Low W H H, Seet W, A S Ramli, Ng K K, H Jamaiyah, Dan S P, Teng C L, Lee V K M, Chua S S, M Y Faridah Aryani, T Karupaiah, Chee W S S, Goh P P, M Zaki, Lim T O
Clinical Research Center, Clinical Epidemiology Unit, 1st Floor MMA House, 124, Jalan Pahang, Kuala Lumpur 53000 Malaysia.
Med J Malaysia. 2013 Apr;68(2):129-35.
Hypertension is the number one cardiovascular risk factor in Malaysia. This study aimed to evaluate the effectiveness of a Community-Based Cardiovascular Risk Factors Intervention Strategies (CORFIS) in the management of hypertension in primary care.
This is a pragmatic, non-randomized controlled trial. Seventy general practitioners (GPs) were selected to provide either CORFIS (44 GPs) or conventional care (26 GPs) for 6 months. A total of 486 hypertensive patients were recruited; 309 were in the intervention and 177 in the control groups. Primary outcome was the proportion of hypertensive patients who achieved target blood pressure (BP) of <140/90mmHg (for those without diabetes mellitus) and <130/80mmHg (with diabetes mellitus). Secondary outcomes include change in the mean/median BP at 6-month as compared to baseline.
The proportion of hypertensive patients who achieved target BP at 6-month was significantly higher in the CORFIS arm (69.6%) as compared to the control arm (57.6%), P=0.008. Amongst those who had uncontrolled BP at baseline, the proportion who achieved target BP at 6-month was also significantly higher in the CORFIS arm (56.6%) as compared to the control arm (34.1%), p<0.001. There was no difference in the patients who had already achieved BP control at baseline. There were significant reductions in SBP in the CORFIS arm (median -9.0mmHg; -60 to 50) versus control (median -2mmHg; -50 to 48), p=0.003; as well as in DBP (CORFIS arm: median -6.0mmHg; ranged from -53 to 30 versus control arm: median 0.0mmHg; ranged from -42 to 30), p<0.001.
Patients who received CORFIS care demonstrated significant improvements in achieving target BP.
高血压是马来西亚首要的心血管危险因素。本研究旨在评估基于社区的心血管危险因素干预策略（CORFIS）在基层医疗中管理高血压的有效性。
这是一项实用的非随机对照试验。选取70名全科医生（GP），为其提供为期6个月的CORFIS（44名GP）或常规护理（26名GP）。共招募了486名高血压患者；309名在干预组，177名在对照组。主要结局是达到目标血压（对于无糖尿病患者，血压<140/90mmHg；对于糖尿病患者，血压<130/80mmHg）的高血压患者比例。次要结局包括与基线相比6个月时平均/中位数血压的变化。
与对照组（57.6%）相比，CORFIS组在6个月时达到目标血压的高血压患者比例显著更高（69.6%），P = 0.008。在基线时血压未得到控制的患者中，与对照组（34.1%）相比，CORFIS组在6个月时达到目标血压的比例也显著更高（56.6%），p<0.001。在基线时已实现血压控制的患者中无差异。CORFIS组收缩压显著降低（中位数 -9.0mmHg；范围-60至50），而对照组为（中位数 -2mmHg；范围-50至48），p = 0.003；舒张压也是如此（CORFIS组：中位数 -6.0mmHg；范围-53至30，对照组：中位数0.0mmHg；范围-42至30），p<0.001。
接受CORFIS护理的患者在达到目标血压方面有显著改善。
