Karagiannis Asterios, Hatzitolios Apostolos I, Athyros Vasilios G, Deligianni Kalliopi, Charalambous Charalambos, Papathanakis Christos, Theodosiou Georgios, Drakidis Theodoros, Chatzikaloudi Veronika, Kamilali Chysanthi, Matsiras Sotirios, Matziris Athanasios, Savopoulos Christos, Baltatzi Maria, Rudolf Jobst, Tziomalos Konstantinos, Mikhailidis Dimitri P
Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece.
Open Cardiovasc Med J. 2009 May 5;3:26-34. doi: 10.2174/1874192400903010026.
This study assessed the effects of a pilot best practice implementation enhancement program on the control of hypertension. We enrolled 697 consecutive known hypertensive patients with other vascular risk factors but free from overt vascular disease. There was no "control" group because it was considered unethical to deprive high-risk patients from "best medical treatment". Following a baseline visit, previously trained physicians aimed to improve adherence to lifestyle measures and drug treatment for hypertension and other vascular risk factors. Both at baseline and at study completion (after 6 months), a 1-page form was completed showing if patients achieved treatment targets. If not, the reasons why were recorded. This program enhanced compliance with lifestyle measures and increased the use of evidence-based medication. There was a substantial increase in the number of patients who achieved treatment targets for blood pressure (p<0.0001) and other vascular risk factors. In non-diabetic patients (n=585), estimated vascular risk (PROCAM risk engine) was significantly reduced by 41% (p<0.0001). There was also a 12% reduction in vascular risk according to the Framingham risk engine but this did not achieve significance (p=0.07). In conclusion, this is the first study to increase adherence to multiple interventions in hypertensive patients on an outpatient basis, both in primary care and teaching hospitals. Simple, relatively low cost measures (e.g. educating physicians and patients, distributing printed guidelines/brochures and completing a 1-page form) motivated both physicians and patients to achieve multiple treatment goals. Further work is needed to establish if the improvement observed is sustained. [ClinicalTrials.gov NCT00416611].
本研究评估了一项试点最佳实践实施强化计划对高血压控制的效果。我们纳入了697例连续的已知高血压患者，这些患者伴有其他血管危险因素，但无明显血管疾病。由于剥夺高危患者接受“最佳医疗治疗”被认为不符合伦理道德，因此没有设立“对照组”。在进行基线访视后，先前接受过培训的医生旨在提高患者对高血压及其他血管危险因素的生活方式措施和药物治疗的依从性。在基线和研究结束时（6个月后），均填写一份1页的表格，以显示患者是否达到治疗目标。如果未达到，则记录原因。该计划提高了对生活方式措施的依从性，并增加了循证药物的使用。达到血压及其他血管危险因素治疗目标的患者数量大幅增加（p<0.0001）。在非糖尿病患者（n = 585）中，估计的血管风险（PROCAM风险评估工具）显著降低了41%（p<0.0001）。根据弗雷明汉风险评估工具，血管风险也降低了12%，但未达到显著水平（p = 0.07）。总之，这是第一项在门诊基础上提高高血压患者对多种干预措施依从性的研究，涵盖了初级保健机构和教学医院。简单、成本相对较低的措施（如对医生和患者进行教育、分发印刷指南/手册以及填写1页表格）促使医生和患者实现多个治疗目标。需要进一步开展工作以确定所观察到的改善是否能持续。[ClinicalTrials.gov NCT00416611]
