Evaluation of a structured treatment and teaching programme on hypertension in general practice.

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作者信息

Mühlhauser I, Sawicki P T, Didjurgeit U, Jörgens V, Trampisch H J, Berger M

机构信息

Medical Department for Metabolic Diseases and Nutrition, Heinrich Heine University of Düsseldorf.

出版信息

Clin Exp Hypertens. 1993 Jan;15(1):125-42. doi: 10.3109/10641969309041615.

DOI:10.3109/10641969309041615

PMID:8467308

Abstract

OBJECTIVE

Evaluation of a structured hypertension treatment and teaching programme in general practice.

DESIGN

Prospective controlled trial; follow-up period 18 months.

SETTING

10 primary health care practices. PRACTICES AND PATIENTS: From each practice 20 patients (30 to 60 years old, mean of the last two blood pressure measurements at or above 160 and/or 95 mmHg) were randomly selected; in 5 practices these patients were to participate in the treatment and teaching programme; in the remaining 5 practices hypertension care was continued without the availability of such a programme (controls).

INTERVENTION

Structured treatment and teaching programme based upon four group sessions for patients mainly conducted by paramedical personnel.

MAIN OUTCOME MEASURES

Blood pressure, body weight, prescription of antihypertensive drugs - as documented in the patient's records.

MAIN RESULTS

Of the 100 control patients 26 and of the 100 intervention patients 14 were lost to observation; 46 patients had agreed to participate in the programme. The mean number of prescribed antihypertensive agents per patient decreased in the intervention group (1.8 +/- 1.3 at baseline, vs 1.2 +/- 1.2 at follow-up) compared to the control group (1.6 +/- 1.3 vs 1.8 +/- 1.6); difference 0.8 (95% CI 0.4 to 1.1), p < 0.0001. In the control group 9% and in the intervention group 33% of patients had documented reductions of body weight (p < 0.0001). Blood pressure decreased in the intervention group (162 +/- 14/100 +/- 7 mmHg at baseline, vs 154 +/- 16/95 +/- 9 mmHg at follow-up) compared to the control group (161 +/- 13/98 +/- 7 mmHg vs 158 +/- 18/96 +/- 11 mmHg); differences for systolic blood pressure 5 (95% CI 0 to 10) mmHg, p = 0.071; for diastolic blood pressure 4 (1 to 7) mmHg, p = 0.018.

CONCLUSIONS

The introduction of a structured hypertension treatment and teaching programme in general practice may lead to significant improvements of hypertension care.

摘要