Key result
Goal-oriented management in a specialist clinic achieved both systolic (<140 mm Hg) and diastolic (<90 mm Hg) blood pressure goals in 59% of patients after at least 1 year of follow-up.
Why the study?
Does goal-oriented management improve blood pressure control in hypertensive patients?
Observational (n=437)
No
Does goal-oriented management improve blood pressure control in hypertensive patients?
Goal-oriented hypertension management in a specialist clinic achieves high rates of blood pressure control, though most patients require multiple medications and systolic goals remain harder to achieve.
Answers are grounded in this paper and cite their sources.
May support specialist hypertension clinics; leaves open whether this outperforms usual care in randomized trials.
Several clinical trials using a blood pressure (BP) treatment algorithm focused on a predetermined goal have achieved better control rates than those of national survey data. These trials reached the Sixth Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC VI) diastolic blood pressure (DBP) goal of <90 mm Hg in >90% of volunteers and systolic blood pressure (SBP) goal of <140 mm Hg in >60% of volunteers. We evaluated BP control of 437 consecutive patients after at least one year of follow up in a specialist clinic which employed "goal-oriented management," ie, treating to a specific BP goal without a formal drug treatment algorithm, to determine whether JNC VI goals could be achieved. Overall, 276 (63%) patients achieved SBP goal, with 376 (86%) at DBP goal and 358 (59%) at both goals. Only 23% of patients were on monotherapy, with 34% requiring 2 drugs and 37% requiring 3 or more medications. There was no substantial difference in BP control rates among age, gender, and ethnicity subgroups. However, in the 20% of patients who were diabetic, only 52% had a BP of <140 mm Hg and <90 mm Hg, whereas fewer (22% and 15%, respectively) achieved the more stringent goals of JNC VI and the American Diabetic Association (ADA)/National Kidney Foundation (NKF). Goal-oriented management achieved dramatically better control rates than what is reported. Although DBP control was easy to achieve, achieving SBP goal still remained difficult. Employing goal-oriented management can translate BP control results achieved in clinical trials into outpatient practice.
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Singer et al. (2002) conducted an observational in Hypertension (n=437). Goal-oriented management was evaluated on Achieving both systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg. Goal-oriented management in a specialist clinic achieved both systolic (<140 mm Hg) and diastolic (<90 mm Hg) blood pressure goals in 59% of patients after at least 1 year of follow-up.
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