences at the University of Oxford, Ministries of Health, faith-based and academic partners across Ghana, Kenya, Sierra Leone, and Tanzania, and Medtronic LABS found that patients' blood pressure improved substantially within six months of joining the programme.
Average systolic blood pressure - the top number in a reading, which shows the pressure when the heart beats - fell by 8.3 mmHg, while average diastolic blood pressure - the bottom number, which shows pressure when the heart is at rest - fell by 4.5 mmHg. The largest improvements were seen among patients who entered the programme with uncontrolled systolic blood pressure, with average reduction of 18.1 mmHg.
The proportion of patients with controlled blood pressure rose from 35% to 53%, while just over half, 52.9%, achieved a clinically meaningful reduction in systolic blood pressure of more than 5 mmHg. Patients who had more frequent blood pressure checks, medical reviews and follow-up from community health workers were also significantly more likely to achieve meaningful improvements.
Professor Sir Aziz Sheikh, Head of the Nuffield Department of Primary Care Health Sciences and senior author of the study, said:
“Hypertension remains one of the leading causes of preventable illness and death globally, particularly in low-resource settings where access to continuous care can be challenging. This study demonstrates the real-world potential of digital technology, combined with community-based healthcare, to strengthen long-term management of chronic disease at scale.”
Each participating country adapted the programme to fit its local context with country-specific names, including Akoma Pa in Ghana, Empower Health in Kenya, Afya Imara in Tanzania and Bette Lyfe in Sierra Leone. It was developed through partnerships involving ministries of health, academic institutions, faith-based health networks and Medtronic LABS.
Dr Oren Ombiro, Chief Medical Officer of Medtronic LABS and an author of the paper, said:
“What makes this programme particularly important is that it was embedded within existing national and local healthcare systems. Community health workers, nurses, and clinicians were supported with digital tools that enabled better follow-up, better data, and more coordinated care for patients living with hypertension.”
The study also found that patients treated through local health centres and dispensaries often achieved better outcomes than those seen at larger referral hospitals, highlighting the important role of decentralised care. The authors note that this may reflect differences in patient populations, follow-up patterns, country-level implementation and local healthcare contexts.
Dr Gladwell Gathecha, Non-Communicable Diseases lead at the Kenya Ministry of Health and senior author of the study, said:
“The findings of this study reinforce growing evidence that digitally enabled primary care models can play a major role in addressing non-communicable diseases globally. Importantly, this programme was implemented under routine healthcare conditions, making the results especially relevant for policymakers and health systems.”
The authors note that the main limitation of the study was that it was an uncontrolled investigation. They say randomised controlled trials are needed to establish causal relationships between the intervention and outcomes.
While further research is needed to assess the programme’s long-term impact and cost-effectiveness, the findings point to the potential of digitally enabled, integrated, patient-centred care to strengthen hypertension management at scale. As cardiovascular disease continues to rise across Africa and other low-resource settings, such models may offer a practical way to improve continuity of care and support better outcomes for patients.
Read the full paper, ‘Transforming Hypertension Management with Digital Technology: A Retrospective Cohort Study in Four Sub Saharan Africa Countries’ in BMJ Public Health.