Loading…
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...
Saved in:
| Published in: | Hypertension (Dallas, Tex. 1979) Tex. 1979), 2009-04, Vol.53 (4), p.646-653 |
|---|---|
| Main Authors: | , , , , , |
| Format: | Article |
| Language: | English |
| Subjects: | |
| Citations: | Items that this one cites |
| Online Access: | Get full text |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| cited_by | |
|---|---|
| cites | cdi_FETCH-LOGICAL-c3165-8dcc0e4a66a29a01eaeed4b2a0c21cb48b6a1103bbc6c9cfe38c5786114591443 |
| container_end_page | 653 |
| container_issue | 4 |
| container_start_page | 646 |
| container_title | Hypertension (Dallas, Tex. 1979) |
| container_volume | 53 |
| creator | Feldman, Ross D Zou, Guang Y Vandervoort, Margaret K Wong, Cindy J Nelson, Sigrid A.E Feagan, Brian G |
| description | 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 |
| doi_str_mv | 10.1161/HYPERTENSIONAHA.108.123455 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_67050273</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>67050273</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3165-8dcc0e4a66a29a01eaeed4b2a0c21cb48b6a1103bbc6c9cfe38c5786114591443</originalsourceid><addsrcrecordid>eNqNkF1r1EAUhgdR7Fr9CzII9qpZ52Q-kvRCCMvaLZRW2i3oVZhMTtjoJBNnJpT6682ySwWvvDpweN7z8RDyAdgSQMGnzfev67vt-ub-6vam3JRLYPkSUi6kfEEWIFORCKn4S7JgUIikAPh2Qt6E8IMxEEJkr8kJFCnPVM4XxJb0vutH27UdNrQcR--02dHoaNwh3XrUscchUtfSh8G4PWl0nNHN04g-4hA6N1zQkq7sFCJ6eqeHxvXdb2zO6coN0TtrZ3zrO23fklettgHfHespefiy3q42yfXt5dWqvE4MByWTvDGGodBK6bTQDFAjNqJONTMpmFrktdIAjNe1UaYwLfLcyCxXAEIW84v8lJwd5s7f_JowxKrvgkFr9YBuCpXKmGRpxmfw4gAa70Lw2Faj73rtnypg1d519Y_ruZ9XB9dz-P1xy1T32PyNHuXOwMcjoIPRtvV6MF145lJIcwnFftDnA_fo7Kww_LTTI_pqh9rG3f9c8gfbPJ5w</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>67050273</pqid></control><display><type>article</type><title>A Simplified Approach to the Treatment of Uncomplicated Hypertension: A Cluster Randomized, Controlled Trial</title><source>EZB Electronic Journals Library</source><creator>Feldman, Ross D ; Zou, Guang Y ; Vandervoort, Margaret K ; Wong, Cindy J ; Nelson, Sigrid A.E ; Feagan, Brian G</creator><creatorcontrib>Feldman, Ross D ; Zou, Guang Y ; Vandervoort, Margaret K ; Wong, Cindy J ; Nelson, Sigrid A.E ; Feagan, Brian G</creatorcontrib><description>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 <140 mm Hg and diastolic blood pressure <90 mm Hg for patients without diabetes mellitus or systolic blood pressure <130 mm Hg and diastolic blood pressure <80 mm Hg for diabetic patients) at 6 months was analyzed at the practice level. The proportion of patients achieving target was significantly higher in the intervention group (64.7% versus 52.7%; absolute difference12.0%; 95% CI1.5% to 22.4%; P=0.026). Multivariate analysis of patient-level data showed that assignment to the intervention arm increased the chance of reaching the target by 20% (P=0.028), when adjusted for other covariates. In conclusion, the Simplified Treatment Intervention to Control Hypertension Study indicates that a simplified antihypertensive algorithm using initial low-dose fixed-dose combination therapy is superior to guideline-based practice for the management of hypertension.</description><identifier>ISSN: 0194-911X</identifier><identifier>EISSN: 1524-4563</identifier><identifier>DOI: 10.1161/HYPERTENSIONAHA.108.123455</identifier><identifier>PMID: 19237683</identifier><identifier>CODEN: HPRTDN</identifier><language>eng</language><publisher>Hagerstown, MD: American Heart Association, Inc</publisher><subject>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</subject><ispartof>Hypertension (Dallas, Tex. 1979), 2009-04, Vol.53 (4), p.646-653</ispartof><rights>2009 American Heart Association, Inc.</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3165-8dcc0e4a66a29a01eaeed4b2a0c21cb48b6a1103bbc6c9cfe38c5786114591443</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21285195$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19237683$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Feldman, Ross D</creatorcontrib><creatorcontrib>Zou, Guang Y</creatorcontrib><creatorcontrib>Vandervoort, Margaret K</creatorcontrib><creatorcontrib>Wong, Cindy J</creatorcontrib><creatorcontrib>Nelson, Sigrid A.E</creatorcontrib><creatorcontrib>Feagan, Brian G</creatorcontrib><title>A Simplified Approach to the Treatment of Uncomplicated Hypertension: A Cluster Randomized, Controlled Trial</title><title>Hypertension (Dallas, Tex. 1979)</title><addtitle>Hypertension</addtitle><description>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 <140 mm Hg and diastolic blood pressure <90 mm Hg for patients without diabetes mellitus or systolic blood pressure <130 mm Hg and diastolic blood pressure <80 mm Hg for diabetic patients) at 6 months was analyzed at the practice level. The proportion of patients achieving target was significantly higher in the intervention group (64.7% versus 52.7%; absolute difference12.0%; 95% CI1.5% to 22.4%; P=0.026). Multivariate analysis of patient-level data showed that assignment to the intervention arm increased the chance of reaching the target by 20% (P=0.028), when adjusted for other covariates. In conclusion, the Simplified Treatment Intervention to Control Hypertension Study indicates that a simplified antihypertensive algorithm using initial low-dose fixed-dose combination therapy is superior to guideline-based practice for the management of hypertension.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Algorithms</subject><subject>Angiotensin II Type 1 Receptor Blockers - therapeutic use</subject><subject>Angiotensin-Converting Enzyme Inhibitors - therapeutic use</subject><subject>Antihypertensive agents</subject><subject>Antihypertensive Agents - therapeutic use</subject><subject>Arterial hypertension. Arterial hypotension</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Blood Pressure - drug effects</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular system</subject><subject>Diuretics - therapeutic use</subject><subject>Drug Therapy, Combination</subject><subject>Family Practice</subject><subject>Female</subject><subject>Humans</subject><subject>Hypertension - drug therapy</subject><subject>Hypertension - epidemiology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Patient Compliance</subject><subject>Pharmacology. Drug treatments</subject><subject>Risk Factors</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0194-911X</issn><issn>1524-4563</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><recordid>eNqNkF1r1EAUhgdR7Fr9CzII9qpZ52Q-kvRCCMvaLZRW2i3oVZhMTtjoJBNnJpT6682ySwWvvDpweN7z8RDyAdgSQMGnzfev67vt-ub-6vam3JRLYPkSUi6kfEEWIFORCKn4S7JgUIikAPh2Qt6E8IMxEEJkr8kJFCnPVM4XxJb0vutH27UdNrQcR--02dHoaNwh3XrUscchUtfSh8G4PWl0nNHN04g-4hA6N1zQkq7sFCJ6eqeHxvXdb2zO6coN0TtrZ3zrO23fklettgHfHespefiy3q42yfXt5dWqvE4MByWTvDGGodBK6bTQDFAjNqJONTMpmFrktdIAjNe1UaYwLfLcyCxXAEIW84v8lJwd5s7f_JowxKrvgkFr9YBuCpXKmGRpxmfw4gAa70Lw2Faj73rtnypg1d519Y_ruZ9XB9dz-P1xy1T32PyNHuXOwMcjoIPRtvV6MF145lJIcwnFftDnA_fo7Kww_LTTI_pqh9rG3f9c8gfbPJ5w</recordid><startdate>200904</startdate><enddate>200904</enddate><creator>Feldman, Ross D</creator><creator>Zou, Guang Y</creator><creator>Vandervoort, Margaret K</creator><creator>Wong, Cindy J</creator><creator>Nelson, Sigrid A.E</creator><creator>Feagan, Brian G</creator><general>American Heart Association, Inc</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200904</creationdate><title>A Simplified Approach to the Treatment of Uncomplicated Hypertension: A Cluster Randomized, Controlled Trial</title><author>Feldman, Ross D ; Zou, Guang Y ; Vandervoort, Margaret K ; Wong, Cindy J ; Nelson, Sigrid A.E ; Feagan, Brian G</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3165-8dcc0e4a66a29a01eaeed4b2a0c21cb48b6a1103bbc6c9cfe38c5786114591443</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Algorithms</topic><topic>Angiotensin II Type 1 Receptor Blockers - therapeutic use</topic><topic>Angiotensin-Converting Enzyme Inhibitors - therapeutic use</topic><topic>Antihypertensive agents</topic><topic>Antihypertensive Agents - therapeutic use</topic><topic>Arterial hypertension. Arterial hypotension</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Blood Pressure - drug effects</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular system</topic><topic>Diuretics - therapeutic use</topic><topic>Drug Therapy, Combination</topic><topic>Family Practice</topic><topic>Female</topic><topic>Humans</topic><topic>Hypertension - drug therapy</topic><topic>Hypertension - epidemiology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Patient Compliance</topic><topic>Pharmacology. Drug treatments</topic><topic>Risk Factors</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Feldman, Ross D</creatorcontrib><creatorcontrib>Zou, Guang Y</creatorcontrib><creatorcontrib>Vandervoort, Margaret K</creatorcontrib><creatorcontrib>Wong, Cindy J</creatorcontrib><creatorcontrib>Nelson, Sigrid A.E</creatorcontrib><creatorcontrib>Feagan, Brian G</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Hypertension (Dallas, Tex. 1979)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Feldman, Ross D</au><au>Zou, Guang Y</au><au>Vandervoort, Margaret K</au><au>Wong, Cindy J</au><au>Nelson, Sigrid A.E</au><au>Feagan, Brian G</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Simplified Approach to the Treatment of Uncomplicated Hypertension: A Cluster Randomized, Controlled Trial</atitle><jtitle>Hypertension (Dallas, Tex. 1979)</jtitle><addtitle>Hypertension</addtitle><date>2009-04</date><risdate>2009</risdate><volume>53</volume><issue>4</issue><spage>646</spage><epage>653</epage><pages>646-653</pages><issn>0194-911X</issn><eissn>1524-4563</eissn><coden>HPRTDN</coden><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-News-2</notes><notes>ObjectType-Feature-3</notes><notes>content type line 23</notes><abstract>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 <140 mm Hg and diastolic blood pressure <90 mm Hg for patients without diabetes mellitus or systolic blood pressure <130 mm Hg and diastolic blood pressure <80 mm Hg for diabetic patients) at 6 months was analyzed at the practice level. The proportion of patients achieving target was significantly higher in the intervention group (64.7% versus 52.7%; absolute difference12.0%; 95% CI1.5% to 22.4%; P=0.026). Multivariate analysis of patient-level data showed that assignment to the intervention arm increased the chance of reaching the target by 20% (P=0.028), when adjusted for other covariates. In conclusion, the Simplified Treatment Intervention to Control Hypertension Study indicates that a simplified antihypertensive algorithm using initial low-dose fixed-dose combination therapy is superior to guideline-based practice for the management of hypertension.</abstract><cop>Hagerstown, MD</cop><pub>American Heart Association, Inc</pub><pmid>19237683</pmid><doi>10.1161/HYPERTENSIONAHA.108.123455</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0194-911X |
| ispartof | Hypertension (Dallas, Tex. 1979), 2009-04, Vol.53 (4), p.646-653 |
| issn | 0194-911X 1524-4563 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_67050273 |
| source | EZB Electronic Journals Library |
| 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 |
| title | A Simplified Approach to the Treatment of Uncomplicated Hypertension: A Cluster Randomized, Controlled Trial |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-09-21T15%3A40%3A51IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=A%20Simplified%20Approach%20to%20the%20Treatment%20of%20Uncomplicated%20Hypertension:%20A%20Cluster%20Randomized,%20Controlled%20Trial&rft.jtitle=Hypertension%20(Dallas,%20Tex.%201979)&rft.au=Feldman,%20Ross%20D&rft.date=2009-04&rft.volume=53&rft.issue=4&rft.spage=646&rft.epage=653&rft.pages=646-653&rft.issn=0194-911X&rft.eissn=1524-4563&rft.coden=HPRTDN&rft_id=info:doi/10.1161/HYPERTENSIONAHA.108.123455&rft_dat=%3Cproquest_cross%3E67050273%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c3165-8dcc0e4a66a29a01eaeed4b2a0c21cb48b6a1103bbc6c9cfe38c5786114591443%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=67050273&rft_id=info:pmid/19237683&rfr_iscdi=true |