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Ojji DB, Mayosi B, Francis V, Badri M, Cornelius V, Smythe W, Kramer N, Barasa F, Damasceno A, Dzudie A, Jones E, Mondo C, Ogah O, Ogola E, Sani MU, Shedul GL, Shedul G, Rayner B, Okpechi IG, Sliwa K, Poulter N. Comparison of Dual Therapies for Lowering Blood Pressure in Black Africans. N Engl J Med 2019; 380:2429-2439. [PMID: 30883050 DOI: 10.1056/nejmoa1901113] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The prevalence of hypertension among black African patients is high, and these patients usually need two or more medications for blood-pressure control. However, the most effective two-drug combination that is currently available for blood-pressure control in these patients has not been established. METHODS In this randomized, single-blind, three-group trial conducted in six countries in sub-Saharan Africa, we randomly assigned 728 black patients with uncontrolled hypertension (≥140/90 mm Hg while the patient was not being treated or was taking only one antihypertensive drug) to receive a daily regimen of 5 mg of amlodipine plus 12.5 mg of hydrochlorothiazide, 5 mg of amlodipine plus 4 mg of perindopril, or 4 mg of perindopril plus 12.5 mg of hydrochlorothiazide for 2 months. Doses were then doubled (10 and 25 mg, 10 and 8 mg, and 8 and 25 mg, respectively) for an additional 4 months. The primary end point was the change in the 24-hour ambulatory systolic blood pressure between baseline and 6 months. RESULTS The mean age of the patients was 51 years, and 63% were women. Among the 621 patients who underwent 24-hour blood-pressure monitoring at baseline and at 6 months, those receiving amlodipine plus hydrochlorothiazide and those receiving amlodipine plus perindopril had a lower 24-hour ambulatory systolic blood pressure than those receiving perindopril plus hydrochlorothiazide (between-group difference in the change from baseline, -3.14 mm Hg; 95% confidence interval [CI], -5.90 to -0.38; P = 0.03; and -3.00 mm Hg; 95% CI, -5.8 to -0.20; P = 0.04, respectively). The difference between the group receiving amlodipine plus hydrochlorothiazide and the group receiving amlodipine plus perindopril was -0.14 mm Hg (95% CI, -2.90 to 2.61; P=0.92). Similar differential effects on office and ambulatory diastolic blood pressures, along with blood-pressure control and response rates, were apparent among the three groups. CONCLUSIONS These findings suggest that in black patients in sub-Saharan Africa, amlodipine plus either hydrochlorothiazide or perindopril was more effective than perindopril plus hydrochlorothiazide at lowering blood pressure at 6 months. (Funded by GlaxoSmithKline Africa Noncommunicable Disease Open Lab; CREOLE ClinicalTrials.gov number, NCT02742467.).
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Affiliation(s)
- Dike B Ojji
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Bongani Mayosi
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Veronica Francis
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Motasim Badri
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Victoria Cornelius
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Wynand Smythe
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Nicky Kramer
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Felix Barasa
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Albertino Damasceno
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Anastase Dzudie
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Erika Jones
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Charles Mondo
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Okechukwu Ogah
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Elijah Ogola
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Mahmoud U Sani
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Gabriel L Shedul
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Grace Shedul
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Brian Rayner
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Ikechi G Okpechi
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Karen Sliwa
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
| | - Neil Poulter
- From the Department of Medicine, Faculty of Clinical Sciences, University of Abuja, and University of Abuja Teaching Hospital (D.B.O.), and the Departments of Family Medicine (G.L.S.) and Pharmacy (G.S.), University of Abuja Teaching Hospital, Gwagwalada, Abuja, the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan (O.O.), and the Department of Medicine, Bayero University, and Aminu Kano Teaching Hospital, Kano (M.U.S.) - all in Nigeria; the Department of Medicine (B.M.), the Division of Nephrology and Hypertension (E.J., B.R., I.G.O.), and the Clinical Research Center (V.F., W.S., N.K.), Faculty of Health Sciences, University of Cape Town, and the Hatter Institute of Cardiovascular Research in Africa (K.S.) - all in Cape Town, South Africa; the Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (M.B.); the Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London (V.C., N.P.); the Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret (F.B.), and the Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi (E.O.) - both in Kenya; Eduardo Mondlane University Hospital, Maputo, Mozambique (A. Damasceno); Douala General Hospital, Douala, Cameroon (A. Dzudie); and St. Francis Hospital, Nsambya, Kampala, Uganda (C.M.)
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