Primary care intervention boosts blood pressure control
medwireNews: An interprofessional educational program for primary care leads to marked improvements in patients' blood pressure, a study shows.
"It is notable that the program did not promote any single antihypertensive, or even an algorithm of care," say lead researcher Sheldon Tobe (University of Toronto, Ontario, Canada) and team.
"The goal of the program was to make existing clinical practice guidelines more accessible to and integrated into practice for interprofessional primary care teams and their patients through an educational intervention."
This was achieved via a 2-day educational workshop, involving family physicians, nurses, nurse practitioners, and community pharmacists. The program also included development and supply of patient-management tools for the involved practices and self-management tools for the patients, and provision of ongoing support to the practices.
The first phase of the study involved five practices and 1201 patients. During the 9 months after the program was launched, the patients' average blood pressure fell by a significant 7.3/3.6 mmHg, from 134.6/79.1 mmHg at baseline to 127.3/75.5 mmHg at 9 months.
"A reduction of only 5 mm Hg in systolic [blood pressure] has been estimated to translate into a 14% drop in stroke mortality, a 9% drop in coronary heart disease mortality and a 7% reduction in overall mortality," the team comments in the Journal of Human Hypertension.
There were similar results in the second phase of the study, which involved six clinics and 1654 patients, who achieved a 8.1/3.3 mmHg reduction in blood pressure. This second phase began 9 months after the first, and the repeated success rules out the possibility that improvements in the first phase were down to changes in general practice over that period.
"All clinics reported a high satisfaction with the program and with the results they were seeing," note the researchers.
At baseline, just over half of the patients had controlled blood pressure; this improved to around three-quarters, with the largest improvements seen among patients with the highest blood pressure at baseline. For example, average systolic blood pressure among patients in the first phase who had a baseline value of 160 mmHg or higher fell from 167.8 to 137.4 mmHg.
"It is interesting to note that, during baseline, the highest [blood pressure] level group was taking the fewest antihypertensives," say Tobe et al.
This group then had the largest increase in number of antihypertensives used "suggesting that they had been undertreated at baseline."
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By Eleanor McDermid, Senior medwireNews Reporter