Kiliç Birsen, Biermans Marion C J, Bots Michiel L, van der Wel Mark, de Grauw Wim J C, Rutten Frans H, Hollander Monika
Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
BMC Prim Care. 2025 Jul 2;26(1):212. doi: 10.1186/s12875-025-02885-z.
Clinically apparent resistant hypertension (CARH) is common and a major health problem because it increases the risk of cardiovascular events. We aim to assess whether a stepwise work-up management strategy for patients with CARH in primary care would result in better blood pressure control compared to usual care.
A pragmatic, cluster-randomised controlled trial (cRCT). General practitioners (GPs) from 22 practices (10 intervention arm; 12 usual care) recruited 106 patients aged 18-80 years who had an office blood pressure (BP) > 140/90 mmHg and were prescribed three or more antihypertensive drugs from different therapeutic classes for three or more months in an adequate dose. This study was conducted between October 2018 and June 2021. The intervention was a stepwise approach comprising of (i) 24-hour blood pressure measurements, (ii) dedicated attention on intake of blood pressure raising compounds, (iii) on lifestyle and on compliance to and (iv) optimalisation of medication, and (v) referral to specialist care, when appropriate. The control group received usual care. Primary outcome was the difference in 24-hours systolic BP between intervention and usual care measured at 8 months after baseline.
Neither 24-hour nor office systolic BP 8 months after baseline significantly differed between intervention and usual care arm: 136.9 mmHg versus 132.6 mmHg (p = 0.15) and 146.1 mmHg versus 147.6 mmHg (p = 0.51), respectively. No significant differences across groups were seen in number of prescribed BP lowering medication: 2.98 versus 3.11, or controlled hypertension after 8 months: 22% versus 28%.
Our results suggest that a pragmatic, structured stepwise approach of CARH does not result in lower 24 h or office BP values compared to usual primary care.
NTR7304 (www.trialregister.nl/trial/7099), May 4th, 2018.
临床显性难治性高血压（CARH）很常见，是一个重大的健康问题，因为它会增加心血管事件的风险。我们旨在评估基层医疗中针对CARH患者的逐步检查管理策略与常规治疗相比是否能更好地控制血压。
一项实用的整群随机对照试验（cRCT）。来自22家医疗机构（10家干预组；12家常规治疗组）的全科医生（GPs）招募了106名年龄在18 - 80岁之间的患者，这些患者的诊室血压（BP）>140/90 mmHg，并且已足量服用三种或更多不同治疗类别的降压药物三个月或更长时间。本研究于2018年10月至2021年6月进行。干预措施是一种逐步方法，包括（i）24小时血压测量，（ii）对升压化合物摄入的专门关注，（iii）对生活方式、依从性的关注，（iv）药物优化，以及（v）在适当的时候转诊至专科护理。对照组接受常规治疗。主要结局是基线后8个月测量的干预组与常规治疗组之间24小时收缩压的差异。
基线后8个月，干预组与常规治疗组的24小时收缩压和诊室收缩压均无显著差异：分别为136.9 mmHg对132.6 mmHg（p = 0.15）和146.1 mmHg对147.6 mmHg（p = 0.51）。在降压药物的处方数量方面（2.98对3.11）或8个月后控制的高血压患者数量方面（22%对28%），各组之间均无显著差异。
我们的结果表明，与常规基层医疗相比，实用的、结构化的CARH逐步方法并不会导致24小时或诊室血压值更低。
