Key result
A structured hypertension treatment and teaching programme significantly reduced the mean number of prescribed antihypertensive agents (difference 0.8; 95% CI 0.4-1.1; p<0.0001) compared to usual care.
Why the study?
Does a structured treatment and teaching programme improve blood pressure control and reduce medication burden in hypertensive patients in general practice?
RCT (n=200)
Cluster
Yes
Does a structured treatment and teaching programme improve blood pressure control and reduce medication burden in hypertensive patients in general practice?
Effect estimate: Difference 0.8 (95% CI 0.4-1.1)
Absolute Event Rate: 1.2% vs 1.8%
p-value: p=< 0.0001
A structured hypertension treatment and teaching programme in primary care significantly reduces the need for antihypertensive medications and improves diastolic blood pressure and body weight.
Hypothesis-generating for medication reduction in primary care hypertension; leaves open randomized confirmation before practice change.
OBJECTIVE: Evaluation of a structured hypertension treatment and teaching programme in general practice. DESIGN: Prospective controlled trial; follow-up period 18 months. SETTING: 10 primary health care practices. PRACTICES AND PATIENTS: From each practice 20 patients (30 to 60 years old, mean of the last two blood pressure measurements at or above 160 and/or 95 mmHg) were randomly selected; in 5 practices these patients were to participate in the treatment and teaching programme; in the remaining 5 practices hypertension care was continued without the availability of such a programme (controls). INTERVENTION: Structured treatment and teaching programme based upon four group sessions for patients mainly conducted by paramedical personnel. MAIN OUTCOME MEASURES: Blood pressure, body weight, prescription of antihypertensive drugs - as documented in the patient's records. MAIN RESULTS: Of the 100 control patients 26 and of the 100 intervention patients 14 were lost to observation; 46 patients had agreed to participate in the programme. The mean number of prescribed antihypertensive agents per patient decreased in the intervention group (1.8 +/- 1.3 at baseline, vs 1.2 +/- 1.2 at follow-up) compared to the control group (1.6 +/- 1.3 vs 1.8 +/- 1.6); difference 0.8 (95% CI 0.4 to 1.1), p < 0.0001. In the control group 9% and in the intervention group 33% of patients had documented reductions of body weight (p < 0.0001). Blood pressure decreased in the intervention group (162 +/- 14/100 +/- 7 mmHg at baseline, vs 154 +/- 16/95 +/- 9 mmHg at follow-up) compared to the control group (161 +/- 13/98 +/- 7 mmHg vs 158 +/- 18/96 +/- 11 mmHg); differences for systolic blood pressure 5 (95% CI 0 to 10) mmHg, p = 0.071; for diastolic blood pressure 4 (1 to 7) mmHg, p = 0.018. CONCLUSIONS: The introduction of a structured hypertension treatment and teaching programme in general practice may lead to significant improvements of hypertension care.
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Mühlhauser et al. (1993) conducted an RCT in Hypertension (n=200). Structured treatment and teaching programme vs. Usual care was evaluated on Mean number of prescribed antihypertensive agents per patient (Difference 0.8, 95% CI 0.4-1.1, p=< 0.0001). A structured hypertension treatment and teaching programme significantly reduced the mean number of prescribed antihypertensive agents (difference 0.8; 95% CI 0.4-1.1; p<0.0001) compared to usual care.
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