TY - JOUR
T1 - More rigorous protocol adherence to intensive structured management improves blood pressure control in primary care: Results from the Valsartan Intensified Primary carE Reduction of Blood Pressure study
AU - Stewart, Simon
AU - Stocks, Nigel
AU - Burrell, Louise
AU - De Looze, Fred
AU - Esterman, Adrian
AU - Harris, Mark
AU - Hung, Joseph
AU - Swemmer, Carla
AU - Kurstjens, Nicol
AU - Jennings, Garry
AU - Carrington, Melinda
PY - 2014/6
Y1 - 2014/6
N2 - Objective: To examine protocol adherence to structured intensive management in the Valsartan Intensified Primary carE Reduction of Blood Pressure (VIPER-BP) study involving 119 primary care clinics and 1562 randomized participants. Methods: Prospective criteria for assessing adherence to treatment prescription, uptitration, and visit attendance at 6, 10, 14, and 18 weeks postrandomization were applied to 1038 intervention participants. Protocol adherence scores of 1-5 (least to most adherent) were compared to blood pressure (BP) control during 26 weeks of follow-up. Results: Mean age was 59.3±12.0 years, 963 (62%) were men, and 1045 (67%) had longstanding hypertension. Clinic attendance dropped from 91 (week 6) to 83% (week 26) and pharmacological instructions were followed for 93% (baseline) to 61% at week 14 (uptitration failures commonly representing protocol deviations). Overall, 26-week BP levels and BP target attainment ranged from 132±14/79±9 and 51% to 141±15/83±11mmHg and 19% in those participants subject to the highest (n=270, 26%) versus least (n=148, 14%) per protocol adherence, respectively; adjusted relative risk (RR) 1.22 per unit protocol adherence score, 95% confidence interval (CI) 1.15-1.31; for achieving BP target (P<0.001). Participants with a per protocol score of 4 or 5 (512/1038, 49.3%) were 1.54-fold (95% CI 1.31-1.81; P<0.001) more likely to achieve their individual BP target compared with usual care. Clinics equipped with a practice nurse significantly influenced protocol adherence (adjusted RR 1.20, 95% CI 1.06-1.37; P=0.004) and individual BP control (RR 1.21, 95% CI 1.04-1.41; P=0.015). Conclusion: There is considerable potential for structured care management to improve BP control in primary care, especially when optimally applied.
AB - Objective: To examine protocol adherence to structured intensive management in the Valsartan Intensified Primary carE Reduction of Blood Pressure (VIPER-BP) study involving 119 primary care clinics and 1562 randomized participants. Methods: Prospective criteria for assessing adherence to treatment prescription, uptitration, and visit attendance at 6, 10, 14, and 18 weeks postrandomization were applied to 1038 intervention participants. Protocol adherence scores of 1-5 (least to most adherent) were compared to blood pressure (BP) control during 26 weeks of follow-up. Results: Mean age was 59.3±12.0 years, 963 (62%) were men, and 1045 (67%) had longstanding hypertension. Clinic attendance dropped from 91 (week 6) to 83% (week 26) and pharmacological instructions were followed for 93% (baseline) to 61% at week 14 (uptitration failures commonly representing protocol deviations). Overall, 26-week BP levels and BP target attainment ranged from 132±14/79±9 and 51% to 141±15/83±11mmHg and 19% in those participants subject to the highest (n=270, 26%) versus least (n=148, 14%) per protocol adherence, respectively; adjusted relative risk (RR) 1.22 per unit protocol adherence score, 95% confidence interval (CI) 1.15-1.31; for achieving BP target (P<0.001). Participants with a per protocol score of 4 or 5 (512/1038, 49.3%) were 1.54-fold (95% CI 1.31-1.81; P<0.001) more likely to achieve their individual BP target compared with usual care. Clinics equipped with a practice nurse significantly influenced protocol adherence (adjusted RR 1.20, 95% CI 1.06-1.37; P=0.004) and individual BP control (RR 1.21, 95% CI 1.04-1.41; P=0.015). Conclusion: There is considerable potential for structured care management to improve BP control in primary care, especially when optimally applied.
KW - antihypertensive treatment
KW - blood pressure
KW - cardiovascular disease
KW - hypertension
KW - management
KW - primary care
KW - treatment targets
UR - http://www.scopus.com/inward/record.url?scp=84900439398&partnerID=8YFLogxK
U2 - 10.1097/HJH.0000000000000180
DO - 10.1097/HJH.0000000000000180
M3 - Article
SN - 0263-6352
VL - 32
SP - 1342
EP - 1350
JO - Journal of Hypertension
JF - Journal of Hypertension
IS - 6
ER -