Key result
Education and feedback on hypertension management to primary care physicians was not associated with a reduced risk of first-ever stroke (2.3% vs 2.7%; HR 0.96, 95% CI 0.90-1.03).
Why the study?
Education and feedback on hypertension management improves blood pressure control, but its effectiveness in reducing stroke and cardiovascular events remains uncertain.
Does education and feedback on hypertension management to primary care physicians reduce the risk of stroke and cardiovascular events in adults with a blood pressure recording?
Cohort (n=253,289)
Yes
Does education and feedback on hypertension management to primary care physicians reduce the risk of stroke and cardiovascular events in adults with a blood pressure recording?
Education and feedback on hypertension management to primary care physicians did not significantly reduce the risk of first-ever stroke or major cardiovascular events compared to standard care.
Answers are grounded in this paper and cite their sources.
Physician education and feedback showed no stroke benefit in this cohort; leaves open whether randomized interventions improve hypertension outcomes.
PURPOSE: Education and feedback on hypertension management has been associated with improved hypertension control. This study aimed to assess the effectiveness of such interventions to reduce the risk of stroke and cardiovascular events. MATERIALS AND METHODS: Individuals ≥18 years with a blood pressure (BP) recording in Västerbotten or Södermanland County during the study period 2001 to 2009 were included in 108 serial cohort studies, each with 24 months follow-up. The primary outcome was risk of first-ever stroke in Västerbotten County (intervention) compared with Södermanland County (control). Secondary outcomes were first-ever major adverse cardiovascular event (MACE), myocardial infarction, and heart failure, as well as all-cause and cardiovascular mortality. All outcomes were analysed using time-to-event data included in a Cox proportional hazards model adjusted for age, sex, hypertension, diabetes, coronary artery disease, atrial fibrillation, systolic BP at inclusion, marital status, and disposable income. RESULTS: A total of 121 365 individuals (mean [SD] age at inclusion 61.7 [16.3] years; 59.9% female; mean inclusion BP 142.3/82.6 mmHg) in the intervention county were compared to 131 924 individuals (63.6 [16.2] years; 61.2% female; 144.1/81.1 mmHg) in the control county. A first-ever stroke occurred in 2 823 (2.3%) individuals in the intervention county, and 3 584 (2.7%) individuals in the control county (adjusted hazard ratio 0.96, 95% CI 0.90 to 1.03). No differences were observed for MACE, myocardial infarction or heart failure, whereas all-cause mortality (HR 0.91, 95% CI 0.87 to 0.95) and cardiovascular mortality (HR 0.91, 95% CI 0.85 to 0.98) were lower in the intervention county. CONCLUSIONS: This study does not support an association between education and feedback on hypertension management to primary care physicians and the risk for stroke or cardiovascular outcomes. The observed differences for mortality outcomes should be interpreted with caution.
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Brunström et al. (2022) conducted a cohort in Hypertension (n=253,289). Education and feedback on hypertension management vs. Control county (Södermanland) was evaluated on first-ever stroke (HR 0.96, 95% CI 0.90 to 1.03). Education and feedback on hypertension management to primary care physicians was not associated with a reduced risk of first-ever stroke (2.3% vs 2.7%; HR 0.96, 95% CI 0.90-1.03).
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