EVALUATION OF A STRUCTURED TREATMENT AND TEACHING PROGRAM ON HYPERTENSION IN GENERAL-PRACTICE

Objective: Evaluation of a structured hypertension treatment and teaching programme in general practice. Design: Prospective controlled trial; follow-up period 18 months. Setting: 10 primary health care practices. Practices and patients: From each practice 20 patients (30 to 60 years old, mean of the last two blood pressure measurements at or above 160 and/or 95 mmHg) were randomly selected; in 5 practices these patients were to participate in the treatment and teaching programme; in the remaining 5 practices hypertension care was continued without the availability of such a programme (controls). Intervention: Structured treatment and teaching programme based upon four group sessions for patients mainly conducted by paramedical personnel. Main outcome measures: Blood pressure, body weight, prescription of antihypertensive drugs - as documented in the patients' records. Main results: Of the 100 control patients 26 and of the 100 intervention patients 14 were lost to observation; 46 patients had agreed to participate in the programme. The mean number of prescribed antihypertensive agents per patient decreased in the intervention group (1.8+/-1.3 at baseline, vs 1.2+/-1.2 at follow-up) compared to the control group (1.6+/-1.3 vs 1.8+/-1.6); difference 0.8 (95% CI 0.4 to 1.1), p<0.0001. In the control group 9% and in the intervention group 33% of patients had documented reductions of body weight (p<0.0001). Blood pressure decreased in the intervention group (162+/-14/100+/-7 mmHg at baseline, vs 154+/-16/95+/-9 mmHg at follow-up) compared to the control group (161+/-13/98+/-7 mmHg vs 158+/-18/96+/-11 mmHg); differences for systolic blood pressure 5 (95% CI 0 to 10) mmHg, p=0.071; for diastolic blood pressure 4 (1 to 7) mmHg, p=0.018. Conclusions: The introduction of a structured hypertension treatment and teaching programme in general practice may lead to significant improvements of hypertension care.