Abstract 1341: Hypertension Management Program Improves Blood Pressure Control in Primary Care
Introduction: Effective blood pressure therapy is a central primary care goal. Yet, studies worldwide show insufficient control rates. While structured forms of care improved blood pressure control in randomized controlled trials, there are few data about the effects under practice conditions.
Hypothesis: We assessed the hypothesis that a one-year quality improvement project in a primary care practice can improve blood pressure control in patients with known coronary artery disease or those at high risk.
Methods: The project was performed in a primary care teaching practice in Germany. The complex intervention included a standardized therapy protocol, educational sessions about blood pressure readings using the WHO-MONICA approach, special office hours for patients with hypertension and a phone recall system. All patients with known hypertension or on antihypertensives plus angiographically proven coronary disease, peripheral or cerebral vascular disease or known diabetes were included. If office blood pressure readings showed uncontrolled hypertension, medications were adjusted stepwise and follow-up appointments were scheduled till control was reached (under 140/90 mmHg). The statistical analysis compared the percentage of patients with controlled hypertension before and after the intervention using the ChiSquare-Test. Blood pressure measurements were compared using the paired t-test.
Results: The inclusion criteria were fulfilled by 334 patients. Patients’ average age was 70 years, 61 % were males, 92 % were insured publically, 87 % were retired. Coronary disease was documented in 58,4 % of patients, 9,6 % had prior bypass surgery, 50 % were diabetics, 11,4 % had cardiac insufficiency. One year follow-up was completed by 94,6 % of patients. Hypertension was controlled in 45,5 % of patients at baseline and 73,7 % after the intervention (p under 0,006). Average blood pressure decreased from 140/85 mmHg to 127/77 mmHg (p under 0,001).
Conclusions: In conclusion, our study shows that a blood pressure management program markedly improves hypertension control rates in a regular primary care office setting.