Effects of a multifaceted intervention on cardiovascular risk factors in high-risk hypertensive patients: the ESCAPE trial, a pragmatic cluster randomized trial in general practiceReportar como inadecuado




Effects of a multifaceted intervention on cardiovascular risk factors in high-risk hypertensive patients: the ESCAPE trial, a pragmatic cluster randomized trial in general practice - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Trials

, 14:318

First Online: 01 October 2013Received: 03 May 2013Accepted: 19 September 2013DOI: 10.1186-1745-6215-14-318

Cite this article as: Pouchain, D., Lièvre, M., Huas, D. et al. Trials 2013 14: 318. doi:10.1186-1745-6215-14-318

Abstract

BackgroundSeveral observational studies on hypertensive patients have shown a gap between therapeutic targets recommended in guidelines and those achieved in daily practice. The ESCAPE trial aimed to determine whether a multifaceted intervention focused on general practitioners GPs, could increase significantly the proportion of hypertensive patients at high risk in primary prevention who achieved all their recommended therapeutic targets.

MethodsA pragmatic, cluster randomized trial involving 257 GPs randomized by region. The GPs in the intervention group had a one-day training session and were given an electronic blood pressure measurement device and a short recommendation leaflet. Along with usual follow-up, they focused one consultation on hypertension and other cardiovascular risk factors every six months for two years. They also received feedback at baseline and at one year on their patients’ clinical and biological parameters. Main outcome measures were change in the proportion of patients achieving all their therapeutic targets and each individual therapeutic target at two years, and quality of life.

Results1,832 high-risk hypertensive patients were included. After two years, the proportion of patients achieving all their therapeutic targets increased significantly in both groups, but significantly more in the intervention group: OR odds-ratio 1.89, 95% confidence interval CI 1.09 to 3.27, P = 0.02. Significantly more patients achieved their blood pressure targets in the intervention group than in the usual care group: OR 2.03 95% CI 1.44 to 2.88, P < 0.0001. Systolic and diastolic blood pressures decreased significantly more in the intervention group than in the usual care group, by 4.8 mmHg and 1.9 mmHg, respectively P < 0.0001 for both. There were no significant difference changes in physical and mental quality of life between groups.

ConclusionAn easy-to-perform, multifaceted intervention targeting only GPs increased significantly the proportion of high-risk hypertensive patients in primary prevention achieving their recommended therapeutic targets.

Trial registrationThis trial was registered with ClinicalTrials.gov, number NCT00348855

KeywordsHypertension Primary prevention Cluster randomized trial General practice AbbreviationsBPBlood pressure

CIConfidence interval

CNGEFrench national college of teachers in general practice

DBPDiastolic blood pressure

GFRGlomerular filtration rate

GPsGeneral practitioners

HbA1cGlycated hemoglobin

HDLHigh-density lipoprotein cholesterol

LDLLow-density lipoprotein cholesterol

MCSSMental component summary score

MDRDModified diet in renal disease

OROdds ratio

PCSSPhysical component summary score

SBPSystolic blood pressure

SDStandard deviation

SF-8Short-Form-8 quality of life questionnaire.

Electronic supplementary materialThe online version of this article doi:10.1186-1745-6215-14-318 contains supplementary material, which is available to authorized users.

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Autor: Denis Pouchain - Michel Lièvre - Dominique Huas - Jean-Pierre Lebeau - Vincent Renard - Eric Bruckert - Xavier Girerd - Fl

Fuente: https://link.springer.com/







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