A simplified antihypertensive treatment algorithm was superior to guideline-based management for achieving target blood pressure at 6 months (64.7% vs 52.7%; absolute difference 12.0%, P=0.026).
RCT
Cluster randomization
Yes
Does a simplified treatment algorithm improve the proportion of patients achieving target blood pressure compared to guideline-based management in patients with uncomplicated hypertension?
A simplified antihypertensive algorithm using initial low-dose fixed-dose combination therapy is superior to standard guideline-based practice for achieving blood pressure control.
Effect estimate: Absolute difference 12.0% (95% CI 1.5 to 22.4)
Absolute Event Rate: 64.7% vs 52.7%
Absolute Risk Reduction: 12%
p-value: p=0.026
Notwithstanding the availability of antihypertensive drugs and practice guidelines, blood pressure control remains suboptimal. The complexity of current treatment guidelines may contribute to this problem. To determine whether a simplified treatment algorithm is more effective than guideline-based management, we studied 45 family practices in southwestern Ontario, Canada, using a cluster randomization trial comparing the simplified treatment algorithm with the Canadian Hypertension Education Program guidelines. The simplified treatment algorithm consisted of the following: (1) initial therapy with a low-dose angiotensin-converting enzyme inhibitor/diuretic or angiotensin receptor blocker/diuretic combination; (2) up-titration of combination therapy to the highest dose; (3) addition of a calcium channel blocker and up-titration; and (4) addition of a non-first-line antihypertensive agent. The proportion of patients treated to target blood pressure (systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg for patients without diabetes mellitus or systolic blood pressure <130 mm Hg and diastolic blood pressure <80 mm Hg for diabetic patients) at 6 months was analyzed at the practice level. The proportion of patients achieving target was significantly higher in the intervention group (64.7% versus 52.7%; absolute difference: 12.0%; 95% CI: 1.5% to 22.4%; P=0.026). Multivariate analysis of patient-level data showed that assignment to the intervention arm increased the chance of reaching the target by 20% (P=0.028), when adjusted for other covariates. In conclusion, the Simplified Treatment Intervention to Control Hypertension Study indicates that a simplified antihypertensive algorithm using initial low-dose fixed-dose combination therapy is superior to guideline-based practice for the management of hypertension.
Feldman et al. (Mon,) conducted a rct in Uncomplicated hypertension. Simplified treatment algorithm vs. Canadian Hypertension Education Program guidelines was evaluated on Proportion of patients treated to target blood pressure at 6 months (Absolute difference 12.0%, 95% CI 1.5 to 22.4, p=0.026). A simplified antihypertensive treatment algorithm was superior to guideline-based management for achieving target blood pressure at 6 months (64.7% vs 52.7%; absolute difference 12.0%, P=0.026).