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

• 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
• DOI: 10.1097/HJH.0000000000001177
• EISSN: 1473-5598
• ISSN: 0263-6352

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