Structured primary care algorithm significantly improves BP control

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MedWire News: A structured computer-based algorithm could significantly improve blood pressure (BP) control among patients in primary care, a study suggests.

Garry Jennings (Baker IDI Heart and Diabetes Institute, Melbourne, Australia) presented the findings of his team’s late-breaking study at the 22nd European Meeting on Hypertension and Cardiovascular Protection in London, UK.

Speaking to MedWire News, Jennings emphasized: “Most doctors in primary practice these days have a clinic medical record system. This was an add-on to the most commonly used system in our region, and they [the doctors] like it… They like the idea of having something to help give them decision support.”

The study was a national, multicenter randomized trial that included 119 clinics and 270 general practitioners across Australia.

Jennings and team compared usual primary care enhanced by automated absolute risk profiling with the study intervention, which comprised initial angiotensin receptor blocker (ARB) monotherapy or ARB-based combination therapy (ARB plus a thiazide diuretic or ARB plus a calcium channel blocker) supported by a vigorous computer-assisted care approach, including a standardized algorithm for open-label pharmacotherapy.

Overall, 1562 newly diagnosed or currently treated hypertensive patients (59% male, mean age 59 years) who had a higher BP than their individual target (according to their physician’s judgment) following a 28-day run-in period were eligible for randomization to usual care or the study intervention in a 1:2 ratio.

The primary endpoint, reached by 1492 (96%) patients, was individualized BP control at 6 months. This was defined on an individual basis but was generally classified as 140/90 mmHg or less in patients with no cardiovascular disease (CVD), 135/80 mmHg in those with existing CVD, or 125/75 mmHg or less in those with proteinuria.

Significantly more patients in the intervention group achieved their individual target BP than in the usual care group, at 358 (36%) of 988 versus 138 (27%) of 504 patients, corresponding to a 1.28-fold increased probability of reaching goal BP (p=0.0013).

Overall, 61%, 29%, and 15% of the intervention group patients achieved their BP targets of 140/90 mmHg, 130/80 mmHg, and 125/75 mmHg or less versus 49%, 22%, and 10% of patients who received usual care, respectively.

The intervention group also achieved a greater mean BP reduction than the group that received usual care, at 13.2/7.7 mmHg versus 10.1/5.5 mmHg.

Consequently, 64% of intervention patients achieved the BP target of 140/90 mmHg or less, compared with only 54% of patients who received usual care, corresponding to a 1.2-fold increased likelihood of reaching this target (p=0.0007).

Asked how soon the algorithm could be applied in primary care practice, Jennings replied: “It could be tomorrow. It’s really a matter of implementing it and how we would roll it out. It’s off-the-shelf and could be used now.”

In terms of future directions, he added: “We’re certainly going to have a look at different kinds of indications like diabetes management, which is another condition where there are a lot of options and where stepwise care can be very important.

“The idea of the doctor sitting in a room with a pile of books to look up drug names and that kind of stuff is a bit passé and I’m sure we can do better than that. I think this is the way forward.”

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