A Simplified Approach to the Treatment of Uncomplicated Hypertension: A Cluster Randomized, Controlled Trial

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 m...

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Bibliographic Details
Published in:Hypertension (Dallas, Tex. 1979) Tex. 1979), 2009-04, Vol.53 (4), p.646-653
Main Authors: Feldman, Ross D, Zou, Guang Y, Vandervoort, Margaret K, Wong, Cindy J, Nelson, Sigrid A.E, Feagan, Brian G
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Algorithms
Angiotensin II Type 1 Receptor Blockers - therapeutic use
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Antihypertensive agents
Antihypertensive Agents - therapeutic use
Arterial hypertension. Arterial hypotension
Biological and medical sciences
Blood and lymphatic vessels
Blood Pressure - drug effects
Cardiology. Vascular system
Cardiovascular system
Diuretics - therapeutic use
Drug Therapy, Combination
Family Practice
Female
Humans
Hypertension - drug therapy
Hypertension - epidemiology
Male
Medical sciences
Middle Aged
Patient Compliance
Pharmacology. Drug treatments
Risk Factors
Treatment Outcome
Young Adult
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Summary: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
ISSN:0194-911X
1524-4563
DOI:10.1161/HYPERTENSIONAHA.108.123455