More rigorous protocol adherence to intensive structured management improves blood pressure control in primary care
Why the study?
Does structured intensive management improve blood pressure control in primary care patients with hypertension?
Population
1562 randomized participants from 119 primary care clinics, mean age 59.3 ± 12.0 years, 62% men, 67% with…
Comparison
Structured intensive management with protocol… vs Usual care.
Design
RCT, Randomized
Follow-up
26 weeks
Authors
Discussion
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Member takes
Implication
High adherence to structured intensive BP protocols should be prioritized in primary care; confirms RCT benefits for target attainment over usual care.
Key Points
- To assess how adherence to an intensive, structured management protocol influences blood pressure control among hypertensive patients in primary care.
- Secondary analysis of the VIPER-BP randomized trial involving 1562 participants across 119 primary care clinics.
- Assessed 1038 intervention participants using a 1-5 protocol adherence score based on prescription adherence, drug uptitration, and visit attendance over 26 weeks of follow-up.
- Blood pressure target attainment reached 51% (132 ± 14/79 ± 9 mmHg) in the highest adherence group (score 5, n = 270) compared to 19% (141 ± 15/83 ± 11 mmHg) in the least adherent group (score 1, n = 148), with an adjusted RR of 1.22 per unit increase in adherence score (95% CI 1.15-1.31; P < 0.001).
- Participants with high adherence scores of 4 or 5 were more likely to achieve BP targets than those receiving usual care (RR 1.54, 95% CI 1.31-1.81; P < 0.001).
- Clinics with a practice nurse showed significantly higher protocol adherence (adjusted RR 1.20, 95% CI 1.06-1.37; P = 0.004) and better BP control (RR 1.21, 95% CI 1.04-1.41; P = 0.015).
Structured PICO
Does structured intensive management improve blood pressure control in primary care patients with hypertension?
P
Population
1562 randomized participants from 119 primary care clinics, mean age 59.3 ± 12.0 years, 62% men, 67% with longstanding hypertension.
I
Intervention
Structured intensive management with protocol adherence to treatment prescription, uptitration, and visit attendance at 6, 10, 14, and 18 weeks postrandomization (n=1038).
C
Comparator
Usual care.
O
Outcome
Blood pressure (BP) control and BP target attainment during 26 weeks of follow-up.surrogate
Higher protocol adherence to structured intensive management significantly improves blood pressure target attainment in primary care.
Cite This Study
Stewart et al. (2014) studied this question.