Key result
A multifaceted intervention targeting general practitioners significantly increased the proportion of high-risk hypertensive patients achieving all recommended therapeutic targets compared to usual care (OR 1.89).
Why the study?
Does a multifaceted intervention targeting general practitioners improve the proportion of high-risk hypertensive patients achieving all recommended therapeutic targets?
RCT (n=1,832)
Open-label
Cluster randomized
Yes
Does a multifaceted intervention targeting general practitioners improve the proportion of high-risk hypertensive patients achieving all recommended therapeutic targets?
Effect estimate: OR 1.89 (95% CI 1.09 to 3.27)
Absolute Event Rate: 12.8% vs 13.7%
p-value: p=0.024
A multifaceted intervention targeting general practitioners significantly improved the proportion of high-risk hypertensive patients achieving their recommended therapeutic targets compared to usual care.
Supports implementing multifaceted GP-targeted interventions in high-risk hypertension; extends RCT evidence for quality improvement in primary care.
BACKGROUND: Several observational studies on hypertensive patients have shown a gap between therapeutic targets recommended in guidelines and those achieved in daily practice. The ESCAPE trial aimed to determine whether a multifaceted intervention focused on general practitioners (GPs), could increase significantly the proportion of hypertensive patients at high risk in primary prevention who achieved all their recommended therapeutic targets. METHODS: A pragmatic, cluster randomized trial involving 257 GPs randomized by region. The GPs in the intervention group had a one-day training session and were given an electronic blood pressure measurement device and a short recommendation leaflet. Along with usual follow-up, they focused one consultation on hypertension and other cardiovascular risk factors every six months for two years. They also received feedback at baseline and at one year on their patients' clinical and biological parameters. Main outcome measures were change in the proportion of patients achieving all their therapeutic targets and each individual therapeutic target at two years, and quality of life. RESULTS: 1,832 high-risk hypertensive patients were included. After two years, the proportion of patients achieving all their therapeutic targets increased significantly in both groups, but significantly more in the intervention group: OR (odds-ratio) 1.89, (95% confidence interval (CI) 1.09 to 3.27, P = 0.02). Significantly more patients achieved their blood pressure targets in the intervention group than in the usual care group: OR 2.03 (95% CI 1.44 to 2.88, P < 0.0001). Systolic and diastolic blood pressures decreased significantly more in the intervention group than in the usual care group, by 4.8 mmHg and 1.9 mmHg, respectively (P < 0.0001 for both). There were no significant difference changes in physical and mental quality of life between groups. CONCLUSION: An easy-to-perform, multifaceted intervention targeting only GPs increased significantly the proportion of high-risk hypertensive patients in primary prevention achieving their recommended therapeutic targets. TRIAL REGISTRATION: This trial was registered with ClinicalTrials.gov, number NCT00348855.
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Pouchain et al. (2013) conducted an RCT in High-risk hypertension in primary prevention (n=1,832). Multifaceted general practitioner intervention (training, electronic BP device, leaflet, focused consultations, feedback) vs. Usual care was evaluated on Change in the proportion of patients achieving all of their therapeutic targets at two years (OR 1.89, 95% CI 1.09 to 3.27, p=0.024). A multifaceted intervention targeting general practitioners significantly increased the proportion of high-risk hypertensive patients achieving all recommended therapeutic targets compared to usual care (OR 1.89).
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