Effects of risk assessment and management programme for hypertension on clinical outcomes and cardiovascular disease risks after 12 months: a population-based matched cohort study

Effects of risk assessment and management programme for hypertension on clinical outcomes and cardiovascular disease risks after 12 months: a population-based matched cohort study

OBJECTIVES:This study evaluated the effectiveness of a structured multidisciplinary risk assessment and management programme for patients with hypertension (RAMP-HT) who were managed in public primary care clinics but had suboptimal blood pressure (BP) control in improving BP, LDL-cholesterol (LDL-C...

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Bibliographic Details
Published in:Journal of hypertension Vol. 35; no. 3; pp. 627 - 636
Main Authors: Yu, Esther Y.T, Wan, Eric Y.F, Wong, Carlos K.H, Chan, Anca K.C, Chan, Karina H.Y, Ho, Sin-yi, Kwok, Ruby L.P, Lam, Cindy L.K
Format: Journal Article
Language:English
Published: England Copyright Wolters Kluwer Health, Inc. All rights reserved 01-03-2017
Lippincott Williams & Wilkins
Subjects:
Adult
Aged
Ambulatory Care
Antihypertensive Agents - therapeutic use
Blood Pressure
Case-Control Studies
Cholesterol, LDL - blood
Cohort Studies
Female
Hong Kong
Humans
Hypertension - drug therapy
Hypertension - physiopathology
Longitudinal Studies
Male
Middle Aged
ORIGINAL PAPERS: Therapeutic aspects
Primary Health Care
Risk Assessment
Risk Factors
Time Factors
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Summary:OBJECTIVES:This study evaluated the effectiveness of a structured multidisciplinary risk assessment and management programme for patients with hypertension (RAMP-HT) who were managed in public primary care clinics but had suboptimal blood pressure (BP) control in improving BP, LDL-cholesterol (LDL-C) and predicted 10-year cardiovascular disease (CVD) risk after 12 months of intervention. METHODS:A total of 10 262 hypertension patients with suboptimal BP despite treatment, aged less than 80 years and without existing CVD were enrolled in RAMP-HT between October 2011 and March 2012 from public general out-patient clinics in Hong Kong. Their clinical outcomes and predicted 10-year CVD risk were compared with a matched cohort of hypertension patients who were receiving usual care in general out-patient clinics without any RAMP-HT intervention by propensity score matching. Multivariable linear and logistic regressions were used to determine the independent effectiveness of RAMP-HT after adjusting for potential confounding variables. RESULTS:Compared with the usual care group after 12 months, significantly greater proportions of RAMP-HT participants achieved target BP (i.e. BP < 140/90 mmHg) (OR = 1.18, P < 0.01) and LDL-C levels (i.e. <3.4 mmol/l for patients with CVD risk ≤20% or <2.6 mmol/l for CVD risk >20%) (OR = 1.13, P < 0.01). RAMP-HT participants also had significantly greater reduction in predicted 10-year CVD risk by 0.44% (coefficient = −0.44, P < 0.01). CONCLUSION:The structured multidisciplinary RAMP-HT was more effective than usual care in achieving target BP, LDL-C and reducing predicted 10-year CVD risk in public primary care patients with suboptimal hypertension control after 12 months of intervention. A long-term follow-up should be conducted to confirm whether the improvement in clinical outcomes can be translated into actual reductions in CVD complications and mortalities and whether such approach is cost-effective.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0
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ISSN:0263-6352
1473-5598
DOI:10.1097/HJH.0000000000001177