Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
J Hypertens. 2011 Oct;29(10):2024-30. doi: 10.1097/HJH.0b013e32834aa769.
Although hypertension is the most prevalent risk factor for cardiovascular and cerebrovascular morbidity and mortality, the level of blood pressure control remains poor. To amplify quality of care in hypertensive patients, a multifaceted program consisting of structured educational programs for both patients and staff, structured documentation and feedback reports with peer comparison, was implemented on a multicentre basis. Main targets were improvement of blood pressure control and reduction of cardiovascular risk. A provisional reimbursement was provided.
Patients were eligible for inclusion in the program if office blood pressure was uncontrolled (>160/95 or >140/90 mmHg) in addition to elevated cardiovascular risk [>15% according to the New Zealand Risk Score (NZRS)]. Blood pressure and lipid panels were measured at entry in the program and after 12 months. Patients attended four educational units held by hypertension nurses and physicians. All data were collected in structured documentation sheets and benchmarking reports were provided every 6 months.
Two thousand and forty-one patients were enrolled in the program within 5 years and 3 months; 54% female, age 62.8 ± 11.1years, BMI 29.50 ± 7.88 kg/m (mean ± SD). To date, 744 patients have been seen at 1-year follow-up. Entry blood pressure was 156.1 ± 20.8/88.9 ± 11.1 mmHg. Total cholesterol showed mean levels of 207.0 ± 46.0 mg/dl, low-density lipoprotein 122.3 ± 41.6 mg/dl, high-density lipoprotein 57.2 ± 22.4 mg/dl and calculated cardiovascular risk level (NZRS) was 17.28 ± 8.29%. One year following the educational program, blood pressure was reduced to 139.2 ± 15.6 (P < 0.001)/82.1 ± 9.5 mmHg (P < 0.001). NZRS (14.1 ± 7.2%; P < 0.001) and BMI (29.26 ± 4.92 versus 29.06 ± 4.99) also improved significantly.
This structured educational program showed its ability to improve intermediate outcomes in hypertensive patients. Better blood pressure control and significant reduction of the individual cardiovascular risk profile were achieved. A broad implementation of the program in the management of hypertension seems justified.
尽管高血压是心血管和脑血管发病率和死亡率的最常见风险因素，但血压控制水平仍然很差。为了提高高血压患者的护理质量，我们在多中心基础上实施了一个由针对患者和医务人员的结构化教育计划、结构化文档和具有同行比较的反馈报告组成的多方面计划。主要目标是改善血压控制和降低心血管风险。提供了临时报销。
如果诊室血压（>160/95 或 >140/90mmHg）加上升高的心血管风险（根据新西兰风险评分（NZRS）>15%），患者符合该计划的纳入标准。在计划开始时和 12 个月后测量血压和血脂谱。患者参加了由高血压护士和医生举办的四个教育单元。所有数据均在结构化文档中收集，并每 6 个月提供基准报告。
在 5 年零 3 个月内，该计划共纳入 2041 例患者；54%为女性，年龄 62.8±11.1 岁，BMI 29.50±7.88kg/m（均值±标准差）。迄今为止，已有 744 例患者在 1 年随访时就诊。入组时的血压为 156.1±20.8/88.9±11.1mmHg。总胆固醇平均水平为 207.0±46.0mg/dl，低密度脂蛋白胆固醇 122.3±41.6mg/dl，高密度脂蛋白胆固醇 57.2±22.4mg/dl，计算的心血管风险水平（NZRS）为 17.28±8.29%。在参加教育计划一年后，血压降低至 139.2±15.6（P＜0.001）/82.1±9.5mmHg（P＜0.001）。新西兰风险评分（14.1±7.2%；P＜0.001）和 BMI（29.26±4.92 与 29.06±4.99）也显著改善。
该结构化教育计划显示了其改善高血压患者中间结局的能力。实现了更好的血压控制和个体心血管风险状况的显著降低。在高血压管理中广泛实施该计划似乎是合理的。
