Lack of Impact of a Comprehensive Intervention on Hypertension in the Primary Care Setting

• Published in: American journal of hypertension Vol. 27; no. 3; pp. 489 - 496
• Main Authors: Niiranen, Teemu J., Leino, Kimmo, Puukka, Pauli, Kantola, Ilkka, Karanko, Hannu, Jula, Antti M.
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 01.03.2014
• Subjects: Adult; Aged; Antihypertensive Agents - therapeutic use; Blood Pressure - drug effects; Blood Pressure Monitoring, Ambulatory; Counseling; Drug therapy; Female; Finland; Group Processes; Health Behavior; Health Knowledge, Attitudes, Practice; Humans; Hypertension - diagnosis; Hypertension - drug therapy; Hypertension - physiopathology; Intervention; Male; Middle Aged; Older people; Patient Education as Topic; Predictive Value of Tests; Primary care; Primary Health Care; Risk Reduction Behavior; Time Factors; Treatment Outcome; Finland; blood pressure; blood pressure measurement; patient education; home blood pressure measurement; exercise; diet; hypertension
• ISSN: 0895-7061; 1941-7225
• DOI: 10.1093/ajh/hpt204

BACKGROUND The implementation of lifestyle modifications, home blood pressure (BP) measurement, and optimization of antihypertensive drug therapy have been shown to improve BP control in tightly controlled research settings. Our objective was to determine the effect of these interventions in a primary care setting, with the family practitioners and nurses serving as the interventionists. METHODS Two hundred twenty hypertensive patients were recruited from 2 health centers that operated in the same building and covered similar populations, with the health centers randomized to function as intervention or control sites. Participants in the intervention group received repeated individual and group counseling from the centrally trained staff of the health center on healthy lifestyles. In addition, their antihypertensive drug therapy was guided by home BP measurements performed at 3-month intervals instead of by conventional office measurements. RESULTS After 12 months of follow-up, the between-group differences in the changes of lifestyle variables (body mass index, physical activity, dietary recalls, and urinary sodium/potassium) were nonsignificant. Antihypertensive treatment intensity increased in both groups, but the between-group difference was nonsignificant (P = 0.63). Office systolic/diastolic BP decreased significantly in the intervention (8/6mm Hg; P < 0.001) and control (11/7mm Hg; P < 0.001) groups, but the between-group differences were nonsignificant (P = 0.25/0.16). CONCLUSIONS Our intervention did not improve BP control as suggested by many prior studies performed in controlled academic settings. This result could be attributed to a lack of motivation and incentives among the staff or because the population was relatively unselected. Greater attention to education and financial incentives might be required in typical primary care settings to obtain better results. CLINICALTRIALS.GOV IDENTIFIER NCT01915199