Adherence optimises success of primary care hypertension programme

By Eleanor McDermid, Senior medwireNews Reporter

The value of a structured hypertension-treatment programme in primary care increases with increasing adherence to the programme, say researchers.

Melinda Carrington (Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia) and co-workers analysed data from a randomised trial of a structured, intensive hypertension-treatment programme involving 1562 patients and 119 primary care clinics.

The 1038 patients assigned to enter the structured treatment programme had mandatory visits 6, 10, 14 and 18 weeks after randomisation, at which point therapy was to be uptitrated if their blood pressure (BP) remained above target. There was also a final follow-up visit at week 26.

The proportion of patients attending these visits declined over the study period, from 91% at week 6 to 80% at week 18, and the proportion doing so within 7 days of the scheduled date fell from 86% to 71%. The proportion of patients who received per protocol treatment at a visit fell from 74% to 65%.

“[W]e found some resistance to uptitrating antihypertensive therapy when clinically indicated, but not typically when participants were close to their BP target”, the researchers comment in the Journal of Hypertension.

Carrington et al gave the patients an adherence score between 0 and 5 according to visits attended and treatment received. They found that each 1-point increase in protocol adherence was associated with a significant 22% increase in the likelihood of patients achieving their BP target.

In all, 47.8% of 512 patients managed according to the study protocol (adherence score of 4 or 5) achieved their BP target, compared with 27.4% of 504 patients assigned to the usual care group, with 70.9% versus 54.0% achieving BP below 140/90 mmHg. This equated to a number needed to treat to achieve this target of 5.9 for the per protocol intensive programme compared with usual care.

The researchers noted several other factors that influenced the chances of patients achieving their personal BP targets, including the presence of a practice nurse, which improved the likelihood 1.21-fold.

“Successful, algorithm-based interventions to improve BP management have increased potential if there is someone like a practice nurse to implement them”, the team comments.

Conversely, patients treated at a clinic that was part of a larger network had a reduced chance of achieving their BP target, which the researchers say reinforces “the need to maintain high standards of care across larger organizations with typically higher volume caseloads per physician.”

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